bluuebunny/crossref_metadata_2025 huggingface dataset:
Endovascular Grafting in Patients with Short Proximal Necks: An Analysis of Short-Term Results
Authors: Greenberg R. , Fairmman R. , Srivastava S. , Criado F. , Green R.
Published: September 2024

Objectives:

To evaluate the safety of endovascular graft placement in patients with short proximal aneurysm necks, and assess factors contributing to endoleak formation.

Methods:

55 patients were enrolled over a two year period from five centers following the placement of a Talent® endograft with a suprarenal stent. Preoperative and 30-day post-implant CT scans were retrospectively analyzed in a blinded fashion by two physicians. Aortic measurements were obtained, the amount of thrombus was subjectively graded, and any extravasation of contrast into the aneurysm sac defined an endoleak. The data were analyzed using a t-test. Analyses compared patients with proximal necks < 10 mm (SN), n = 13) to those with longer necks (LN. n = 42), and then contrasted patients with endoleaks ( n = 12), to those without ( n = 43).

Results:

Endoleak rates were identical in the SN and LN groups (21 and 23%). Maximal aneurysm size was larger in the SN group (63 vs 56 mm, P < 0.05). Endoleaks were more frequently noted in larger aneurysms ( P < 0.05), but not related to SN ( P = 0.6). There was no correlation between endoleaks and the amount of thrombus, aneurysm length, proximal neck diameter or other morphologic characteristics. One of 12 endoleaks resulted from a problem with proximal fixation, nine were due to perfusing vessels, and two were undefined. The proximal neck diameter increased (0.9 mm) over the 30 days ( P < 0.005).

Conclusions:

Short-term proximal fixation can be achieved in proximal necks measuring less than 10 mm. The narrow margin of acceptable seal mandates careful follow-up. Larger aneurysms were associated with an increased incidence of endoleaks. SNs were associated with larger aneurysms, but not with an increased incidence of endoleaks. Proximal neck dilation was noted, but likely relates to the placement of an oversized endograft during this brief period of observation.
Long-Term Relative Survival following Surgery for Abdominal Aortic Aneurysm: A Review
Authors: Norman Paul E. , Semmens James B. , Lawrence-Brown Michael M.D.
Published: September 2024

Background

The literature reporting the long-term survival following surgery for abdominal aortic aneurysm (AAA) tends to be confusing. As a result, many clinicians looking after patients with AAA may be uncertain about the five-year survival of a given patient. This is in marked contrast to the situation for patients with malignant disease. With the current interest in population screening and endoluminal stenting for AAA, an understanding of long-term survival is increasingly important.

Methods

Thirty two publications in the English language over the last 20 years, containing data pertaining to five-year survival following routine elective surgery for AAA in unselected patients, were identified using Medline searches.

Results and conclusions

A range of important methodological differences were noted. The mean five-year crude survival was about 70% while the expected survival of a matched population was close to 80%. Survival was further reduced by about 10% in cases with significant coronary heart disease. Age alone is not a predictor of long-term relative survival with octogenarians who survive beyond 30 days surviving longer than an age-matched population.
Endovascular Treatment of type B Aortic Dissections
Authors: Lundbom J. , Wesche J. , Hatlinghus S. , Ødegaard A. , Aadahl P. , Tromsdal A. , Karevold A. , Kaspersen J.H. , Myhre H. O.
Published: September 2024

The purpose is to describe our experience with endovascular treatment of type B aortic dissections. Five patients were treated for complications following type B dissections like, false channel aneurysm formation, rupture and arterial obstruction. They were treated in general anaesthesia using a ‘homemade’ endoprosthesis or a commercially available endoprosthesis (Excluder®) deployed during fluoroscopy.

The patients have been followed at regular intervals with a median observation time of 18 months (range 12–36). One patient needed a secondary intervention due to dislodgement of the proximal stentgraft with haemorrhage into both the false and the true lumen. Otherwise there have been no early or late mortality or major complications in this series.

Even if our experience with endovascular treatment of type B dissections is rather limited, the results so far are promising. Open surgery in many of these cases is complicated with high morbidity and mortality rate and the endovascular technique offers great advantages. A longer follow-up period is necessary to define the place of endovascular treatment.
CD40 Co-Stimulatory Molecule Expression by Dendritic Cells in Primary Atherosclerotic Lesions in Carotid Arteries and in Stenotic Saphenous Vein Coronary Artery Grafts
Authors: Ozmen J. , Bobryshev Y.V. , Lord R.S.A.
Published: September 2024

We have previously identified dendritic cells in the intima of human large arteries and stenotic vein coronary bypass grafts. The mechanisms by which these dendritic cells might regulate immune responses in atherosclerotic lesions and stenotic vein grafts are unknown. The aim of the present study was to investigate whether dendritic cells in carotid plaques and in stenotic aortocoronary vein grafts express an immunoregulatory molecule CD40.

Segments of wall from eight carotid arteries and three stenotic aortocoronary saphenous vein grafts were obtained at operation. CD40+ cells were detected in all specimens of both occluded and stenotic grafts and carotid plaques. Although CD40+ cells of various cell types were intermingled in most areas within the plaques and stenotic grafts, there were sites where CD40+ cells were located in small groups. Consecutive sections demonstrated that a small population of CD40+ cells stained positively for S100. These CD40+/S100+ cells were clustered within the intima but were also found in the media and adventitia. This suggests that dendritic cells, which accumulate within vessels affected by atherosclerosis and graft disease, express CD40 co-stimulatory molecule. The expression of CD40 molecule on the dendritic cells may be important in regulating T cell responses within atherosclerotic plaques and stenotic vein grafts.
Effect of Radial Artery Harvesting on Tissue Perfusion and Function of the Hand
Authors: Sadaba J. Rafael , Conroy Jonathan L. , Burniston Maria , Maughan Janice , Munsch Christopher
Published: September 2024

This study was designed to measure the degree to which hand and forearm blood flow is reduced following harvesting of the radial artery in myocardial revascularization surgery and determine whether there is an effect on hand function.

Twenty patients who had the radial artery used for myocardial revascularization underwent bilateral blood flow assessment of hands and forearms using Technetium-99m human serum albumin and clinical evaluation of hand function.

Mean tissue perfusion in ml/100 ml/min ±SD was as follows: donor hand 21.9±5.6, non-donor hand 25.5±6.1 ( P = 0.00043), donor arm (hand and forearm) 17.5±3.7 and non-donor arm (hand and forearm) 21 ±5.1 ( P = 0.000681). No clinical evidence of hand claudication was detected.

This study suggests that removal of the radial artery reduces the tissue perfusion of the hand and forearm but does not affect hand function in the short term. The use of radial artery grafts in patients at risk of developing peripheral vascular disease should be carefully considered
Effective Surgical Management of High-Risk Coronary Patients Using Preoperative Intra-Aortic Balloon Counterpulsation Therapy
Authors: Christenson J. T. , Schmuziger M. , Simonet F.
Published: September 2024

The proportion of high-risk coronary patients submitted to surgical myocardial revascularization (CABG) is steadily increasing. High-risk patients utilize more hospital resources and have a higher procedural cost than low—moderate risk CABG patients. An efficient management is essential to improve outcome and reduce costs. This report entails three study periods. In an initial retrospective study coronary high-risk criteria were established. At least two of the following factors were required: redo CABG, unstable angina, left main stem stenosis greater than 70%, preoperative left ventricular ejection fraction <0.30 and diffuse coronary artery disease. Poor preoperative cardiac performance was the major contributing factor for poor outcome. Intra-aortic balloon counterpulsation therapy (IABP) was introduced as preoperative therapy. During a second study period prospective randomized studies found preoperative IABP-therapy efficient, significantly improving both preoperative cardiac index ( P<0.0001), decreasing postoperative mortality ( P<0.0001) and morbidity, shorten intensive care unit stay as well as total hospital stay ( P<0.0001). Drug consumption was significantly reduced ( P<0.0001). Optimal timing was found to be 2 h prior to aortic cross-clamping and the therapy was found highly cost-beneficial with an average 36% reduction of the total procedural cost. During a third study period, well beyond any study protocol period, preoperative IABP therapy was again found highly effective with a close to 100% utilization rate in high-risk patients and continuous efficacy with excellent outcome, despite acceptance of sicker patients. During this post-study evaluation period 1/3 of the high-risk patients presented with 4 of the established risk factors.

The use of preoperative IABP therapy is therefore highly recommended for high-risk coronary patients undergoing CABG.
Coronary Artery Stabilization Causes Endothelial Damage: An Electron Microscopic Study on Dogs
Authors: Sokullu Onur , Karabulut Hasan , Gercekoglu Hakan , Coruh Turkan , Ercan Feriha , Bilgen Fuat , Eren Ergin , Ozler Azmi
Published: September 2024

In recent years, to protect patients from adverse effects of cardiopulmonary bypass, off-pump coronary artery bypass operations are performed. In these operations, effective coronary artery immobilization is the standard for a fine anastomosis. This is usually maintained with the help of prolene immobilization sutures, bulldog occluders or mechanical epicardial devices. The aim of this study is to show whether these stabilization devices cause any damage to the coronary artery endothelium. Sixteen dogs are included in this study and are divided into four groups. The control group consisted of one dog (Group I) and different immobilization techniques are applied to the other groups, which were five dogs each (Groups II, III, and IV). Coronary artery biopsies are obtained, then the samples are studied under scanning electron microscope (SEM) for endothelial injury and all samples are scored. Among the techniques used, bulldog occluders caused less injury on the coronary endothelium than the prolene sutures.
The Hemashield Woven® Prosthesis in the Thoracic Aorta: A Prospective Computer Tomography Follow-Up Study
Authors: Vermeulen F. , Schepens M. , de Valois J. , Wijers L. , Kelder J.
Published: September 2024

Background.

Dacron prostheses in humans have been documented to present long-term fiber alterations, that may account for late graft dilatation. Late dilatation has been documented mainly in knitted prostheses, implanted in the abdominal and thoracic aorta. Dilatation of the collagen-impregnated Hemashield Woven® prosthesis has not been studied prospectively in the thoracic aorta.

Methods.

Twenty patients were prospectively included. The intraoperative performance of the graft and mid-term clinical behaviour were studied. The graft distensibility was evaluated by postoperative, 1 and 3 yr computed tomographic diameter follow-up.

Results.

There were no hospital deaths. Two graft-unrelated deaths occurred at 3 yr. The graft performance was excellent or good for most aspects. No significant changes in CT diameter occurred throughout the 3 yr follow-up.

Conclusion.

The collagen-impregnated Hemashield Woven® prosthesis is considered safe in replacements of the thoracic aorta. Future evaluation should focus on the very long-term behaviour in young adults.
Cerebral Reserve and Indications for Shunting in Carotid Surgery
Authors: Palombo D. , Porta C. , Peinetti F. , Brustia P. , Udini M. , Antico A. , Cantalupi D. , Varetto T.
Published: September 2024

The aim of this study was to establish whether a preoperative evaluation of cerebral haemodynamic reserve, carried out by means of transcranial Doppler and single photoemission computed tomography with a provocative test (acetazolamide) is able to select those patients who require carotid shunting to avoid cerebral ischaemia during clamping. All patients were monitored during operation by means of somatosensitive evoked potentials. Those patients who required shunting because of abnormal evoked potentials were also those who had a poor cerebral reserve with a perfusion and velocity increase below 15%. Only one neurological deficit developed in patients who were not shunted.
Myocardial Revascularization in Patients with Severe Ischaemic Left Ventricular Dysfunction: A Clinical Experience
Authors: Paolini G. , Zuccari M. , Mariani M. A. , Credico G. Di , Pocar M. , Gaili L. , Grossi A.
Published: September 2024

The benefits of myocardial revascularization in patients with ischaemic left ventricular dysfunction are widely reported. However, myocardial revascularization in such cases is associated with higher mortality and morbidity rates. Sixty patients with severe left ventricular dysfunction underwent myocardial revascularization at the authors' institution. Ejection fraction was assessed by angiocardioscintigraphy before and at 3 months after surgery. All patients underwent elective surgery and received complete myocardial revascularization. Myocardial protection was achieved using Buckberg's protocol. One perioperative death occurred. Weaning from cardiopulmonary bypass required inotropic drug therapy in 22 cases and aortic counterpulsation in nine. Perioperative myocardial infarction occurred in three patients with no further haemodynamic impairment. The mean postoperative ejection fraction was 41.0%, compared with a mean preoperative value of 26.5%. The extent of left ventricular functional improvement was greatest in those patients having the worst preoperative left ventricular function. It is concluded that, with this technique, myocardial revascularization can be achieved in patients with severe left ventricular dysfunction with an acceptable operative mortality.
Thoracic Outlet Syndromes: New Concepts from a Century of Discovery
Authors: Machleder H. I.
Published: September 2024

From March of 1861 to the present day there has been a striking evolution in the understanding of the neurovascular compressive disorders arising at the thoracic outlet. In 1958, Rob and Standeven reported the clinical characteristics of a group of patients with upper-extremity arterial complications. They suggested the commonality of the various compressive abnormalities by introducing the term. ‘Thoracic Outlet Compression Syndrome’ to the surgical literature. The development of morphologic, embryologic, and histochemical concepts is outlined in the framework of the author's investigations.
Healing Characteristics of Polymer-Coated or Collagen-Treated Dacron Grafts: An Experimental Porcine Study
Authors: Pärsson H. , Jundzill W. , Johansson K. , Jonung T. , Norgren L.
Published: September 2024

The healing characteristics of polymer-coated Dacron grafts with or without heparin-bonding and collagen-coated Dacron grafts are compared with standard knitted Dacron grafts by implanting eight of each graft into pig iliac arteries. The grafts were implanted at random bilaterally with end-to-side anastomoses. The grafts were explanted after 1, 2 and 4 weeks and prepared for histological evaluation by in vivo fixation. Graft segments were investigated by light microscopy, scanning electron microscopy and transmission electron microscopy. The endothelial coverage, intimal thickness and healing characteristics were subjected to one-way analysis of variance. One week after surgery endothelial-like cells appeared close to the anastomoses and after 2 weeks a clear growing endothelial edge was observed in the collagen-coated grafts. After 4 weeks' implantation all grafts were patent and endothelial cells covered the grafts to a various extent. Collagen-coated grafts had significantly greater endothelial cell coverage compared with Dacron and polymer-coated grafts without heparin bonding ( P<0.05). Evaluation by transmission electron microscopy revealed the luminal coverage of the collagen-coated grafts to consist of organized smooth muscle cells and endothelial cells containing Weibel-Palade bodies. The smooth muscle cells in the other grafts were less organized and were covered by endothelial cells to a lesser degree. No differences were noted regarding the inflammatory response of the graft materials and no further positive effects were encountered by the addition of heparin to the polymer coating. The study demonstrates that various coating procedures and surface modulation of knitted Dacron grafts produce a graft which is impervious to blood but still allows tissue incorporation. Collagen-coating might promote endothelial attachment and proliferation.
Combined Coronary Artery Bypass Grafting and Abdominal Aortic Aneurysm Repair
Authors: Vicaretti M. , Fletcher J. P. , Richardson A. , Chard R. , Klineberg P. , Nicholson I.
Published: September 2024

Fifteen patients of mean age 65 years underwent simultaneous coronary artery bypass grafting and abdominal aortic aneurysm repair between 1988 and 1992. Of these 13 had coexistent angina and two had symptomless coronary artery disease detected by preoperative dipyridamole thallium scanning or exercise stress testing. All patients had significant coronary artery disease on coronary angiography. Coronary artery bypass grafting was performed first, with a median number of grafts of 4, a median aortic cross-clamp time of 39 min and a median bypass time of 74 min. Abdominal aortic aneurysm repair followed with a median aortic clamp time of 66 min. Six straight and nine bifurcated grafts were inserted. The median total operating time was 395 min. All patients were managed postoperatively in the cardiothoracic intensive care unit with a median duration of 5 days. The median total hospitalization was 14 days. One patient died of non-cardiac causes; hence the mortality rate was 6.7%. The authors' experience suggests that combined coronary artery bypass grafting and abdominal aortic aneurysm repair is feasible in carefully selected patients.
Cerebrovascular Accidents Resulting from Segmental Mediolytic Arteriopathy of the Cerebral Arteries in Young Adults
Authors: Leu H. J.
Published: September 2024

Five cases of cerebrovascular accident or transient ischaemia in young adults resulting from segmental mediolytic arteriopathy are reported. The aetiology of segmental mediolytic arteriopathy is unknown but the disorder is characterized by focal, non-inflammatory mucoid degeneration of the media of muscular, non-arteriosclerotic arteries, frequently involving cerebral intracranial or extracranial vessels. It is similar to Erdheim—Gsell's medionecrosis of the aorta and may occur in any muscular artery. The consequences are mostly fatal in cerebral arteries. Histological analysis of each case is described. Clinicians should be aware of the possibility of intramural haemorrhage and dissecting aneurysm as a result of mucoid degeneration of the arterial media in young adults with cerebrovascular accident.
Coronary Artery Bypass after Substernal Colon Interposition for Carcinoma of the Esophagus
Authors: Safi H. J. , Barnett M. G. , Turner W.
Published: September 2024

A 70-year-old man presented with severe angina pectoris caused by critical stenosis of the left anterior descending coronary artery 11 years after mediastinal radiation therapy, esophagectomy and substernal colon interposition for squamous cell carcinoma of the esophagus. Coronary artery bypass was performed through a left thoracotomy using the left internal mammary artery with profound hypothermia. This uncommon approach to an unusual case is described here.
Incidental Finding of Papillary Fibroelastoma on the Atrial Septum
Authors: Nakao T. , Hollinger I. , Attai L. , Oka Y.
Published: September 2024

Papillary fibroelastoma is rare but one of the most common benign primary cardiac tumors after myxoma. This lesion may be associated with embolization, angina and sudden death. The incidental finding of a small pedunculated papillary fibroelastoma arising from the atrial septum detected by transesophageal two-dimensional echocardiography (TEE) in a patient undergoing coronary artery bypass grafting is reported. The advantage of TEE in diagnosing intracardiac tumors is also described.
Measurement of Cardiac Troponin T and Myosin to Detect Perioperative Myocardial Damage during Coronary Surgery
Authors: Triggiani M. , Simeone F. , Gallorini C. , Paolini G. , Donatelli F. , Paolillo G. , Dolci A. , Grossi A.
Published: September 2024

This study evaluated the use of monitoring blood levels of the isoenzyme of creatine Phosphokinase, troponin T (tnT) and myosin in the detection of perioperative myocardial damage after coronary artery surgery. Serial blood samples were collected in 24 patients undergoing myocardial revascularization. The patients were retrospectively divided into three groups: group A with no changes in their electrocardiogram; group B showing non-specific signs of perioperative myocardial infarction such as deep and permanent T wave inversion; and group C with definite electrocardiographic signs of perioperative myocardial infarction (new persistent Q-waves and loss of R-waves). Group A ( n= 17) demonstrated a mean(s.d.) troponin T peak blood level of 0.64(0.35) ng/ml at 12 −24 h after surgery, a myosin peak of 1030(670) μunits/l at 3−6 days afterwards, and a creatine Phosphokinase isoenzyme peak of 25.8(10.6) units/l. In group B ( n = 5), mean(s.d.) troponin T levels were elevated to a peak of 4.8(3.9) ng/ml 24 h after intervention, while myosin rose to 2074(340) μunits/l 3−6 days after surgery and creatine Phosphokinase isoenzyme reached 57.8(38) units/l. Group C( n = 2)had a mean(s.d.) troponin T peak of 4.8(2.6) ng/ml, a myosin peak of 2404(392) μunit/l and a creatine Phosphokinase isoenzyme peak of 88.5(20) units/l. Peak values of troponin T and myosin in groups B and C were statistically different from those in group A ( P< 0.001). These results suggest that troponin T and myosin are reliable indicators of perioperative myocardial damage. In particular, troponin T may allow the differentiation of reversible from irreversible myocardial injury.
Postinfarction Left Ventricular Pseudoaneurysm -Echocardiography Diagnosis and Surgical Repair
Authors: Ivert T. , Almdahl S. M. , Lunde P. , Lindblom D.
Published: September 2024

Left ventricular wall perforation after acute myocardial infarction, without Immediate rupture to fatal haemopericardium. is a rare complication that may result in a pseudoaneurysm. Transoesophageal echocardiography demonstrated a posterior wall perforation and the unique blood flow pattern at the neck of a pseudoaneurysm 6 days after acute myocardial infarction. In a second patient with angina and congestive heart failure 7 years after an acute myocardial infarction echocardiography demonstrated a huge pseudoaneurysm. Surgical repair was successful in both patients. Turbulence of blood at the neck of a pseudoaneurysm generates a murmur, and systolic regurgitation into a large aneurysm may cause symptoms of heart failure. Exact diagnosis, anatomical relations and size can be assessed with echocardiography. Angiography is required before surgery only to rule out coronary artery pathology. Occasionally a pseudoaneurysm may persist for many years but because of a high risk of rupture. prophylactic repair is indicated soon after diagnosis.
Failure of Elastin or Collagen as Possible Critical Connective Tissue Alterations Underlying Aneurysmal Dilatation
Authors: Dobrin P. B. , Mrkvicka R.
Published: September 2024

Previous studies in the authors' laboratory have demonstrated that degradation of arterial elastin produces vessel dilatation, decreased vessel distensibility, and vessel elongation which can cause tortuosity. By contrast, degradation of collagen produces increased vessel distensibility and rupture. However, neither degradation of elastin nor of collagen produced the true gross enlargement characteristic of human aneurysms. The present study was performed to identify the connective tissue critical to aneurysm formation. Vessel dimensions were measured repeatedly in human arteries during progressive enzymatic degradation. Experiments were performed on six intact human common, external and internal iliac arteries, and two aneurysmal human common iliac arteries. The vessels were mounted in vitro and subjected to pressure steps up to 200 mmHg while diameters were measured. Repeated pressure-diameter curves were obtained for up to 18h during treatment with elastase or collagenase. Degradation of elastin produced moderate dilatation (6-10% at 100 mmHg) with decreased vessel distensibility; this occurred as the load was shifted to remaining collagen. Degradation of collagen produced greater dilatation (10-23% at 100 mmHg), increased distensibility, and vessel rupture. These findings suggest that the critical element in both the gross enlargement and rupture of aneurysms resides in collagen. They also suggest that, in vessels obtained from patients with a family history of aneurysms, defects should be sought in: (i) the structure of collagen; (ii) increased susceptibility of collagen to degradation by endogenous mechanisms; (iii) increased endogenous collagenolytic activity; or (iv) decreased inhibition of endogenous collagenolytic activities.
Abdominal Aortic Aneurysmectomy in a Renal Transplant Patient: Protection of the Kidney without Adjunctive Measures
Authors: Mellière D. , Becquemin J.-P. , Ecollan P. , Fitoussi M.
Published: September 2024

Abdominal aneurysmectomy in kidney transplant recipients can be successfully performed without adjunctive protective measures if the period of renal ischaemia is short. A technique that attains this goal is described here. An aortic aneurysm (5 cm) was removed 2 years after kidney transplantation to the left external iliac vessel. The right common iliac artery was divided first and anastomosed to the right branch of the bifurcated graft. Aortic anastomosis was then performed: the period of renal ischaemia was only 20 min. Arterial flow was re-established in the right common iliac artery, providing profuse collateral flow to the transplanted kidney through the internal iliac arteries during the time necessary to complete the left common iliac artery anastomosis. This procedure is feasible unless the internal iliac artery is severely stenosed, occluded or terminally anastomosed to the transplanted renal artery. In all other cases, this technique may be the optimal procedure to protect the kidney during elective abdominal aorta aneurysmectomy in renal transplant recipients by reducing the period of ischaemia to that of one anastomosis only.
Subclavian Artery Aneurysm: The Role of Magnetic Resonance Imaging
Authors: Laitt R. D. , Thompson J. F. , Goddard P. , Wakeley C. J. , Murphy P. , Lamont P.
Published: September 2024

Subclavian artery aneurysms are rare. Diagnosis is important as complications can be life threatening. A case is reported which is diagnosed by magnetic resonance imaging; moreover it is suggested that magnetic resonance imaging is now the initial imaging modality of choice in the invetigation of these lesions.
Abdominal Aortic Hypoplasia: Clinical and Technical Considerations
Authors: Magnoni F. , Pisano E. , Cirelli M. , Tarantini S. , Pedrini L.
Published: September 2024

Hypoplasia of the distal abdominal aorta, first described by Quain in 1847, is rarely associated with atherosclerotic occlusive disease. The condition usually occurs early in life; the principal clinical features are hypertension and arterial insufficiency of the lower extremities which is often well tolerated. Some 20 patients had operations for abdominal aortic hypoplasia; 16 underwent prosthetic reconstruction and four had aortoiliac endarterectomy with angioplasty. Reconstructive techniques were influenced by narrow renal arteries and by the presence of extensive atheroma. The long-term prognosis is often poor, especially in patients with extensive disease.
Hematemesis as Initial Presentation of Traumatic Paraceliac Pseudoaneurysm of the Abdominal Aorta
Authors: Udekwu P. O. , Oller D. W.
Published: September 2024

This case report describes a patient whose hematemesis is an unusual presentation of a post-traumatic pseudoaneurysm of the paraceliac aorta resulting from a penetrating epigastric injury 20 months previously.
Left Aortic Arch and Right Descending Aorta -Interruption or Severe Coarctation of the Aortic Arch in the Newborn
Authors: Korbmacher B. , Rammos S. , Schmitt H.H. , Heusch A. , Schulte H. D. , Bircks W.
Published: September 2024

Three consecutive neonates (aged 7, 14 and 30 days, body-weight 2980 g, 3000 g and 3400 g respectively) with interruption of the aorta ( n = 2) and severe coarctation ( n = 1) in the presence of left aortic arch and right descending aorta are reported. Associated lesions were an aortopulmonary window in the first case and an unrestrictive ventricular septal defect in the two others. Intractable heart failure and the complexity of the malformation led to the decision of a staged operation. A prosthetic graft was interposed between the ascending and descending aorta via a right thoracotomy in order to bridge the atretic or hypoplastic segment without using extracorporeal circulation. There was no intraoperative complication. One patient developed a thrombocytopenia within the frame of a sepsis syndrome and died on day 5 after operation, death being caused by a massive bleeding into the left thoracic cavity, although the operation was carried out via a right thoracotomy. Angiography 1 year after operation revealed a good flow through the grafts and no stenosis at the site of the anastomoses. The two surviving infants are clinically well without any medication. The reported operative technique provides an alternative palliative possibility to manage critically ill neonates without any obstacle to later definitive repair.
Acute Postoperative Obstruction of the Ascending Aorta following Replacement with an Intraluminal Graft
Authors: Apostolakis E.
Published: September 2024

A fourth case of displacement of one ring of an intraluminal graft is reported. This occurred in a woman who was operated on for acute dissection of the aorta. The displacement happened 8 h after surgery and produced acute obstruction of the ascending aorta. Restoration of the proximal ring of the graft into its correct position was successful.
Does Concomitant Aortic Bypass and Renal Artery Revascularization Using the Retroperitoneal Approach Increase Perioperative Risk?
Authors: Darling R. C. , Shah D. M. , Chang B. B. , Leather R. P.
Published: September 2024

While elective repair of abdominal aortic aneurysms and aortoiliac occlusive disease is associated with an acceptable (3%) mortality rate, combined aortic and renal revascularization has usually been reported to have a higher perioperative mortality. Over the past 5 years, 785 elective aortic procedures have been performed at the authors' medical center. During the same period, 77 renal artery reconstructions have been performed in 73 patients in conjunction with aortic procedures. All were done using the retroperitoneal approach to the aorta and renal arteries. Indication for concomitant renal artery revascularization included 79% (61 of 77 patients) for either significant stenosis or anatomic involvement. 18% for renovascular hypertension (14 of 73) and 3% (two of 73) for renal impairment. The demographics and risk factors were similar in both groups. Operative mortality rate was 2.9% (23 of 785) in the aortic group and 3% (two of 73) in the combined group. Complications in the combined group were one stroke (1.4%), one re-exploration for bleeding (1.4%), two pulmonary pneumonia (2.7%) and five patients had elevated serum creatinine (>350 μmol/l) after operation. Of these patients two died, one had an occluded graft and two eventually improved. There was one early graft thrombosis and one late thrombosis. In the authors' experience, concominant aortic bypass and renal artery revascularization can be performed with an acceptable-mortality and morbidity using the retroperitoneal approach.
Venous Aneurysm of Extremities: A Case Report and Literature Review
Authors: Legnani G. , Mettini L. , Bonfioli C. , Motta F.
Published: September 2024

A case of venous aneurysm of the short saphenous vein is described in a young woman. The aetiology, diagnosis and treatment of this rare anomaly is reviewed.
Surgical Repair of Coarctation of the Aorta in Neonates: Factors Affecting Early Mortality and Re-Coarctation
Authors: Wu Jing-Lei , Leung M. P. , Karlberg J. , Chiu C. , Lee J. , Mok Che-Keung
Published: September 2024

Between October 1979 and January 1993, 85 Chinese neonates in Hong Kong underwent surgical repair for coarctation of the aorta. Their mean(s.e.) age and body weight at operation was 15.6(8.5) days and 3.06(0.56) kg, respectively. Simple coarctation was present in 17 babies, while 36 had additional ventricular septal defect and 31 had associated major complex intracardiac lesions. Subclavian flap aortoplasty was performed in 56 babies, resection with end-to-end anastomosis in 18 and aortoplasty with the use of a GORETEX patch in 11. The overall early mortality rate was 16.5%. To identify risk factors for early operative mortality. various clinical variables, surgical options, associated heart lesions and dimensions of the aortic arch at different sites for each patient were reviewed. Univariate analysis identified statistically significant differences between the survivors and non-survivors for the following factors: preoperative body-weight, arterial pH and base excess, serum urea and creatinine levels. Stepwise logistic regression further distinguished serum creatinine levels and the period of operation as two significant risk factors. Contrary to previous reports, the dimensions of the aortic arch and type of surgery did not affect early operative mortality. Among the 71 hospital survivors followed for 38.2(38) months, residual or recurrent coarctation of the aorta was detected in 12(17%). The different surgical operations were not related to the incidence of late complication. The size of the distal transverse arch, however, was different ( P= 0.05) in those who did and did not develop aortic sequela. Successful balloon angioplasty was subsequently performed in 11 patients. In an era of echocardiography with prenatal diagnosis and therapeutic catheterization, early recognition of the disease with prompt prostaglandin infusion should prevent collapse of the baby, thus avoiding renal impairment and severe metabolic acidosis. Balloon angioplasty would offer a simple effective treatment for patients who developed aortic re-coarctation.
Surgical Treatment for Acute Native Aortic Valvular Infective Endocarditis: Long-Term Follow-Up
Authors: Amrani M. , Schoevaerdts J. C. , Rubay J. , Verhelst R. , Eucher Ph. , Bruneau M. , Piret V. , Kremer R. , Dion R.
Published: September 2024

During the period 1970-1993, 116 patients (63 men, 53 women) with native aortic valvular infective endocarditis were treated surgically. The mean age was 37 years. The main causative organisms were streptococci and staphylococci. Indication for surgery was cardiac failure (70 cases), uncontrolled sepsis (30), peripheral emboli (11) and overwhelming destruction of the aortic valve (five). Hospital and late mortality rates were 8% and 11 % respectively. Patients who died in hospital and those who presented a paravalvular leakage had a ring abscess associated with aortic wall destruction. Among 34 patients screened for cerebral septic emboli the condition was confirmed in 15, of whom six were symptom-free. Thus, it is believed that in the presence of root abscess, surgery should be undertaken promptly, regardless of the cardiac status. It is confirmed that cerebral septic emboli should be systematically screened for in the presence of any infective endocarditis.
Normal and Pathological Aspects of Mass Transport Across the Vascular Wall
Authors: Kennedy J. H. , Tedgui A.
Published: September 2024

The rapid progress in cardiovascular surgery during the past 10 years has been matched by a complementary increase in the understanding of underlying cellular and molecular aspects of normal and pathological physiology of blood vessels. This review focuses on one aspect of vascular biology, namely the transport of macromolecules and water across the vascular wall, with particular attention to the role of endothelial permeability, and offers a bridge between the basic biological sciences and clinical care.
Thrombus Formation on Polytetrafluoroethylene Surfaces: The Importance of Von Willebrand Factor
Authors: Cho J.-S. , Ouriel K. , DeWeese J. A. , Green R. M. , Chen G.-Y. , Stoughton J.
Published: September 2024

The importance of von Willebrand factor (vWf) in the formation of platelet-fibrin thrombi on expanded polytetrafluoroethylene (ePTFE) surfaces was studied in an in vitro system, perfusing non-anticoagulated human blood over ePTFE grafts for 3 min at varying shear rates (100, 500 and 1500/s shear). Platelet (111In) and fibrin (125I) deposition was assessed on ePTFE surfaces in the presence and relative absence of vWf, achieved by use of polyclonal anti-vWf antibody (anti-vWf Ab). A total of 29 perfusions were performed. Increasing shear rate was associated with greater platelet deposition in the presence of vWf (P< 0.001). This shear-dependent rise in platelet deposition was not observed when vWf was blocked by anti-vWf Ab ( P<0.1), confirming the role of vWf in platelet deposition at high shear rates. Fibrin deposition increased with increasing shear rate in the presence of vWf ( P<0.01). Inhibiting vWf abolished the shear-dependent increase in fibrin deposition. These data suggest that vWf plays a critical role in platelet and fibrin thrombus formation on ePTFE surfaces. These effects are particularly important under conditions of high shear rate. These mechanisms may lead to the observed pathologic thrombus formation and platelet-dependent neointimal processes occurring at areas of high shear rate within the anastomotic regions of ePTFE grafts.
Vascular Trauma to the Lower Extremity: The Lebanese War Experience
Authors: Sfeir R. E. , Khoury G. S. , Kenaan M. K.
Published: September 2024

The authors' experience with 386 patients who were operated on for vascular injuries to the lower extremities is reviewed. Of these, 118 had popliteal injuries, 252 had femoral injuries and 16 had tibial injuries. The overall mortality rate was 2.33% with no mortality in the popliteal and tibial injuries group whereas there were nine deaths in the femoral injuries group. The overall amputation rate was 5.95%, with 3.17% amputation rate for the femoral injuries group versus 11.86% for the popliteal injuries group and 6.25% for the tibial injuries group. Delay in repair (more than 6 h from injury), associated femoral fractures and shocked condition on admission led to increased amputation rate. Prompt surgical repair, arterial as well as venous repair for popliteal and femoral injuries especially if femoral fracture is present, external skeletal fixation and/or traction, and fasciotomy when necessary led to improved limb salvage.
Sequential Aortofemoropopliteal/Distal Bypass for Treatment of Critical Lower-Limb Ischaemia
Authors: Zukauskas G. , Ulevicius H. , Triponis V.
Published: September 2024

Multilevel arterial occlusive disease is often the main cause of critical ischaemia of the lower limb. The aim of this study was to determine the diagnostic criteria that could help select patients for sequential aortofemoropopliteal/distal reconstruction and to compare the results after simultaneous and two-stage surgery. Some 1953 aortofemoral reconstructions were performed during a 6-year period (1987-1992). In 245 cases (12.5%) sequential aortofemorodistal (popliteal or tibial) procedures were performed for critical limb ischaemia Fontaine classification grade III and IV. Two-segment reconstructions were performed in one stage in 161 cases (group A), and two separate operations were performed, the outflow procedure usually following within 12 months after inflow surgery, in 84 cases (group B). The perioperative mortality rates were 3.2% in group A (five deaths) and 5.9% in group B (five deaths). Limb salvage rates were 95.6% at 1 year and 90.4% at 5 years for group A and 88.8% at 1 year and 80.0% at 5 years for group B. Primary inflow bypass patency rates were 97.7% at 1 year and 91.3% at 5 years for group A and 93.4% at 1 year and 76.3% at 5 years for group B, while secondary inflow bypass patency rates were 98.8% at 1 and 5 years for group A, and 95.3% and 88.3% at 1 and five years respectively for group B. Primary outflow bypass patency rates were 91.4% at 1 year and 65.5% at 5 years for group A, and 84.9% at 1 year and 59.4% at 5 years for group B. Secondary outflow bypass patency rates were 92.2% at 1 year and 81.8% at 5 years for group A, and 86.1% at 1 year and 65.9% at 5 years for group B. The data demonstrate that single-stage multisegment reconstruction for multilevel arterial occlusive disease is a safe and effective method of treating critical limb ischaemia.
Rupture of a Dissecting Thoracic Aortic Aneurysm into the Pulmonary Artery: Successful Surgical Repair
Authors: Coselli J. S. , LeMaire S. A. , Van Cleve G. D.
Published: September 2024

A rare complication of dissecting thoracic aortic aneurysms is rupture into a cardiac chamber or great vessel with fistula formation. A case of congestive heart failure caused by a chronic DeBakey type I dissecting aortic aneurysm that ruptured into the pulmonary artery is reported. Surgical repair involved closure of the fistula followed by graft replacement of the ascending aorta and transverse aortic arch. A review of the literature revealed no previous reports describing successful repair of this lesion. A clinical picture consistent with concomitant aortic dissection and biventricular heart failure, especially when a continuous cardiac murmur is present, suggests the diagnosis of an aortopulmonary arterial fistula caused by a ruptured dissecting thoracic aortic aneurysm. Various imaging studies confirm the diagnosis.
An Arginine Analog Inhibits Responses of Both the Endothelium and Smooth Muscle of Canine in situ Vein Grafts
Authors: Rhee R. Y. , Gloviczki P. , Miller V. M.
Published: September 2024

Increased shear, pressure, and oxygen tension in vein grafts may alter production of endothelium-derived vasoactive and anti-mitogenic factors such as nitric oxide which subsequently affect development of neointimal hyperplasia. This study was designed to determine whether or not nitric oxide mediates endothelium-dependent responses in femoral in situ vein grafts. Non-reversed, canine femoral vein grafts were placed bilaterally to bypass a ligated segment of the femoral artery in dogs. After 6 weeks, the grafts were removed, cut into rings, and suspended in organ chambers for measurement of isometric force. In some rings the endothelium was removed deliberately. In the presence of indomethacin, the synthetic analog of L-arginine, L-NG-monomethyl-arginine (10−4 M: L-NMMA) did not cause a significant change in baseline tension of rings with endothelium. L-NMMA reduced only contractions of rings with endothelium to the alpha-adrenergic agonist UK 14,304. The analog also reduced maximal relaxations to the calcium-ionophore, A23187 in rings with endothelium. In addition, L-NMMA reduced relaxations of rings without endothelium to adenosine diphosphate by 35%. Positive immunostaining for nitric oxide synthase was present in both the myointima and media of histological sections of grafts. In conclusion, these results suggest that in situ vein grafts exhibit two unique properties which are unlike unoperated arteries or veins: (i) alpha2-adrenergic receptors may be coupled to the release of contractile endothelium-derived factors associated with production of nitric oxide; and (ii) nitric oxide may be released by the smooth muscle in response to purinergic stimulation. The presence of nitric oxide synthase throughout the wall of the graft may result in production of nitric oxide in response to adenosine diphosphate released by platelets and to circulating catecholamines.
Implication of Myocardial Lactate Metabolism during Coronary Artery Bypass Grafting
Authors: Ando H. , Tanaka J. , Hisahara M. , Nagano I. , Shimizu I.
Published: September 2024

Sixty-six consecutive patients with coronary artery disease were analysed in terms of myocardial lactate extraction during cardiac surgery. Sixteen patients had left main coronary heart disease and 50 were without such disease. Mean (s.d.) lactate extraction during empty beating in patients with and without left main coronary tract disease was −29.8(67)% and 12.0(15.3)%, respectively ( P<0.001). No significant differences in lactate extraction were recognized during 15 min of reperfusion. Mean (s.d.) preoperative values of haemoglobin were 11.2(1.0) g/dl and these fell to 6.5(0.9) g/dl in an empty beating state during cardiopulmonary bypass ( P<0.001). There was no significant difference between the two groups in preoperative and postoperative left ventricular stroke work index. An empty beating state before aortic clamping could induce unexpected ischaemia in the heart with left main coronary tract disease. A short duration of this ischaemic state does not influence functional recovery: however, exposing the left main coronary artery diseased heart to such a condition for long periods would be dangerous.
The Stentless Bravo 300 Aortic Porcine Xenograft: Supra-Annular Versus Annular Implantation
Authors: Hvass U. , Chatel D. , Assayag P. , Juliard J. M. , Laperche T. , Caliani J. , Oroudji M. , Pansard Y.
Published: September 2024

The aim of the study was to compare the supra-annular and intra-annular implantation techniques by evaluating the differences in early haemodynamic outcome (gradients, effective orifice area, regurgitation). Since August 1991, 200 stentless Bravo model 300 valves have been implanted. Patients were divided into three groups of consecutive cases: group 1 ( n = 50) represents exclusively intra-annular implantation; group 2 ( n = 50) is a transitional period; and group 3 ( n = 100) comprises only patients with supra-annular implantation. Significant differences were found ( P<0.001) in low postoperative gradients (mean ≤10 mmHg): 24% in group 1, 42% in group 2, and 95% in group 3. Comparing groups 1 and 3, gradients were lower and effective orifice area was augmented in all valve sizes in group 3. Trivial central regurgitation was present in groups 1–3 (6%, 12% and 0% respectively). Peripheral regurgitation was trivial in 6%, 8% and 0% and mild to moderate in 4%, 2% and 0% ( P<0.001).
The Role of the Neutrophil in Ischaemia-Reperfusion Injury: Potential Therapeutic Interventions
Authors: Cavanagh S. P. , Gough M. J. , Homer-Vanniasinkam S.
Published: September 2024

The pathogenesis of the reperfusion syndrome is complex and as yet not fully elucidated. It is characterized by the development of increased microvascular permeability, oedema and tissue necrosis, and is associated with free radical release, cellular calcium overload and activation of neutrophils. Furthermore, systemic release of putative mediators may result in distant organ injury (lung, kidney, heart). This review, after briefly describing the role of neutrophils in these events, will concentrate on potential therapeutic interventions that might be employed to minimise ischaemia-reperfusion syndrome. Issues of safety will be considered, and potential applications of these techniques in patient management discussed.