bluuebunny/crossref_metadata_2025 huggingface dataset:
Recognition of a Non-Recurrent Laryngeal Nerve during Carotid Endarterectomy
Authors: Ayerdi Juan , Gupta Sushil K. , Sampson Lawrence N. , Deshmukh Narayan
Published: September 2022

Cranial nerve injury during carotid endarterectomy (CEA), while infrequent, may have serious consequences. The recurrent laryngeal nerve is one of the most commonly injured cranial nerves. Fortunately, most of these injuries are temporary. Anatomic variations in the position of cranial nerves present challenges to surgeons during CEA. Although the occurrence of a non-recurrent laryngeal nerve (NRLN) is rare, proper recognition of this anatomic variation is critical in order to minimize complications. We present a case in which a NRLN was discovered intraoperatively and carefully preserved.
Surgical Management of Left Ventricular Aneurysms by Endoventricular Pericardial Patch Plasty
Authors: Suzer Kaya , Yorgancioglu Cem , Gunaydin Serdar , Tokmakoglu Hilmi , Tezcaner Tevfik
Published: September 2022

Background:

Early and late surgical outcomes of endocardial resection and aneursymectomy repaired with an autologous pericardial patch were studied.

Methods:

We studied 125 patients who underwent endoaneurysmorrhaphy with pericardial patch during the period from June 1993 until June 2000. Preoperative, early and late postoperative results, annual postoperative echocardiography of all patients and hemodynamic controls of 35 patients within a mean follow-up of 64±8 months were analyzed.

Results:

Mean NYHA improved to postoperative 2.1±0.5 from preoperative 2.8±0.4. Mean number of bypass grafts was 2.6±1.1. Left ventricular ejection fraction rate improved to 36.2±8% in one month. 39.3±9% in 6 months, 42.3±8% in one year versus preoperative 29.2±9% (P≤0.05). Perioperative mortality was 6.4% (eight patients) and 11 deaths were observed in the late follow-up (9.4%).

Conclusion:

Endoaneurysmorrhaphy with pericardial patch may be an alternative option in the management of left ventricular aneurysms within acceptable surgical results.
Heparin Reversal in Off-Pump Coronary Artery Bypass Surgery: Complete, Partial, or no Reversal?
Authors: Gatti G. , Pugliese P.
Published: September 2022

Several clinical studies have reported that avoiding cardiopulmonary bypass reduces postoperative bleeding. The purpose of this study is to verify that protamine during off-pump coronary artery bypass surgery produces significant reduction of postoperative bleeding.

Sixty consecutive patients undergoing off-pump coronary artery bypass surgery were prospectively randomized in three groups: Group A received 1 mg of protamine every 100 IU of heparin, Group B 0.5 mg of protamine every 100 IU of heparin, and Group C none. The three groups were analyzed for differences in preoperative cardiac function, pre-, intra-, and post-operative coagulation profile, intraoperative variables, and postoperative bleeding.

In the three study groups, no statistically significant difference was found in preoperative cardiac function, pre- and intraoperative coagulation profile, and prothrombin time, activated partial thromboplastin time, platelet count in the first postoperative day. In Group A, total postoperative bleeding, use of packed red blood cells, and mild pericardial effusion prevalence at discharge were significantly lower only when compared to Group C, but they were not significantly different when compared to Group B.

In off-pump coronary artery bypass surgery, heparin should be reverted with protamine, otherwise the postoperative bleeding risk might increase. Partial heparin reversal might not increase postoperative bleeding risk, but it may reduce dose-dependent protamine adverse effects.
A Comparison between Ischemic Preconditioning, Intermittent Cross-Clamp Fibrillation and Cold Crystalloid Cardioplegia for Myocardial Protection during Coronary Artery Bypass Graft Surgery
Authors: Teoh L. K. K. , Grant R. , Hulf J. A. , Pugsley W. B. , Yellon D. M.
Published: September 2022

The aim of this study was to compare ischemic preconditioning (IPC) with two established methods of myocardial protection, namely cold crystalloid cardioplegia and intermittent cross-clamp fibrillation (ICCF), in coronary artery bypass graft (CABG) surgery. This was a prospective randomised study Thirty CABG patients were randomised to receive: (a) St Thomas' cardioplegia solution no. 2; (b) ICCF; or (c) IPC (two 3-min periods of ischemia with 2-min of reperfusion). Surgery was performed under standardised conditions by one surgeon (WBP). The Primary endpoint was cardiac troponin T release during the first 72 h after surgery. Mean troponin T at 72 h was significantly lower in the IPC group (0.5 μg/l; p=0.05. ANOVA) compared with the cardioplegia and ICCF groups (2.1 and 1.3 μg/l respectively). This suggests that ischemic preconditioning is superior at limiting myocardial necrosis during CABG, but there is no difference between cold crystalloid cardioplegia and intermittent cross-clamp fibrillation.
Early Reoperation for Iatrogenic Left Main Stenosis after Aortic Valve Replacement: A Perilous Situation
Authors: Chavanon O. , Carrier M. , Cartier R. , Hébert Y. , Pellerin M. , Perrault L. P.
Published: September 2022

Background.

Iatrogenic left main coronary artery (LMCA) stenosis secondary to direct ostial cannulation during aortic valve replacement still occurs and is a morbid situation due to the difficulties of early reoperation and in providing adequate myocardial protection.

Methods.

A retrospective analysis was performed and identified seven patients with an iatrogenic LMCA stenosis, after 2158 aortic valve replacements (AVR) (0.3%) in our institution since 1987.

Results.

All patients with LMCA stenosis after AVR had undergone direct ostial cannulation with self-inflating balloon cannulas at the time of AVR. At reoperation for LMCA stenosis, severe ischemia developed in one patient and injury to cardiac structures occurred in four patients. Four patients suffered a perioperative myocardial infarction and congestive heart failure developed in two patients at late follow-up.

Conclusions.

LMCA stenosis following coronary ostial cannulation at the time of AVR is a rare yet morbid complication. Reoperation for this condition is fraught with a high operative morbidity rate and poor long-term outcome. Prevention of this complication is quintessential, avoiding ostial cannulation with self-inflating balloons.
Use of Superficial Femoral Vein in the Treatment of Infected Aortoiliofemoral Prosthetic Grafts
Authors: Cardozo M. A. , Frankini A. D. , Bonamigo T. P.
Published: September 2022

Purpose:

To assess the use of the superficial femoral vein for the reconstruction of the aortoiliofemoral sector in the treatment of prosthetic infections.

Methods:

From December 1995 to November 1999, 12 patients with infection involving a synthetic vascular prosthesis were submitted to thirteen surgical procedures involving partial or total resection of a synthetic vascular prosthesis and restoration of arterial flow with an in situ femoral vein.

Results:

The overall operative mortality rate was 15.3% (2 out of 3 patients who underwent total graft replacement and 0 out of 9 patients who underwent unilateral graft replacement). Major amputations related to the surgical procedures were performed in two cases (an 87.5% rate of limb salvage). The series was followed up on average for 22 months (range: 6–65 months). No patient presented clinically significant edema or signs of chronic venous insufficiency in the lower limbs used as donors of autogenous venous grafts. All surviving patients presented complete resolution of the infectious signs and symptoms and none of them presented late thrombosis of the venous graft.

Conclusion:

The use of the superficial femoral vein is a good surgical alternative for the treatment of prosthetic infections with minimal venous morbidity of the lower limbs used as venous graft donors. The autogenous venous grafts present good long-term patency and excellent adaptation to the aortoiliofemoral position.
Infrainguinal Bypass Grafting Using Lyophilized Saphenous Vein Allografts for Limb Salvage
Authors: Timaran Carlos H. , Stevens Scott L. , Freeman Michael B. , Goldman Mitchell H.
Published: September 2022

Critical ischemia in patients with extensive femoropopliteal occlusive disease often ends in amputation in the absence of a suitable autologous vein for reconstruction. Cryopreserved vascular allografts have been used as an alternative conduit with poor results. Antigenicity and rejection are assumed to account for graft failure. Lyophilized vessels have demonstrated patency and structural integrity in the vascular system in our previous experimental studies. We report four patients that underwent femorodistal bypass grafting with lyophilized saphenous veins who lacked usable autologous vein for arterial reconstruction. Early graft thrombosis occurred in three patients who required major amputations. Duplex scans for graft surveillance did not reveal previous significant abnormalities. These cases demonstrate that the clinical use of lyophilized venous allografts for infrainguinal arterial reconstructions failed to yield satisfactory patency and limb salvage. Lyophilized veins therefore are not useful alternative conduits in patients with critical ischemia and no suitable autologous vein grafts.
The Anatomy of the Aortic Root
Authors: Berdajs Denis , Lajos Patonay , Turina Marko
Published: September 2022

Objective:

Since the aortic root preserving methods are spreading in heart surgery, the importance of aortic root anatomy is increasing. The surgical and anatomical descriptions of the aortic root are not always congruent. Therefore, the present study focuses on the surgical aspects of the aortic root anatomy.

Methods:

We measured the distances between the three commissures, the distances between the basal point of the sinus and the sinotubular junction and the heights of the sinuses. The circumference of the sinotubular junction and the annuli fibrosi were also obtained. In addition, the volume of every sinus was directly measured. Finally both vertical and horizontal histological sections of annuli fibrosi were made.

Results:

All measured parameters were averaged and the standard deviation (SD) was calculated, except in the case of the tilt angle. The distance for the right sinus commissures was 18.82 mm (SD 1.93 mm), and that of the non- and left coronary sinus were 17.43 (SD 2.06) and 15.21 (SD 1.88) mm, respectively. The mean height of the right, non- and left coronary sinus were 19.45 (SD 1.91), 17.68 (SD 1.77) and 17.45 (SD 1.39) mm, respectively. These differences between the height of the sinuses determines a mean tilt angle of 5.47° for the sinotubular junction and aortic root base. The mean circumference of the aortic root base and of the sinotubular junction was 69.20 (SD 6.93), and 65.82 (SD 8.31) mm. respectively. Mean volumes of the right, non- and left coronary sinuses were 1.6 (SD 0.34). 1.33 (SD 0.27) and 1.04 (SD 0.23l) ml. According to the histological sections we can say that the histological border of the annuli fibrosi is positioned at the interleaflate triangles.

Conclusion:

According to the measured data we can state that all parameters follow the pattern in which the right sinus structures had the greatest dimensions followed by the non coronary sinus, and finally the left coronary sinus. The tilt angle for aortic root base and sinotubular junction, and the difference in the diameters could be of hemodynamic and of surgical relevance
Obstruction of St Jude Medical Valves in the Aortic Position: A Consideration for Pathogenic Mechanism of Prosthetic Valve Obstruction
Authors: Aoyagi S. , Nishimi M. , Tayama E. , Fukunaga S. , Hayashida N. , Akashi H. , Kawara T.
Published: September 2022

Between 1995 and 2000, 8 patients with St. Jude Medical (SJM) valves in the aortic position required 9 redo valve replacement for prosthetic valve obstruction. Obstruction of the prosthetic valve was diagnosed by simultaneous echocardiography and cineradiography, and process of restricted leaflet movement that progressed to hemodynamic impairment was observed by serial studies in three recent patients. An oral anticoagulation was considered to be adequate in all patients except one patient who had withdrawal of warfrain. Pannus was the sole cause of valve obstruction in seven events in 6 patients, and both thrombus and pannus in 2 patients. Pannus overgrowth was found on the inflow aspect of the SJM valve, and involved the ends of the straight edge of the leaflets over pivot guards. These results suggest that pannus might play the primary role in development of obstruction of aortic SJM valves in patients on adequate oral anticoagulation.
Atrial Fibrillation after Coronary Bypass: Etiology and Pharmacologic Prevention
Authors: Jayam V. K. S. , Flaker G. C. , Jones J. W.
Published: September 2022

Coronary bypass surgery is performed on over 400,000 patients each year in the United States. Atrial Fibrillation (AF) is the most common complication after bypass surgery. The significance of its occurrence lies not only in the potentially dangerous and physiologic derangement to patients, but also in the impact it has on the utilization of health care resources. Several clinical observations suggest that the occurrence of atrial fibrillation after bypass surgery has some unique features related to the perioperative circumstances. Numerous therapies, both pharmacologic and non-pharmacologic have been tested to prevent this tenacious problem. Its persistence continues to intrigue cardio-thoracic surgeons, cardiologists, anesthesiologists and the insurers alike. In this review we discuss the published literature on postbypass AF, with a special emphasis on pharmacologic prevention.
Aortic Graft Infection: Evolution in Management
Authors: Reilly Linda M.
Published: September 2022

Over the past three decades our management of patients with aortic graft infection has evolved in terms of the optimal revascularization technique, the optimal reconstruction conduit and the optimal operative approach. As a result we have achieved a reduction in mortality, limb loss, disruption of aortic closure, reinfection of the new conduits and late revascularization failure. This manuscript describes this evolution and reports our results.
How Effective is Acute Normovolaemic Haemodilution in Femoro-Distal Bypass Surgery?
Authors: Spark J. I. , Chetter I. C. , Kester R. C. , Scott D. J. A.
Published: September 2022

Background:

Recent guidelines have emphasised the use of autologous blood in the surgical setting. The aim of this study was to analyse the efficacy and efficiency of acute normovolaemic haemodilution (ANH) as a blood conservation intervention in patients undergoing elective femoro-distal surgery for critical limb ischaemia.

Methods:

Forty patients were studied prospectively. The volume of the blood collected was derived as follows: Blood volume removed = patient's blood volume (initial haematocrit - final haematocrit/average haematocrit) where final haematocrit is 30% and patient's blood volume is 70 and 65 ml/kg for a man and a woman, respectively.

Results:

Twenty-five patients were suitable for ANH and 15 patients were excluded because of poor ventricular function, anaemia or renal disease. Nine of the 25 patients (44%) had < 500ml of surgical blood loss and would have avoided homologous blood transfusion (HBT). Four of the patients lost >2000ml of blood and could not avoid HBT through ANH. Twelve patients had moderate blood loss (950–1400 ml), with eight of these patients requiring transfusion. Four patients avoided exposure to homologous blood.

Conclusion:

ANH is in evolution and as a single blood conservation intervention, contributes only modestly to blood conservation.
Platelet-Monocyte Aggregates in Patients with Chronic Venous Insufficiency Remain Elevated following Correction of Reflux
Authors: Rohrer Michael J. , Claytor R. Brannon , Garnette Charles S. C. , Powell Craig C. , Barnard Marc R. , Furman Mark I. , Michelson Alan D.
Published: September 2022

Introduction.

An increased number of circulating platelet-monocyte aggregates (PMAs) is present in patients with all clinical classes of chronic venous insufficiency (CVI). The purpose of this study was to determine whether patients with CVI maintain elevated levels of PMAs following complete surgical correction of chronic venous insufficiency. Methods. Patients with superficial venous insufficiency and a normal deep venous system documented by duplex scan were included in the study. Venous blood was drawn from a superficial vein in the leg and an antecubital vein prior to vein stripping and again six weeks postoperatively. Control subjects without evidence of venous disease had blood drawn from an antecubital vein. Whole blood flow cytometry was used to analyze the samples for the presence of platelet-monocyte aggregates following incubation with buffer or 0.5 μM adenosine diphosphate (ADP). Results. Postoperative duplex scanning demonstrated elimination of venous reflux in the superficial venous system and normal deep vein physiology in all nine patients, Preoperatively, patients with CVI had significantly elevated levels of circulating PMAs in both arm and leg samples without stimulation by an agonist compared to controls (15.2±1.1 and 14.3±1.3 vs 7.4 ±0.3 for controls, p<0.02 for each), and after stimulation by 0.5 μM ADP (33.7±4.7 and 34.3±5.2 vs 12.5±3.8 for controls, p<0.04 for each). There was no significant change in the number of PMAs in either patient arm or leg blood samples six weeks following correction of venous reflux by removal of the diseased veins. Conclusions. Complete correction of chronic venous insufficiency did not diminish the elevated circulating levels of platelet-monocyte aggregates. We conclude that the presence of an increased number of PMAs identified in patients with CVI is not secondary to the presence of venous reflux, but may be involved with the primary etiology of chronic venous insufficiency. This finding also suggests that a stimulus other than venous hypertension may be important in triggering the leukocyte activation seen in patients with chronic venous disease.
Sequential Use of Internal Thoracic Artery in Myocardial Revascularization: Mid- and Long-Term Results of 430 Patients
Authors: Bakay C. , Erek E. , Salihoǧlu E. , Kinoǧlu B. , Öztürk S.
Published: September 2022

Background:

There is still controversy about early and late results of sequenital use of internal thoracic artery (ITA) in coronary artery bypass (CAB) operations.

Methods:

In this study, we report on a series of 430 consecutive patients who underwent CAB operations between 1986 and 1998, with the use of at least one sequential ITA graft. The patients, 379 men and 51 women had a mean age of 56.4 years (range 29–80 years). Both ITA grafts were used in 227 (52.8%) patients. A total of 1744 (mean 4.05 per patient) distal coronary anastomoses were performed: 1172 of which (mean 2.72) were arterial and 980 (mean 2.28) were sequential ITA anastomoses.

Results:

Thirty-day mortality was 1.8% ( n = 8 patients). Perioperative myocardial infarction occurred in 12 patients (2.8%) and five of them (1.2%) were confined to the sequential ITA grafted area. Follow-up ranged from 1 month to 13 years (mean 63 ±37.7 months) for 372 patients (86.5%). Nine patients died during follow-up period. According to Kaplan-Meier method, 5 and 10 year survival rates were 95.6 and 93.4%, respectively. Coronary angiography was performed in 64 patients (17.2%) after a mean of 33 months. In 31 of these patients angiography was performed due to return of symptoms. Overall patency rate of sequential ITA anastomoses was 91.7% (111/121). Two patients underwent repeat CAB operations.

Conclusion:

Sequential use of ITA grafts was not associated with the increased perioperative mortality and morbidity and has the potential to improve the long-term results of CAB surgery because of excellent patency rates of sequential ITA anastomoses.
Preoperative Prediction of Early Mortality and Morbidity in Coronary Bypass Surgery
Authors: Wouters Stijn C. W. , Noyez Luc , Verheugt Freek W. A. , Brouwer Rene M. H. J.
Published: September 2022

Objective.

A scoring system to predict early mortality and morbidity in CABG, distinguishing low and high risk patients.

Methods.

563 patients (1998) served as development dataset, 969 patients as validation set. Univariate and logistic regression analysis was used to identify risk factors.

Results.

Gender, hypertension, pulmonary disease, reoperation, age. operative status and left-ventricular function were predictive variables for early mortality. The area under the ROC curve was 0.81. We identified a low risk, mortality of 1.8% and a high-risk group, mortality of 13.4%. Diabetes, hypertension, kidney and lung disease, reoperation, operative status and left ventricular function were predictive variables for morbidity. The area under the ROC curve was 0.73. We identified a low risk, morbidity of 17%, and a high-risk group, morbidity of 41%.

Conclusion.

This scoring system is a simple system identifying a low and high-risk group for morbidity and early mortality.
Abdominal Aortic Aneurysm Associated with a Horseshoe Kidney and Renal Carcinoma: A Case Report
Authors: Bastounis Elias , Georgopoulos Sotiris , Pikoulis Emmanouil , Leppaniemi Ari , Diamantis Theodoros
Published: September 2022

A horseshoe kidney is the most common renal embryological abnormality, but its association with an abdominal aortic aneurysm is rare. The conbination of a horseshoe kidney with a renal carcinoma and an abdominal aortic aneurysm is extremely rare and, to our knowledge, has only been reported twice in the English literature ( Hinyokika kiy46 (2000) 15; Eur J Vasc Endovas Surg22 (2001) 280).
Intrapericardial Urokinase Irrigation and Systemic Corticosteroids: An Alternative to Pericardectomy for Persistent Fibrino-Purulent Pericarditis
Authors: Schafer M. , Lepori M. , Delabays A. , Ruchat P. , Schaller M-D. , Broccard A. F.
Published: September 2022

A 39-year-old man was admitted for upper abdominal pain and shortness of breath. The chest roentgenogram demonstrated cardiomegaly and left lower lobe atelectasis. Echocardiography showed circumferential pericardial effusion with signs of cardiac tamponade. Pericardial biopsy and fluid analysis were consistent with fibrino-purulent pericarditis. Despite broad-spectrum antibiotics, percutaneous and subsequently surgical drainage, pericardial effusion and tamponade recurred. We report successful treatment of a non-resolving fibrino-purulent pericardial effusion by combined intrapericardial irrigation of fibrinolytics and systemic corticosteroids administration as an alternative to pericardectomy.
Carotid Endarterectomy in the Elderly: Does Gender Effect Outcome?
Authors: Ozsvath Kathleen J. , Darling R. Clement , Tabatabai Laila , Roddy Sean P. , Paty Philip S. K. , Chang Benjamin B. , Kreienberg Paul B. , Mehta Manish , Shah Dhiraj M.
Published: September 2022

Objectives:

Carotid endarterectomy (CEA) has a positive effect on stroke free survival in patients with either symptomatic or asymptomatic severe carotid bifurcation stenosis. However, most trials have excluded octogenarians. In addition, concerns have arisen regarding the benefits of CEA in the elderly population, especially in women. In this study, we performed an outcome analysis in patients undergoing CEA comparing those eighty and older to their younger counterparts. Additionally, we evaluated the elderly group based on gender.

Methods:

Over the past 10 years, all patients undergoing CEA for asymptomatic and symptomatic carotid disease have been entered into our vascular surgery registry. Demographics, indications for operative intervention, outcomes and survival of patients who had undergone CEA were reviewed. Procedures were preferentially performed under regional anesthesia with selective shunting. Chi square analysis was used to assess significance and assumed for P< 0.05.

Results:

Over the last 10 years, 125 carotid endarterectomies were performed in 125 patients eighty years of age or older. Fifty-six were male and 69 were female. Mean age was 83 (range: 80–97). Asymptomatic disease was identified in 28 of the male patients (50%) and 44 of the female patients (64%). There were no deaths and a permanent neurological deficit occurred in one female patient. There was no difference in thirty-day morbidity or mortality in female patients compared to males.

Conclusions:

These observations suggest that CEA can be safely performed in selected elderly patients with asymptomatic or symptomatic carotid artery stenosis. Furthermore, women over 80 may expect equally optimistic results as their male counterparts.
Unusual Haemorrhage Complication after Carotid Endarterectomy
Authors: Scavee V. , Dutranoy J. C. , Devos B. , Schoevaerdts J. C.
Published: September 2022

An unusual case of haemorrhage complication after carotid endarterectomy caused by vein patch perforation is presented.
Outcome of Endovascular Intervention for Infrainguinal Vein Graft Stenosis
Authors: Tong Y. , Matthews P. G. , Royle J. P.
Published: September 2022

Assisted graft patency rate following revision of a graft stenosis is far better than that following thrombectomy of an occluded graft. Graft revision by endovascular means has been proposed as a suitable alternative to more invasive surgery. This study reports our experience with endovascular treatment of vein graft stenosis.

Between December 1992 and September 2000, percutaneous transluminal balloon angioplasty (PTA) was performed on 90 vein graft stenoses in 87 infrainguinal vein bypass grafts identified by routine graft duplex scan (peak systolic velocity, PSV > 300 cm/sec). All 90 stenoses treated by PTA were retrospectively analysed for stenosis-free patency rate (life-table analysis). Re-stenosis was defined by PSV exceeding 300 cm/sec at the same site of the vein graft where a stenosis was dilated.

Ninety vein graft stenoses (72 primary stenoses and 18 recurrent stenoses) in 33 femoropopliteal (above knee), 30 femoropopliteal (below knee) and 24 femorotibial vein bypass grafts were treated by PTA. The timing of PTA ranged from one to 252 months (mean. 23.9 months) from the initial surgery. Cumulative stenosis-free patency rate after PTA was 55.8% at 6 months, 54.0% at one year and 45.0% at three years. Stenosis-free patency rate at six months was significantly lower for revision of recurrent stenosis (25.9%) than for primary stenosis (61.6%) ( P = 0.01).

The revision of duplex scan detected vein graft stenosis with endovascular intervention was associated with an acceptable stenosis-free patency rate. However, recurrent stenosis treated by PTA had a significantly inferior outcome. Direct surgical revision would be more appropriate for recurrent lesions.
Primary Aortoenteric Fistula: Report of Six New Cases
Authors: van Olffen T. B. M. , Knippenberg L. H. A. , van der Vliet J. A. , Lastdrager W. B.
Published: September 2022

Primary aortoenteric fistula (PAEF) is defined as a communication between the native aorta and the gastrointestinal tract, in contrast to secondary fistulas, which arise between a suture line of a vascular graft and the intestine. Arteriosclerosis is the predominant cause of PAEF and accounts for more than two-thirds of the cases reported. The pathogenesis is usually based on direct adhesion of a segment of the gastrointestinal tract to an aortic aneurysm, followed by progressive erosion through the bowel wall. The clinical presentation is usually one of intermittent gastrointestinal haemorrhage resulting in lethal exsanguination. Pain in the abdomen, a pulsatile abdominal mass or fever may be present. The choice of various diagnostic procedures is often decided by the clinical presentation. Esophagogastroduodenoscopy, ultrasound and CT scan may be useful in the evaluation of these patients. Current recommendations for repair include debridement of the aneurysmal aorta, repair with an in situ graft and primary repair of the gastrointestinal tract, followed by aggressive antimicrobial therapy. We present six cases of PAEF surgically treated at the St. Radboud Hospital, the Canisius Wilhelmina Hospital in Nijmegen and the Lukas Hospital in Apeldoorn over a period of 15 years.
Assessment of Prosthetic Vascular Graft Thrombogenicity Using the Technetium-99m Labeled Glycoprotein IIb/IIIa Receptor Antagonist DMP444 in a Dog Model
Authors: Scharn Dirk M. , Oyen Wim J. G. , Klemm Peter L. , Wijnen Marc H. W. A. , vanderVliet J. Adam
Published: September 2022

Introduction:

Prosthetic graft patency greatly depends on graft thrombogenicity. The concept of graft thrombogenicity is poorly understood and difficult to measure or quantify. In a study we tested the experimental radiopharmaceutical DMP444 and developed a suitable dog model. This agent is a radiolabelled (99mTechnetium) glycoprotein llb/llla receptor antagonist with a high affinity for activated platelets. It binds to platelets that are intimately involved in thrombus formation. The agent does not affect thrombocyte function, when used in a dose necessary for imaging. DMP444 does not require platelet harvesting and processing. Early imaging of thrombocyte aggregation sites such as vascular prostheses is possible within 4 hours after injection. Material and methods: Adult Beagle dogs weighing 12–15 kg were used for the experiments. In 16 dogs a prosthetic patch was sewn onto the abdominal aorta (Bovine pericard: n= 4, Dacron: n=6. Human Umbilical Vein: n=6). Imaging cycles after injection of 99mTechnetium-labelled DMP444 were performed on days 1,7, 14 and 28 after surgery. Results: We noticed differences in thrombus formation on the tested graft materials. The bovine pericard patches ( n=4) showed a relatively high rate of thrombocyte aggregation. In the Dacron patches ( n=6) aggregation was not seen. In 1 of 6 cases of human umbilical vein patches a measurable focal aggregation was recorded. Conclusion: The method outlined in this study is a relatively simple and reproducable method to visualize thrombocyte aggregation.
Is 100% Beating Heart Coronary by-Pass Justified?
Authors: Davit Saba , Senkaya Isik , Ercan Abdül Kadir , Kan Irem Iris , Özkan Hayati
Published: September 2022

Coronary by-pass on a beating heart may provide a safer form of surgical revascularization by avoiding the well-documented side effects of cardiopulmonary by-pass. In addition, off-pump bypass is suggested to be a good alternative to on-pump especially in high risk patients. This study reviews the feasibility of coronary by-pass on the beating heart in all patients referred to surgery. Two hundred and ninety-four patients operated on the beating heart were prospectively followed and compared to the control group of 100 consecutive patients operated with the conventional method. There were no significant differences between the groups with respect to risk factors, except the incidence of chronic obstructive pulmonary disease and ejection fraction which were higher in the conventional group, whereas peripheral vascular disease was higher in the beating heart group. There was more distal anastomosis in the conventional group. Postoperative inotrope requirement, peak creatine phosphokinase—MB, ventilation time, blood loss in the first 24 h, transfusion needs, new atrial fibrillation and length of hospital stay were significantly lower in the beating heart operations. However, there were no significant differences between the groups in terms of neurological complications, chest infection, intraaortic balloon pump usage and mortality. In conclusion, multivessel off pump coronary by-pass is feasible with the same or better results as it is observed in the conventional technique when postoperative bleeding, neurogenic complications, arrythmias. hospital stay, overall morbidity and mortality are compared.
Effects of Coronary Artery Bypass Grafting on Cellular Immunity with or without Cardiopulmonary Bypass: Changes in Lymphocytes Subsets
Authors: Akbas Haluk , Erdal A. Cenk , Demiralp Emel , Alp Mete
Published: September 2022

Cell-mediated immunity responses decrease after all kinds of surgical procedures. Either anesthesia or surgical trauma plays an important role in this effect. Identification of functional lymphocyte subsets, by using appropriate monoclonal antibodies and analysis of flow cytometry data, appears to provide an accurate measurement of cellular immune competence. We found a significant decrease in the total number of T helper/inducer cells ( p<0.035), B cells ( p<0.043) and natural killer cells (NK) ( p<0.018) but in contrast, increase in NK cell activity ( p<0.012) in the peripheral arterial blood of ten patients undergoing coronary artery bypass grafting with cardiopulmonary bypass (group 1) immediately after surgery and postoperative day 1 (POD1). On the other hand, there was no significant change of these parameters occurred in the peripheral arterial blood of ten patients (group 2) who were undergoing coronary artery bypass grafting without cardiopulmonary bypass. Therefore, we conclude that coronary artery bypass grafting (CABG) with cardiopulmonary bypass induce a greater decrease in immunologic response than CABG without cardiopulmonary bypass (off pump) operations. Nevertheless, off pump CABG operations do not induce a greater decrease in immunologic response than other surgical operations.
Regional Myocardial Oxygenation during Surgical Revascularisation
Authors: Perko Mario J. , Bay-Nielsen Henning
Published: September 2022

The aim of the study was to assess changes in myocardial oxygenation in patients with ischaemic heart disease during surgical revascularisation. In 20 patients, regional oxygen saturation, oxyhaemoglobin and total haemoglobin concentrations were examined by near-infrared spectroscopy in the myocardium and in a non-ischaemic skeletal muscle, which served as a control. Pre-revascularisation values of all spectroscopy parameters were 40–50% lower in the myocardium than in the control. After successful revascularisation 02 saturation, oxy-, and total haemoglobin in the myocardium increased by 20, 29. and 18%, respectively (P<0.01). A negative correlation was found between aorta cross-clamping time and the post-operative increase in the myocardial 02 saturation. In the control muscle and in a patient with incomplete revascularisation the regional 02 saturation decreased. This preliminary report indicates potential value of the near infrared spectroscopy in an immediate assessment of postoperative changes in myocardial perfusion and oxygenation.
The Heavily Calcified Aorta and Re-Do CABG Surgery: Technical Considerations How to Avoid Aortic Crossclamp. How-to-Do-it
Authors: Kuhn-Régnier Ferdinand , Geissler Hans J. , Mehlhorn Uwe
Published: September 2022

Aortic crossclamp may increase the risk for acute aortic dissection and embolic stroke in patients with severe aortic calcification. Additionally, in CABG re-operation aortic crossclamp may necessitate extensive dissection of fibrous adhesions which may intensify the potential risk of injury to the aorta, pulmonary artery or patent bypass grafts. Therefore, it appears to be advantageous in patients undergoing re-do CABG or with aortic calcification to minimize surgical manipulation of the aorta by abandonment of aortic crossclamp. Adequate myocardial protection and convenient surgical exposure without aortic crossclamp max be achieved by intraaortic administration of the short acting ß-blocker esmolol.
Comparison of Metabolic Responses to Deep Hypothermic Total Circulatory Arrest and Retrograde Cerebral Perfusion in an Experimental Model
Authors: Katircioglu S. Fehmi , Saritas Zülfikar , Kügüker Seref , Ulus A. Tulga , Tütün Ufuk , Aksöyek Aysen , Koç Bahattin , Ayaz Selime
Published: September 2022

An experimental study was designed to search the effectiveness of retrograde cerebral perfusion which is presently used as cerebral protection method for the surgery of arcus aorta. Twelve dogs were subjected to the study. Six of them were remained in total circulatory arrest at 20 °C for 60 min. Retrograde cerebral perfusion was done again at 20 °C for 1 h for the other six dogs.

Tumor necrosis factor (TNF). P-selectin, Intracelluler Adhesion Molecule (ICAM), Creatine Phosphokinase (CPK-BB) and tissue Adenosine triphosphate (ATP) levels were measured, before the cardiopulmonary bypass at 37 °C and during perfusion period at 5, 60 min and 4 h.

Tissue ATP level for retrograde cerebral perfusion group was 3.99±0.7 mcmol/g tissue and 2.8610.1 mcmol/g tissue for total circulatory arrest group at fourth hour (p<0.05). TNF level was significantly higher in total circulatory arrest group than retrograde cerebral perfusion group (p<0.05). The samples taken at fourth hour of reperfusion showed the TNF level was, 162.55±13.1 pcg/ml for total circulatory arrest group and this value was 12.5±3.4 pcg/ml for retrograde cerebral perfusion group.

ICAM (Intracelluler Adhesion Molecule) level was higher in total circulatory arrest group (18.751±3.6 ng/ml) when compared to retrograde cerebral perfusion group (8.75±1.8 ng/ml) (p<0.05).

All parameters showed that retrograde cerebral perfusion preserved the brain functions better comparing with total circulatory arrest. The time necessary for aortic surgery may be provided by the retrograde cerebral perfusion technique.
Congenital Pericardial Defect
Authors: Funken J. C. , d'Acoz Y. d'Udekem , Noirhomme P.
Published: September 2022

A 72-yr-old man was electively admitted for cardiac revascularisation 6 weeks after an inaugural inferior infarct. His physical examination and laboratory test were unremarkable. According to his coronarography the patient was programmed for an off pump coronary artery bypass. During surgery the heart was found to be completely herniated in the left chest, passing on the posterior aspect of the phrenic nerve. Symptomatology and complications of congenital pericardial defects are reviewed.
Fatal Cardiovascular Complications in a Patient with Ehlers-Danlos Syndrome Type IV and Dextrocardia
Authors: Jazayeri S. , Gomez M. C. , Tatou E. , Saleh M. , Parthiot J. P. , Brenot R. , David M.
Published: September 2022

A report is presented of a 31 year female patient with Ehlers-Danlos syndrome type IV who presented a bilateral renal artery dissection and a hematoma of the ascending aorta simultaneously. She had had an uneventful delivery six months before. We also discovered a situs solitus with dextrocardia in this patient. These complications were managed conservatively. Unfortunately the patient died of a pulmonary infection and a multi-organ failure syndrome several days after her admission.
True Aneurysm in a Femoro-Popliteal Dacron Graft — A Case Report and Literature Review
Authors: Khaira Harmeet S. , Vohra Hunaid
Published: September 2022

Infection and anastomotic pseudo-aneurysm formation are the usually reported complications in the use of dacron prosthesis in arterial by-pass surgery. We report a case of true aneurysm formation in the body of a knitted dacron graft used to by-pass a symptomatic above knee occlusion of the superficial femoral artery when suitable long saphenous vein was not available. This was diagnosed 10 years after surgery. A true aneurysm may be a result of pre-implantation trauma to the graft or to late fibre degeneration. Microscopic examination revealed that the dacron fibres had stretched to form a local aneurysm before rupturing to form an associated false aneurysm. Two other areas of the graft had small saccular aneurysms without rupture. The damaged portion was excised and replaced by an interposition graft of the same material.
Primary Embryonal Carcinoma of Heart with SVC Syndrome
Authors: Minami H. , Hara I. , Kamidono S. , Suematsu M. , Wakita N.
Published: September 2022

We present a case report of a 25-year-old man with embryonal carcinoma of right atrium and multiple lung metastases featuring SVC syndrome. We resected the cardiac tumor which occupied the right atrium and performed left upper lobectomy. No tumor mass or vestige was detected in the testes. C/s-platinum based combination chemotherapy was performed for residual lung tumors, which leads to the complete remission.
Dyeless Vascular Surgery
Authors: Hingorani Anil , Ascher Enrico
Published: September 2022

Purpose

The morbidity associated with contrast-based diagnostics performed for preoperative evaluation prior to vascular intervention ranges from 1 to 21%. These complications range from minor hematomas to death. However, these exams are commonly felt to be a necessary step to completely evaluate the arterial tree before intervention is undertaken. Since this has varied from our experience, we reviewed our experience with repair of abdominal aortic aneurysms (AAAs), carotid endartectomy (CEA). and lower extremity revascularization performed without preoperative contrast studies.

Materials and methods

During the last 10 years, we have performed 184 elective AAA repairs with abdominal-pelvis CAT scan without intravenous contrast as a preoperative study. During this same period of time. 903 CEAs were performed in 810 patients based solely on duplex ultrasonography or in combination with magnetic resonance angiography in cases where duplex ultrasonography was inconclusive (53 cases). Finally, over the last 30 months, we have performed 485 revascularizations in the lower extremity based solely on duplex ultrasonography mapping. Direct visualization of all major arteries from the distal aorta to the pedal vessels was performed using duplex imaging. Both the carotid duplex imaging and lower extremity duplex imaging were confirmed to have greater than 95 % positive predictive value during an initial phase of 50 cases confirmed with MRA and contrast angiography respectively.

Results

All cases of venous anomalies such as retrocaval left renal vein or left sided inferior vena cava in AAA patients were accurately identified and confirmed by intraoperative findings. No cases of horseshoe kidney were identified. Despite the presence of diminished femoral pulses in six patients, aortic reconstructions were performed with only duplex imaging. The 30 day mortality of AAA patients was 5% for elective repairs, in addition, no gross differences were appreciated with intraoperative findings of CEA as compared to preoperative duplex findings. However, in 5 cases CEA could not be performed due to extension of the lesion well above the available surgical exposure. The 30 day mortality of the CEA patients was 0.7% and the incidence of postoperative stroke or transient ischemic attack was 0.7%. Finally, in two early cases of lower extremity revascularization, the distal anastomosis was placed proximal to a lesion. This was appreciated during the procedure and corrected with a jump graft in each case.

Conclusions

These data suggest that AAA repair, CEA, and lower extremity revascularization can be performed without contrast based preoperative studies and without compromise to evaluation of disease, patient safety or patency of bypass grafts.
Intra-Operative Assessment of Technical Defects after Carotid Endarterectomy: A Comparison between Angiography and Colour Duplex Scan
Authors: Valenti D. , Gaggiano A. , Berardi G. , Ferri M. , Mazzei R. , Roda G. , Palombo D.
Published: September 2022

We compared the intra-operative diagnostic value of CDS vs IA-DSA in identifying major and minor technical defects after CEA. Between August 1997 and December 1998, 138 consecutive patients undergoing 141 carotid endarterectomies were intra-operatively investigated with colour duplex scan and intra-arterial digital subtraction angiography. Thirty-six (25.5%) technical defects were identified. Four (11.1%) major defects were detected by both methods and they were immediately corrected. Fifteen (41.6%) minor defects were detected by both methods, thirteen (36.1%) minor defects were detected by colour duplex but ignored by angiography. Angiography detected four (11.1%) kinkings missed with the colour duplex. The overall sensitivity of both methods for major defect was 100%. The sensitivity of colour duplex for minor defects was 87% vs 59% for angiography. On the basis of our study, colour duplex could be considered the choice method for quality control after carotid endarterectomy.
The Chemically Treated Bovine Ureter—Clinical Performance of a Novel Biological Vascular Prosthesis
Authors: Field P. L.
Published: September 2022

Aim

This paper describes the rationale, development and clinical performance of a novel small-diameter vascular prosthesis of non-vascular animal tissue origin.

Method

Durable conduits suitable for coronary and peripheral arterial reconstruction are prepared for the first time from non-vascular animal tissue. Australian bovine ureters from young steers from protected herds are processed to form strong, bloodflow-compatible and non-immunogenic biologic grafts (‘Flonova’ R, Bionova International Pty Ltd, Melbourne). Fifty-six patients lacking suitable autogenous veins received 62 prostheses (32 bypasses were implanted above knee and 30 below knee). Determination of patency and function included Doppler ultrasound, duplex scanning and angiography.

Findings

The primary patency rate at 1, 2 and 5 years, respectively was 67, 59 and 52% and the secondary patency for the same time frames was 88, 73 and 61%. There were no occlusions as a result of intimal hyperplasia. Dilatation of the wall was diagnosed in one prosthesis at 3.5 years, and one at 7 years, and a false aneurysm of unknown aetiology occurred in another at 3 months. There were no primary graft infections.

Conclusion

This evaluation shows the chemically treated bovine ureter (CTBU) is a viable medium-term alternative to the currently available artificial vascular prostheses for peripheral revascularisation.
The Effect of Inhibition of Renin-Angiotensin System by Valsartan during Hypovolemic Shock and Low Flow Sigmoideal Ischaemia in Pigs
Authors: Yilmaz E. N. , Vahl A. C. , van Rij G. L. , Vink G. Q. M. , Brom H. L. F. , Rauwerda J. A.
Published: September 2022

The aim of this experiment was to study the effect of Renin-Angiotensin System (RAS) blockade by means of valsartan on the colonic and systemic circulation in pigs during low flow sigmoideal ischemia in combination with hypovolemic shock. This condition resembles the situation that occurs in patients suffering from a ruptured aneurysm and a compromised colonic circulation.

An experimental study in pigs was performed: 6 pigs with low flow sigmoideal ischemia and hypovolemic shock were treated with valsartan and a control group of 5 pigs with low flow sigmoideal ischemia and hypovolemic shock without medical treatment.

Valsartan, 3 mg/kg, was administered intravenously. The operation was performed via left sided lumbotomy. The distal aorta was partially occluded to a flow reduction of 30% of the initial value. Hypovolemic shock was induced by withdrawing 20 ml/kg blood in 45 min. Resuscitation with 30 ml/kg haemaccel was iniated after 2 h of shock.

The following parameterswere measured: blood pressure, cardiac output; hemoglobin, lactate, angiotensin II in mixed venous blood (obtained from pulmonary artery) and in splanchnic blood (obtained from caudal mesenteric vein); and endoluminal pulse oximetry of the sigmoideal mucosa.

Statistical analysis was performed by ANOVA and Wilcoxon signed rank test.

There was a significant increase of lactate levels both in systemic and splanchnic circulation (P<0.05) in both groups. In the control group, the mean angiotensin II concentrations in the systemic circulation increased, after induction of ischaemia and shock. In the experimental group, the increase in angiotensin concentrations after resuscitation was significantly more prominent. In the colonic circulation, in both groups, there was a significant increase in angiotensin II levels in the splanchnic circulation following ischaemia and reperfusion (P<0.05), but there was no significant difference between the groups. There were no detectable mucosal signals measured by pulse oximetry after induction of shock throughout the experiment, whereas in the experimental group, median mucosal oxygen saturations of 81. 74.5 and 85% were achieved after resuscitation and declamping (P<0.01).

In conclusion, angiotensin II inhibition during hypovolemic shock improves the colonic circulation, measured by pulse oximetry. However, other parameters of tissue ischaemia did not improve.