bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetresonanzphasenkontrastgeschwindigkeitsmessungen als noninvasive Nachbeobachtungsmaßnahme nach perkutaner transluminaler Angioplastie
Authors: Heverhagen  , Wagner  , Bandorski  , Hoppe  , Alfke
Published: January 2006

Background: The aim of this study was to evaluate magnetic resonance phase contrast velocimetry (MRVL) as a non-invasive follow up tool to assess restenosis after percutaneous transluminal angioplasty (PTA). Patients and methods: We prospectively investigated 51 consecutive patients who underwent PTA of the femoropopliteal region. MRVL was conducted prior, one day, six weeks, twelve weeks and 24 weeks after PTA using a circular polarized extremity coil and a gradient echo sequence (TR/TE 600/6 ms, flip angle 30°, slice thickness 10 mm). Hemodynamic data, derived from the MR phase contrast sequence, allowed to calculate the degree of area stenosis of the lesion treated with PTA. These data were correlated with clinical hemodynamic parameters (ankle-brachial index and walking distance). Results: The mean grade of area stenosis was 69% ± 27% before PTA, 30% ± 20% one day, 29% ± 23% six weeks, 39% ± 17% twelve weeks and 42% ± 18% 24 weeks after PTA and correlated well with clinical data and the post angioplasty clinical course of the patients. Conclusions: Follow up measurements using MRVL are suitable to assess restenosis after PTA and allow quantifying the grade of recurrent stenosis as well as the hemodynamic consequences.
Epithelioides Angiosarkom der Aorta
Authors: Ghanem  , Riede  , Uhrmeister  , Weigang  , Altehoefer
Published: January 2006

Primary malignant tumors of the aorta are extremely rare. Review of the literature indicates that there are nearly 100 recorded cases of primary malignant tumors of the aorta. The purpose of this article is to present an additional case of the primary malignant tumors of the aorta which initially has been misinterpretated as atherosclerosic disease. This aortic tumor was of endothelial origin and immunohistochemical studies classified the tumor as an epithelioid angiosarcoma. The treatment resulted in an abdominal aortic repair. MRI of the spine revealed multifocal metastastic disease of the axial skeleton and a subsequent chemotherapy was performed. The patient died 17 months after the initial diagnosis.
Femorodistale Rekonstruktionen auf die A. tibialis anterior mit PTFE-Prothesen und Venencuff: Alternativen der Bypassführung
Authors: Lazarides  , Tzilalis  , Georgiadis  , Georgopoulos  , Arvanitis
Published: January 2006

Background: The anterior tibial is the less often used artery for distal anastomosis in infrapopliteal bypass with synthetic grafts; however, several investigators argue against even an attempt to use non-autologous material for such distal reconstructions. Only few studies report patency rates mixing-up popliteal below-knee and various crural bypasses. Patients and methods: Nineteen consecutive femoral-anterior tibial cuffed PTFE bypass grafts, either via the lateral (n = 15) or interosseous (n = 4) route, were inserted in a 10-years period. Results: The 1-year and 2-year primary patency rate was 71% and 53%, respectively. It is noteworthy that in one patient a graft positioned via the lateral route remained patent for ten years. No complications were observed regarding the routing methods, whatever increased operating time was required in the interosseous route cases. The 3-year cumulative survival rate for this particular group of patients was 32%. Conclusions: Our data indicate that femoral-anterior tibial bypasses using cuffed PTFE grafts via the lateral route result in an acceptable medium-term patency. As such patients have a limited life expectancy, these procedures should be performed when an autologous vein is not available, as opposed to primary amputation.
Klinische, funktionelle und Änderungen der Lebensqualität bei Patienten mit Krampfadern nach Thermalbad in schwefelhaltigem Wasser
Authors: Mancini jr.  , Piccinetti  , Nappi  , Mancini  , Caniato  , Coccheri
Published: January 2006

Background: Purpose of this study was to assess the effects of thermal hydrotherapy (balneokinesis) with a sulphurous water on clinical symptoms, quality of life and some functional parameters in patients with varicose veins. Patients and methods: 70 patients with primary or secondary symptomatic varicosis were enrolled and submitted to elastic compression therapy. Patients were then randomized to receive (50 pts, group A) or not receive (20 pts, group B) balneokinetic treatment for 12 days “on top” of elastic compression. Clinical symptoms, quality of life and functional parameters obtained with light reflex plethysmography (PPG) and laser Doppler fluxmetry (LDF) were assessed after 3 and 6 months. Results: Scores for subjective symptoms as pain, edema, and venous claudication were decreased after 6 months in both groups, but more evidently in group A submitted to balneokinesis. Some parameters related to quality of life evaluation as “bodily pain” and “emotional role” were improved only in patients undergoing balneokinesis. Regarding functional parameters, with PPG venous refilling time after foot exercise moderately increased in both groups. With LDF a significant improvement in the veno-arteriolar reflex was seen in the group treated with balneokinesis. Conclusions: These results show additional benefits of balneokinetic treatment in patients with symptomatic varices submitted to elastic compression. In fact, clinical and quality of life improvements were observed. The associated amelioration in the veno-arteriolar reflex may support these subjective benefits.
Endovaskuläre Brachytherapie der peripheren Arterien
Authors: Minar  , Pokrajac  , Budinsky  , Pötter
Published: January 2006

Increasing knowledge about the pathophysiology of the process leading to restenosis has given the rationale to investigate the potential role of radiation in the prevention of restenosis. Compared to the rapidly increasing experience in the coronary circulation, there is until now only a limited number of studies concerning the use of brachytherapy (BT) in the peripheral circulation. The-Vienna 2-Trial was the first randomized study to demonstrate the efficacy of endovascular BT for prophylaxis of restenosis after femoropopliteal percutaneous transluminal angioplasty. The cumulative patency rates at 12 months of follow-up were 63.6% in the PTA+BT-group and 35.3% in the PTA-group (p < 0.005), and the significant improvement in patency was also maintained after two years. The results of two ongoing randomized, double-blinded multicenter trials (PARIS; Vienna 3) have to be awaited before definitive recommendations can be given. The rather high incidence of late thrombotic occlusion after long-segment femoropopliteal stenting and endovascular BT requires optimization of the antithrombotic regimen.
Ultrastrukturelle Untersuchung einer infizierten kollagen-beschichteten Polyesterprothese
Authors: Freytag  , Tautenhahn  , König  , Lippert  , Bürger
Published: January 2006

The incidence of infection following arterial reconstruction using synthetic graft materials varies from less than 1 to 5%. One of three mechanisms is thought to be responsible: 1. intraoperative contamination, 2. extension from adjacent infected or colonized tissue, or 3. hematogenous or lymphogenous seeding. We present ultrastructural data of a patient with a polymicrobial graft infection due to a prostheto-enteric fistula 16 years after reconstruction of an aortobifemoral graft. The polymer surface showed signs of biodegradation and was completely covered with a layer of plasma proteins. Disrupted fibroblasts on the intersegmental graft surface were surrounded by bundles of collagen. Gramnegative rods and grampositive cocci were embedded in an extracellular EPS matrix. Bacterial culture confirmed growth of Eikenella corrodens, Fusobacterium nucleatum and Peptostreptococcus species. Fibrin and granulation tissue from the neoadventitia started to mark off the inflammatory process. Transmission electron microscopy is a valuable tool for the investigation of alloplastic arterial devices. After 16 years of implantation the graft shows different signs of biodegradation.
Vascular manifestation of neurofibromatosis in von Recklinghausen’s disease: case report of venous dysmorphism
Authors: Präve  , Hach-Wunderle  , Hach
Published: January 2006

Wir berichten über eine Patientin mit Neurofibromatosis und einer regionalen Dysmorphie der V. femoralis superficialis. Bei der farbkodierten Duplexsonographie wurde als Zufallsbefund eine kurzstreckige Verdickung der Venenwand mit Kalzifikationen gefunden. Der ungewöhnliche Befund spricht sehr für einen kausalen Zusammenhang mit der Grundkrankheit. Bei der Neurofibromatose von Recklinghausen sind Krankheitsprozesse an den Arterien häufig beschrieben. Als Ursache werden dysplastische und hyperplastische Reaktionen des intramuralen Nervengewebes und der glattmuskulären Elemente in der Gefäßwand beobachtet. Darauf beruht die Entstehung von Aneurysmen und arteriovenösen Fisteln sowie von stenosierenden Prozessen an den peripheren, viszeralen und zerebralen Arterien. Eine Beteiligung der Venen ist bei der Neurofibromatose Typ 1 von Recklinghausen dagegen nur aus alten histopathologischen Untersuchungen von mittleren und kleineren Gefäßen bekannt.
Stent-PTA of secondary symptomatic proximal subclavian artery stenosis
Authors: Eger  , Basche  , Aschenbach  , Aßmann  , Thieler
Published: January 2006

Die perkutane transluminale Angioplastie ist im Vergleich zur offenen chirurgischen Revaskularisation ein alternatives Therapieverfahren bei kurzstreckigen Stenosen oder Verschlüssen im Abgangsbereich der Arteria subclavia. Besteht der Verdacht auf eine Obstruktion der Arteria subclavia (z.B. Blutdruck-Differenz an beiden Armen), sollte vor geplanter Anlage von Hämodialyseshunts am Arm und vor operativer Myokardrevaskularisation unter Verwendung der A. mammaria interna eine DSA der oberen Extremität einschließlich des gesamten Aortenbogens erfolgen. Sekundär symptomatische proximale Subclaviastenosen, z.B. nach Anlage eines Hämodialyseshuntes am Arm mit Ischämiesymptomatik der Hand, können erfolgreich mittels PTA und Stentimplantation behandelt werden.
Erectile impotence due to veno-occlusive dysfunction: Therapy of the venous leckage with retrograde embolisation of vena pudenda interna
Authors: Basche  , Eger  , Elsebach  , Ulshöfer
Published: January 2006

Die venös bedingte Impotenz stellt ein therapeutisches Problem dar, weil bei allen Therapieverfahren die Langzeiterfolge kaum über 50% liegen. Die chirurgische Venenligatur ist ein etabliertes Verfahren, wobei jedoch nicht alle pathologischen Venengruppen okkludiert werden können. Neben der chirurgischen Freilegung der tiefen dorsalen Venen und der antegraden Embolisation stellt die retrograde Embolisierung der in der Kavernosographie gesicherten Venengruppen ein alternatives und erfolgversprechendes Therapieverfahren dar. Vier Männer (zwischen 19 und 42 Jahren) stellten sich wegen vollständigem Rigiditätsverlust vor. Eine Kohabitation war nicht mehr möglich. In der Pharmako-Duplex-Sonographie mit Prostaglandin E, (10 und 20 mug) konnte über allen vier Penisarterien ein normaler arterieller Fluss nachgewiesen werden, wobei es auch nach Prostaglandin E, (20 mug intrakavernös) zu keiner vollständigen Rigidität kam. In der dynamischen Infusionskavernosometrie wurde ein deutlich erhöhter Erhaltungsflow festgestellt. Mittels Kavernosographie konnte bei allen vier Patienten ein venöses Leck über der Vena dorsalis penis profunda dokumentiert werden. Die Embolisation erfolgte über einen Vena-femoralis-Zugang in Koaxialtechnik mit einem Histoacryl/Lipiodol-Gemisch, wobei angestrebt wurde, alle in der Kavernosographie nachgewiesenen insuffizienten Venen zu embolisieren. Auch nach mehr als einem Jahr haben diese Patienten weiterhin spontan Erektionen ohne medikamentöse Unterstützung.
Behandlung akuter embolischer Verschlüsse der A. subclavia und A. axillaris mit einem Rotationsthrombektomie-Katheter
Authors: Zeller  , Frank  , Bürgelin  , Sinn  , Horn  , Schwarzwälder  , Roskamm  , Neumann
Published: January 2006

Acute embolic or local thrombotic ischaemia of the upper limbs can be treated by embolectomy or by endovascular techniques. We report here on the endovascular thrombectomy of acute embolic occlusions of subclavian and axillary arteries in two patients using a rotational thrombectomy device and give an overview about the actual literature. Two female patients, each with a history of multi-vessel coronary disease and intermittent atrial fibrillation, complained of sudden onset of pain at rest and paleness of the left and right arm, respectively. Duplex ultrasound showed a localized embolic occlusion of the left subclavian artery and the bifurcation of the brachial artery in the first patient and a localized embolic occlusion of the distal right subclavian and axillary artery in the second patient. In the first patient, the left subclavian artery was reopened using a 8F-Rotarex device via the femoral access, while the bifurcation of the brachial artery was reopened by local thrombolysis using 25 mg rt-PA because of the insufficient length of the thrombectomy device of 80 cm. In the second patient, the right subclavian and axillary arteries were reopened using a 6F-Rotarex device. Follow-up examinations before discharge and after 6 months showed normalized perfusion of the arms of both patients.
Venous thrombosis during pregnancy
Authors: Hach-Wunderle
Published: January 2006

Die Lungenembolie zählt zu den führenden Todesursachen in Schwangerschaft und Wochenbett. Ursächlich liegt meistens eine Thrombose der tiefen Bein- und Beckenvenen zugrunde. Dank der modernen bildgebenden Untersuchungsmethoden lässt sich die Diagnose heute frühzeitig und zuverlässig stellen. Spezielle hämostaseologische Tests decken in einigen Fällen angeborene oder erworbene Defekte auf. Damit gelingt eine erste Einschätzung des individuellen Thromboserisikos. Hinsichtlich der medikamentösen Therapie kommt der körpergewichtsadaptierten Antikoagulation mit Heparin die größte Bedeutung zu. Die Kompressionsbehandlung wird unter Berücksichtigung der individuellen Akzeptanz durchgeführt.
Die flowmediierte Dilatation der Brachialarterie von Frauen mit primären Raynaud Phänomen und gesunden Probanden ist nicht jahreszeitabhängig
Authors: Klein-Weigel  , Krall  , Falkensammer  , Heinz-Erian  , Ulmer  , Fraedrich
Published: January 2006

Background: The aim of this study was to examine endothelium function and seasonal variations of endothelium function in women with primary Raynaud’s phenomenon (RP) and healthy controls. Patients and methods: After a fast of at least 8 hours we studied 21 patients with primary RP ( mean age 31.1 years, mean duration of RP 9.1 years) and 22 controls (mean age 27.8 years) by use of high resolution brachial artery sonography in winter (December/January 2000) and summer (July/August 2001). To exclude circadian variations all examinations were performed in the late afternoon only. All subjects were non-smokers. Confounding factors like serum glucose, HbA1c, and lipid concentrations were analyzed immediately before the investigations. Nicotine contamination was randomly analyzed in hair samples in 8 subjects of each study group. Flow mediated dilatation (FMD%) and nitroglycerin induced dilatation (NID%) were calculated by putting the basal vessel diameter as 100%. Results: Basal, flow-mediated, and nitroglycerin-induced absolute diameters of the brachial artery did not differ significantly between the study groups (p = 0.85). The test conditions (basal, postocclusive, nitroglycerin-induced) always let to the same vessel response in winter and summer (p = 0.61) and there was no significant influence between these test conditions and the study groups (p = 0.07). Compared to patients FMD% was slightly reduced in controls in summer (p = 0.09). Analysis of variance excluded a significant relation between study group and season (p = 0.43). For NID% too, no statistically significant differences were found. Conclusions: We were not able to show impaired or seasonally variant flow-mediated or nitroglycerin-induced dilatation of the brachial artery in patients with primary RP. Our results argue against the presence of a more generalized endothelium dysfunction detectable with high resolution ultrasound of the brachial artery in patients with primary RP.
Anpressdruck über sechs Wochen eines speziell für die Behandlung des venösen Ulkus entwickelten Kompressionsstrumpfes
Authors: Jünger  , Häfner
Published: January 2006

Background: The most important component in the treatment of venous ulcers is compression therapy. The function of compression therapy is the pressure exterted on the extrafascial and intrafascial venous system. Therefore the interface pressure of specially designed compressions stockings for the treatment of venous ulcers are in the focus of interest. Patients and methods: We examined 20 patients (6 men and 14 women) with chronic venous insufficiency in CEAP stages CS0-4EPAS1-3PR. Interface pressure was measured under the Venotrain® Ulcertec over an observation period of six weeks with piezoresistance sensors at four different sites on the lower leg and with the patient in different body positions. Results:Resting pressure supine at the ankle corresponded to compression class III and was constant over the period of six weeks (mean difference 2.8 SD 15.3 mmHg, p = 0.49). Working pressure explained as the quotient of maximum pressure during tiptoing/resting pressure in standing position was initially at the ankle 1.70 SD 0.44 and after 6 weeks 1.44 SD 0.29 (mean difference 0.27 SD 0.42, p < 0.03). Conclusions: The compression stocking maintained a therapeutically effective pressure profile over a period of six weeks. Working interface pressure was comparable to that of short-stretch compression bandages applied by an experienced bandager immediately after application.
The pathogenetic relevance of methicillin-resistant Staphylococcus aureus in chronic wounds
Authors: Dissemond  , Goos  , Esser
Published: January 2006

Die Kontamination und Infektion mit Methicillin resistentem Staphylococcus aureus (MRSA) stellt ein zunehmendes interdisziplinär relevantes medizinisches Problem insbesondere bei der Behandlung chronischer Wunden dar. Es ist daher zu fordern, dass bei Patienten mit chronischen Wunden regelmäßig bakteriologische Abstriche erfolgen, damit MRSA-kolonisierte und -infizierte Patienten identifiziert, konsequente Hygienemaßnahmen und Therapien eingeleitet werden können und sich medizinische Einrichtungen nicht zu Vektoren weiterer Epidemien entwickeln. Insbesondere bei Infektionen sollte die Einleitung einer adäquaten Therapie gezielt nach mikrobiologischer Diagnostik durchgeführt werden und bei dem systemischen rationalen Einsatz von Antibiotika die spezifischen Resistenzen berücksichtigen. Der unkritische Einsatz von Breitband- und Reserveantibiotika fördert lediglich die bereits kritische Entwicklung weiterer Resistenzen.
Endotheliale Dysfunktion und kardiovaskuläre Ereignisse bei Patienten mit peripherer arterieller Verschlusskrankheit
Authors: Pasqualini  , Marchesi  , Vaudo  , Siepi  , Angeli  , Paris  , Schillaci  , Mannarino
Published: January 2006

Background: Patients with peripheral arterial disease (PAD) are characterized by a high mortality for cardiovascular events. An impairment of endothelial function, expressed as brachial-artery flow-mediated vasodilation (FMV), has been described in PAD patients. Aim of this study was to investigate the association between FMV and cardiovascular events in patients with PAD. Patients and methods: Thirty-eight patients with intermittent claudication (71% men, mean age 71 years) were divided into two groups according to the presence or absence of previous major cardiovascular events (myocardial infarction or stroke). Results: Brachial FMV was significantly lower in patients with a history of myocardial infarction or stroke (n = 16) than in patients without cardiovascular events (3.2 ± 3.6% vs. 5.7 ± 3.6%; p = 0.042). In the group with cardiovascular events there was a significantly higher proportion of subjects in the lower FMV tertile (56% vs. 18%), and a lower proportion of subjects in the upper tertile (25% vs. 41%; chi2 test, p = 0.047). Conclusion: We conclude that FMV of the brachial artery is significantly reduced in PAD patients with a history of stroke and myocardial infarction. These cross-sectional results suggest a potential role of FMV as a marker of major cardiovascular events.
Fibrinolyse- und Thrombophilieparameter unter systemischer Prostaglandin E1-Therapie bei peripherer arterieller Verschlusskrankheit
Authors: Kuss  , Heidrich  , Koettgen
Published: January 2006

Background: The study was designed to evaluate if there is any evidence of a hyperfibrinolytic bleeding-risk under systemic treatment with prostaglandin E1 (PGE1) of patients with peripheral arterial disease (PAD). Patients and methods: The in vivo effect of PGE1 on the fibrinolytic and hemostatic process was tested on 15 patients before and after treatment with Alprostadil for 21 days using D-dimers (DD), fibrinogen, prothrombin time (PT), partial thromboplastin time (PTT), antithrombin (AT), ProC-Global®, plasminogen, plasminogen activator inhibitor activity (PAI), alpha2-antiplasmin, coagulation factor XII, basal and activated fibrinolytic capacity (fib. cap.). Results: There was no significant difference in DD, fibrinogen, PT, PTT, AT, ProC-Global®, plasminogen, PAI, alpha2-antiplasmin, coagulation factor XII, basal and activated fibrinolytic capacity observed after the treatment. Conclusion: Summarizing this study there is no hyperfibrinolytic bleeding-risk after the systemic therapy with Alprostadil to be expected.
Proteus Syndrom
Authors: Dragieva  , Stahel  , Meyer  , Kempf  , Häffner  , Burg  , Hafner
Published: January 2006

A 34-year-old male patient was referred with a recalcitrant leg ulcer overlying an extensive vascular malformation, which had led several times to septic soft tissue infections. During his infancy he had been diagnosed to have Klippel-Trenaunay syndrome. Clinical examination revealed asymmetric hypertrophy of the lower extremities, an extensive portwine stain on the more severely affected left limb as well as prominent venous varicosities of both legs. Hands and feet showed striking cerebriform palmoplantar hypertrophy, and macrodactily with syndactily of several fingers. All toes had been amputated in early childhood due to extreme overgrowth and currently the patient walked on his forefeet in a prominent pes equinus deformity. Further symptoms consisted in several lipomas at both arms, another portwine stain at the left hemithorax and a single café-au-lait spot at the left scapula. Angio-magnetic resonance imaging scans of both legs showed an extensive venous-lymphatic vascular malformation involving the whole subcutis and infiltrating the muscle. The chronic wound was interpreted as venous stasis ulceration. Local percutaneous sclerotherapy of the dilated veins underneath the ulcer was discussed, but considered to carry a relevant risk of skin necrosis with consecutive progression of the wound. A conventional split-skin graft led to complete wound healing. Since, the patient consequently wears custom-made compression stockings and remained free from recurrences. The syndromatic constellation of palmoplantar overgrowth, multiple lipomas, giant fingers and toes, limb overgrowth, venous-lymphatic malformation and a café-au-lait spot led to the diagnosis of Proteus syndrome. The possible aetiology, clinical manifestations, differential diagnosis and management of this rare disorder are discussed.
Eine seltene Komplikation der aortoiliakalen Chirurgie: Blutung als Folge einer traumatischen Nierenzystenruptur
Authors: Adovasio  , Griselli
Published: January 2006

The authors describe a clinical case of a retroperitoneal hemorrhage due to rupture of a voluminous renal cyst during a conventional open aortic surgery. Intraoperative trauma is to be considered the cause of bleeding. In most cases the clinical evolution of the patient is benign and conservative treatment is sufficient. Considering the incidence of renal cysts in patients ungergoing conventional aortic surgery, we want to emphasize this possible complication, that has only rarely been dealt with in the literature. We recommend evaluation of such patients in view of preoperative drainage of large cyst including injection of sclerosing agents.
Sekundäre Aneurysmasack-Ruptur nach konventioneller Aneurysmaausschaltung
Authors: Gawenda  , Krueger  , Brunkwall
Published: January 2006

Endotension leading to enlargement of the aneurysm sac following the endoluminal grafting is still handled as an exclusive phenomenon of the endovascular aneurysm repair (EVAR). We report on a case with aneurysm sac enlargement caused by endotension leading to aneurysm rupture after conventional, open aneurysm repair, a so far not described complication. In a 74-year-old patient, following open surgical standard resection and reconstruction of an abdominal aortic aneurysm, a routinely performed abdominal ultra-sonography demonstrated a slowly growing enlargement of the peri-prosthetic aneurysm sac without endoleak. During the pre-operative work-up of the cardiac and pulmonary risk profiles, he complained of abdominal pain and back pain. Control CT revealed contrast inside the aneurysm sac as well as in the right-sided retroperitoneum. At the emergency operation a retroperitoneal haematoma was noticed. Opening the ballooned aneurysm sac, a fresh haematoma was also found. Lifting up the prosthesis, back bleeding at the dorsal circumference of the proximal anastomosis was confirmed due to a 2 cm long disruption of the anastomosis. In patients who present with abdominal or back pain after conventional surgery of an abdominal aortic aneurysm, a contrast CT should be performed to exclude an endoleak as well as other pathologies. The enlargement of the aneurysm sac without endoleak could be interpreted as endotension, with the consequence of urgent re-operation to prevent rupture.
Thrombin-Antithrombin-Komplex und Prothrombinfragment im arteriellen und venösen Blut bei Patienten mit peripherer arterieller Verschluskrankheit
Authors: Hering  , Amann  , Angelkort  , Rottmann
Published: January 2006

Background: Thrombin generation has recently been recognized as an important factor in the development of arterial occlusive disease in all vascular provinces. Several reports concerning markers of thrombin generation have been published with however, conflicting results. It has been demonstrated in vitro that accelerated blood flow velocity causes increased thrombin generation via higher shear rates. In recent articles TAT and F1+F2 concentrations are reported significantly higher in arterial than in venous blood. A correlation with the severity of atherosclerosis or specially with the stage of PAD was expected. In the present investigation we additionally collected blood from the femoral vein. Patients and methods: In 11 patients with Fontaine stages IIb to IV and two healthy subjects TAT and F1+F2 concentrations were determined in blood samples from the femoral artery, the femoral vein (diseased leg) and cubital vein. In all cases and at all puncture sites exactly the same atraumatic technique of venipuncture was used. Results: The concentrations of TAT and F1+F2 were significantly elevated in patients with PAD. There was no significant difference between the concentrations of TAT and F1+F2 in arterial (femoral artery) and venous (femoral vein and cubital vein) blood. Conclusion: The results from previous investigations have been confirmed only partially. Differences in the puncture techniques to collect arterial or venous blood result in an increased scattering of the data and a systematic error.
Die Reproduzierbarkeit des veno-arteriellen FlowIndex für die quantitative Erfassung des hämodynamischen Schweregrads von venösen Erkrankungen
Authors: Kahle  , Hennies  , Bolz  , Pritsch
Published: January 2006

Background: The ratio of volume flow in the common femoral vein and artery denoted as venous-arterial Flowindex (VAFI) is significantly increased in venous insufficiency according the clinical grade of the disease. This study was done to investigate the reliability and reproducibility of VAFI as quantitative pattern. Patients and methods: In 43 patients with varicose veins C4–6 EPAS,D,PPR (PVV), 40 with postthrombotic syndrome C4–6 ESAS,D,PPR,O (PTS) and 48 healthy volunteers volume flow in the common femoral vein (VFV) and artery (VFA) were measured by duplex. Division of VFV by VFA calculated VAFI. VAFI-measurement was repeated 5 times at an interval of ten minutes in 63 subjects (23 PVV, 20 PTS, 20 healthy) and it was performed at three different days in 68 subjects (20 PVV, 20 PTS, 28 healthy). Results: Mean VAFI ± standard deviation was 1.39 ± 0.26 in PVV, 1.42 ± 0.26 in PTS and 0.93 ± 0.13 in healthy veins (p < 0.001). VAFI remained stable and significantly increased (p < 0.001) in PVV and PTS compared to healthy veins during 40 minutes and also within three different days. Conclusion: The venous-arterial flowindex VAFI is a reproducible pattern of the hemodynamic severity in venous insufficiency.
Veränderungen von Faszie und Muskulatur vor und 12 Monate nach erfolgreicher Shave-Therapie des therapieresistenten Ulcus cruris venosum
Authors: Gaber  , Gehl  , Schmeller
Published: January 2006

Background: In chronic venous insufficiency (CVI) III typical changes of skin, subcutaneous tissue, fascia and muscle can be found. It was believed, that the thickening of the fascia is irreversible and it has been postulated that the degeneration of muscles is causative for the persistence of recalcitrant leg ulcers. Patients and methods: By computed tomography (CT) and magnetic resonance imaging (MRI) 8 patients with therapy resistant venous ulcers were examined. Changes of fascia and muscles were determined preoperatively and 12 months after successful shave therapy. Results: By CT a thinning of the preoperatively thickened fascia could be demonstrated in all patients one year after surgery. Before shave therapy MRI showed that the fascia was not only thickend and blurred, but also had fluid accumulations perifascial. 12 months after therapy the fascia was thinner and sharply demarcated. The fluid was either absent or distinctively reduced. Refering to the thickness of fascia an average decrease of 0.084 cm (0.03–0.17 cm) was observed. Before surgery the muscles showed a fatty degeneration as a sign of atrophy; with CT and MRI no changes could be demonstrated after one year in all patients. Conlusion: The results after one year demonstrate for the first time, that the changes of the fascia in CVI III are reversible and that there is no direct correlation between the degeneration of muscles and the persistence of venous leg ulcers.
Spontane Heilung eines chylösen Aszites nach Operation eines abdominellen Aortenaneurysmas
Authors: Parthenis  , Paraskevas  , Staramos  , Spathi  , Georgopoulos
Published: January 2006

Postoperative chylous ascites is a rare complication of aortic surgery. This report presents a patient with chylous ascites after abdominal aneurysmectomy. After a retrospective analysis of full blood count measurements, we observed an association between the number of lymphocytes in the patient’s total blood count and the development and evaluation of chylous ascites. We believe that this hypothesis might be helpful, as it suggests that the number of lymphocytes in a patient’s total blood count may be used as a prognostic factor for the development of chylous ascites. Furthermore, our patient appears to be of interest from a therapeutical point of view, since repeated therapeutic paracenteses alone were sufficient in treating chylous ascites, a finding in contradiction to international literature.
Mykotisches Aneurysma der infrarenalen Aorta
Authors: Papadimitriou  , Tachtsi  , Koutsias  , Pitoulias  , Mpompoti
Published: January 2006

The mycotic aneurysms of the infrarenal aorta (MAIA) are extremely rare and the associated morbidity and mortality is very high. The classification of infected aneurysms considers four types: a) true mycotic aneurysms, b) secondary mycotic aneurysms due to bacterial arteritis, c) infected preexisting abdominal aortic aneurysms and d) post-traumatic infected false aneurysms. The prognosis of true MAIA’s is better than the other forms of infected aneurysms. The standard treatment includes the resection of the aneurysm and infectious surrounding tissues and the restoration of the flow using ex situ (axillobifemoral) bypass or in situ replacement with autologous vein or a rifampicine-bonded graft. We present a case of mycotic aneurysm of the infrarenal aorta and a brief discussion of the alternative treatments from the relevant literature.
Christian Doppler ist 200 Jahre jung
Authors: Bollinger  , Partsch
Published: January 2006

Christian Doppler was born 200 years ago in Salzburg, Austria, on November 29, 1803, worked in Prague and Vienna and died 150 years ago in Venice. In an article of eight pages he described the principle, which made him famous. It appeared in 1842 with the exotic title: “On the Coloured Light of the Double Stars and Certain Other Stars of the Heaven”. The validity of his principle for velocity measurement was confirmed by trumpet sounds produced on a train moving towards and away from the observer. Around 1960 Japanese scientists suggested that flow velocity in blood vessels could be determined by analysing the difference of frequency between emitted and backscattered ultrasound. Rushmer and coworkers built machines suitable for medicine in Seattle, where Eugene Strandness recognized their potential and applied them in first studies. In 1967 the technique jumped to Europe and started to be used worldwide. Already by using continuous wave ultrasound it was possible to diagnose occlusive disease of neck and limb arteries, venous thrombosis and valvular insufficiency with accuracy. Measurements of poststenotic ankle blood pressure were facilitated by Doppler sensing. Over the years more sophisticated instruments were developed. Pulsed emission of ultrasound waves opened a way to study flow velocity profiles across large vessels. By combining the method with A or B mode ultrasound blood flow could be quantified and finally perfused segments of blood vessels visualized. Duplex scanning in its simple and then in its colour coded version is nowadays the standard non-invasive technique that nobody would like to miss. Vascular territories like intracranial, renal and intestinal arteries can also be explored. For the assessment of microvascular flow in skin and mucosae laser Doppler instruments were introduced.
Low level laser therapy for treatment of primary and secondary Raynaud’s phenomenon
Authors: Al-Awami  , Schillinger  , Maca  , Pollanz  , Minar
Published: January 2006

Background: We recently performed a pilot study which suggested that clinical and thermographic improvements occurred in patients with primary and secondary Raynaud’s phenomenon (RP) following treatment with low level laser irradiation (LLLI). In view of these findings, we have proceeded with a double blind, placebo-controlled study. Methods: Forty seven patients suffering from primary or secondary RP were randomly assigned in a double-blind manner to receive either 10 sessions of distant LLLI (16 f, 8 m, median age 45 years) or placebo irradiation (21 f, 2 m, median age 46 years) during winter months. The attack frequency of RP was measured by a diary count; its severity was assessed by means of visual analogue scale. Response to cold challenge test before and after LLL or placebo treatment was assessed by infrared thermography. Result: Overall a significant reduction of the frequency as well as the severity of RP in patients with either LLLI (frequency p < 0.0001, severity p < 0.0001) or placebo treatment (frequency p < 0.0001, severity p = 0.02) was found, but patients in the LLLI group exhibited a statistically more significant improvement of the frequency at 6 weeks p = 0.007 and 3 months p = 0.02 and the severity p = 0.02, p = 0.04 of RP. Thermographic response to cold challenge improved only in patients treated with LLL but not in those treated with placebo. Conclusion: LLLI significantly lowers the frequency and severity of Raynaud’s attacks in patients with primary and secondary RP. Since this therapeutic modality is a safe, and non-invasive treatment, it might be considered as an alternative to existing therapeutic regimes.
Early carotid endarterectomy in patients with a nondisabling ischemic stroke: Results of a retrospective analysis
Authors: Wölfle  , Pfadenhauer  , Bruijnen  , Becker  , Engelhardt  , Wachenfeld-Wahl  , Schulze-Hamma  , Loeprecht  , Wohlgemuth
Published: January 2006

Background: There are several recent recommendations not to delay carotid endarterectomy (CEA) for at least 4 weeks in patients experiencing a nondisabling ischemic stroke. Therefore, we re-examined if these patients could be safely operated on earlier: The aim of our study was to review the perioperative stroke and death rates of CEA performed within 30 days of stroke onset. Patients and methods: During a 4 year period until December 2001, in 66 neurologically stable patients suffering a nondisabling stroke ipsilateral to a carotid artery stenosis > 50% CEA was performed after a median interval of 10 (1–28) days. The modified Rankin scale (mRS) was applied to characterize the severity of impairment of daily living activities pre- and postoperatively: Any postoperative deterioration > 24 hours on the mRS was considered as a new stroke. Results: Operative mortality was 0%, and postoperative neurologic worsening > 24 hours occurred in 8/66 patients (12,1%). In 5/8 patients neurologic deterioration resolved within 5 days after surgery, only one stroke was permanent (1,5%). There was no correlation between timing of surgery or the presence of acute ipsilateral cranial CT defects with the occurrence of postoperative stroke. Stroke severity grading on admission according to the mRS, however, emerged to be a significant determinant of postoperative outcome: While 6/23 patients (26%) with an initial deficit ≥ 3 on the mRS developed neurologic worsening, this was the case in only 2/43 patients (4,6%) with a deficit ≤ 2 (Odds Ratio 7.2; 95% CI 1.32–39.49; two-sided p = 0.01). Conclusion: Our results suggest that selected patients with a minor stroke (mRS ≤ 2 on admission) can safely undergo early CEA.
Outcome of critical foot ischaemia in longstanding diabetic patients: a retrospective cohort study in a specialised tertiary care centre
Authors: Volaco  , Chantelau  , Richter  , Luther
Published: January 2006

Background: We sought to establish risk factors predicting the outcome of foot lesions in longstanding diabetic patients with critical foot ischaemia (CFI). Patients and methods: We investigated retrospectively 98 consecutive diabetic patients with ischaemic foot lesions. The patients (mean age 70 years, duration of diabetes 21 years) were jointly cared for by specialised diabetologists and vascular surgeons; 75 patients were treated by arterial revascularisation. Results: Good outcome (lesions healing) was observed in 53 patients (54%). Bad outcome was observed in 45 patients: not healing lesions (n = 5), major amputation(n = 19), and death in relation to the foot lesion (n = 21). Patients with good and bad outcome did not differ regarding age, sex, smoking status, type, duration and treatment of diabetes mellitus, presence of neuropathy, coronary heart disease, stroke, previous amputations, current revascularization, and localization of the foot lesion. The risk of bad outcome was increased 8.9 times in patients on dialysis for end-stage renal disease; 7.0 times if surgical complications were present; and 5.4 times with C-reactive protein (CRP) above the second quintile (cut-off value 8 mg/dl). Conclusion: Management of longstanding diabetic patients with ischaemic foot lesions leaves room for improvement. Dialysis treatment, elevated CRP levels and surgical complications were strongly predictive of non-healing lesions, major amputation and death.
Stewart-Treves syndrome as a rare complication of a hereditary lymphedema
Authors: Dürr  , Pellengahr  , Nerlich  , Baur  , Maier  , Jansson
Published: January 2006

Lymphangiosarcoma (LAS) may occur as a rare complication of primary lymphedema. A case of LAS in hereditary lymphedema of the lower extremity in a 36-year old female is reported. Despite of chemotherapy, local hyperthermia and later amputation of the extremity the patient died of progressive disease due to pulmonary metastasis. In respect to this case, the different therapeutic concepts, as reported in the literature, and their results are presented and discussed.
A late onset carotido-jugular fistula following shotgun injury
Authors: Hazinedaroglu  , Genc  , Aksoy  , Köksoy  , Tüzüner  , Atahan
Published: January 2006

The incidence of arteriovenous fistulae (AVF) is quite rare in the head and neck region comprising less than 4% of all the traumatic AVF encountered elsewhere in the body. A 42-year-old man presented with a palpable thrill in the cervical region and headache. He had a shotgun injury 10 years ago and had no problem until the previous three months. Diagnosis of a high output traumatic AVF between right common carotid artery and internal jugular vein was made arteriographically. Presence of a neighbouring traumatic aneurysm on the common carotid artery and 9 mm diameter of the fistula tractus suggested open surgery. At the operation ligation of the tractus and aneurysmorraphy was performed and the patient was discharged in the third postoperative day. He has still no problem. This case documented that a shotgun injury even 10 years later may result with an AVF.
Longterm follow-up after percutaneous transluminal angioplasty of the distal abdominal aorta
Authors: Sabeti  , Schillinger  , Mlekusch  , Olbert  , Minar
Published: January 2006

Aortoiliac disease can be either treated with surgery- endarterectomy for localized aortic disease or with bypass graft placement for more extensive aortoiliac disease – or with percutaneous transluminal angioplasty (PTA), which has become an established method. Long term results of surgery are well documented in literature, but long term results of distal aortic PTA are scarce, furthermore angiographic follow-up is very uncommon. We report about a patient with isolated aorta abdominalis stenosis due to atherosclerotic disease who underwent PTA in 1982 and had an angiographic follow-up four and twenty years later, thus we demonstrate that patency can be obtained even after twenty years.
Endovascular treatment of a traumatic thoracic aortic aneurysm initially presenting as acute critical limb ischemia
Authors: Diehm  , Schmidli  , Do  , Triller  , Dinkel
Published: January 2006

We describe the successful endovascular treatment of a traumatic thoracic aortic aneurysm in a 32-year old male presenting with acute critical limb ischemia. The patient's condition arose from embolism growth in an aneurysmal lesion incurred seven years previously in a motorcycle accident.
Frequency of asymptomatic peripheral arterial disease in patients entering the department of general and internal medicine of a general-care hospital
Authors: Heidrich  , Wenk  , Hesse
Published: January 2006

Background: The fact that a high prevalence of asymptomatic peripheral arterial disease (PAD) in the population has repeatedly been noted in recent years, without there being data as to how often asymptomatic PAD has to be anticipated in inpatients treated for divergent internal diseases led us now to performing a screening study in a general-care hospital. Patients and methods: The study population consisted of 990 patients (51.8% women, 48.2% men) with a mean age of 65.2 years (40–93 years) who had to be treated in a hospital for various internal diseases in the period from January 1994 to January 1995. Their case histories were taken, and their clinical findings and the ankle/brachial indices as calculated from Doppler ultrasonographic measurements of the systolic pressures in the malleolar and brachial arteries were used to ascertain how many of the patients presented with asymptomatic and symptomatic PAD. Further the frequency of risk factors (smoking, hypertension, diabetes mellitus, lipid disorders) was recorded for either patient group. Results: The study showed that 6% of the 990 patients suffered from symptomatic PAD and that of the remaining 931 patients, 43.7% were diagnosed, on the basis of the ankle/brachial index (ABI) (_ 0.9), to have asymptomatic PAD, while 56.3% showed no indication of PAD. Conclusions: The high number of cases of aysmptomatic PAD among inpatients who underwent internal treatment – a percentage well above the figures published so far for outpatients – allows the conclusion that the determination of the ABI is well suited to screen patients older than 50 years even in a hospital setting so that early secondary prophylaxis can be initiated.
Femoral artery infection associated with a percutaneous arterial suture device
Authors: Tiesenhausen  , Tomka  , Allmayer  , Baumann  , Hessinger  , Portugaller  , Mahler
Published: January 2006

This is a case report of a femoral artery infection with fatal outcome after using a percutaneous suture mediated closure device: A 77-year old patient underwent diagnostic angiography of his thoracic and abdominal aortic aneurysm, the puncture site was closed with the Perclose® system. He developed a staphylococcal femoral artery infection with groin abscess, requiring surgical intervention with debridement and removal of the Perclose® suture. After stent graft exclusion of the thoracic and abdominal aortic aneurysm a staphylococcal sepsis occurred and the patient died of aneurysm rupture months later despite long term antibiotic therapy. Since the use of the Perclose® device carries an increased risk of femoral artery infection with septic endarteritis and bacteremia, it should not be used in routine diagnostic angiography.
Entrapment-Syndrom der A. poplitea: Morphologische und funktionelle Diagnose mittels MRT einschließlich Provokationstest
Authors: Mohrs  , Dahm  , Nowak  , Fach  , Reinhart  , Hoffmann  , Voigtländer
Published: January 2006

Bei einem 30-jährigen Patient mit Claudicatio intermittens rechts ohne kardiovaskuläre Risikofaktoren erfolgte eine MR-tomographische Abklärung bei duplex-sonographischem Verdacht auf ein Entrapment-Syndrom der A. poplitea. In der Kontrastmittelverstärkten MR-Angiographie unter Ruhebedingungen kam ein Verschluss der rechten A. poplitea zur Darstellung, welche durch einen atypisch kranialen Ursprung des medialen Gastrocnemiuskopf am dorsalen Femurschaft bedingt war. Linksseitig zeigte sich die Poplitealarterie unauffällig. Im Provokationstest bei Kontraktion des M. gastrocnemius fand sich jedoch eine Lateralverlagerung und eine hochgradige funktionelle Stenose der linken A. poplitea. Diese war durch den atypischen Ursprung des medialen Gastrocnemiuskopfes an der Innenseite des medialen Femurcondylus bedingt. Als kausale Therapie erfolgte eine Gefäßrekonstruktion der A. poplitea und die Myotomie des medialen Gastrocnemiuskopfes rechtsseitig sowie die alleinige Myotomie linksseitig. Intraoperativ wurde die MR-tomographische Diagnose eines beidseitigen Entrapment-Syndrom der Poplitealarterie mit unterschiedlichen Varianten bestätigt. Mittels funktioneller MRT besteht die Möglichkeit, unterschiedliche, auch seitendifferente Varianten des poplitealen Entrapment-Syndroms zu unterschiedlichen Stadien zu erkennen. Insbesondere bei frühzeitiger Diagnose können durch entsprechende kausale Therapie irreversible Gefäßschädigungen vermieden werden.