bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcutaneous Oxygen and Carbon Dioxide Measurement in Peripheral Vascular Disease
Authors: Melillo Elio , Catapano Giosue' , Dell'Omo Giulia , Iabichella Letizia , Berchiolli Raffaella , Ferrari Mauro , Pedrinelli Roberto 
Published: June 2007

Combined transcutaneous oxygen tension (tcPO2) and transcutaneous carbon dioxide tension (tcPCo2) measurements were carried out at both the subclavicular and metatarsal level in 29 controls and 100 patients with peripheral arterial obstructive disease (PAOD) (intermittent claudication: n = 40, critical limb ischemia: n = 60). Interindividual variation coefficients of arterial and subclavicular tcPCO2 (n = 94 subjects) were superimposable, while tcPo2 variability was twice the arterial value. Furthermore, arterial tensions were better predicted by tcPCO2 than by tcPO2 measurement. In the 75 limbs with an ABI < 0.9 of patients with intermittent claudication, tcPCO2 did not differ significantly from controls (n = 58 limbs), but it was elevated in those with critical limb ischemia (n = 74 limbs), although control and pathological values overlapped widely even in this latter group. At variance with tcPCO2, tcPQ2 was lower in intermittent claudication than in controls, and undetectable in most of the symptomatic limbs with critical ischemia, irrespective of concomitant diabetes. In the overall sample (n = 255 limbs), tcPCO2 did not show significant changes for tcPo2 values ranging from 80 to 10 mmHg, and it increased markedly in several—but not all—patients whose tcPo2 values were below that limit. To evaluate further the biological significance of an increase in tissue tcPCO2, another sample of 24 subjects underwent acute forearm ischemia for a period of thirteen minutes, a maneuver that increased tcPCO2 markedly, indicating that this parameter is indeed a correlate of drastic reductions in limb perfusion. Thus, tcPCO2 is methodologically less variable than tcPo2 and more predictive of arterial values. However, the wide overlap with control values restrains its use as an isolated diagnostic tool to substantiate PAOD, even in the most advanced stages of disease. Marked elevations in tCPCO2 can be found in patients with critical limb ischemia, although normal values may coexist with low or negligible tcPO2 levels for reasons to be clarified. Further work is needed to establish the extent to which tcPcO2 determination may complement tcPO2 to differentiate extreme from less severe degrees of critical limb ischemia.
Proximal Reflux Adversely Affects Distal Venous Function
Authors: Walsh Jon C. , Bergan John J. , Moulton Steven L. , Beeman Sue 
Published: June 2007

In limbs with chronic venous insufficiency (CVI), the presence of popliteal vein reflux has correlated with severity of venous insufficiency. Correction of proximal deep venous reflux has improved clinical manifestations of CVI, but the hemodynamic results of doing so have been disappointing. The present study was done to ascertain the effects of proximal reflux upon distal vein function. A total of 226 patients (175 women, 51 men) entered this study. Venous insufficiency in each of 450 limbs was classified according to Joint Councils' recommendations, and reflux was assessed by a modification of a method of Nicolaides and of van Bemmelen. Reflux in the femoral vein (FV), greater saphenous vein (GSV), popliteal vein (PV), and lesser saphenous vein (LSV) of the nonweight-bearing limb was quantitated by using the ATL 9 duplex scanner with a 5 MHz probe during rapid distal pneumatic cuff deflation. Data obtained included vein diameter, reflux volume, and reflux peak velocity. Limbs with PV reflux with and without FV reflux were then compared with those without PV reflux with and without FV reflux according to sex. The men in this study group were older than the women (P < 0.05) and had a more advanced stage of venous insufficiency (P < 0.001). Therefore, analyses were performed separately in men and women. In men, when FV reflux was absent, only 14 of 69 limbs had popliteal reflux (20.3%), but when FV reflux was present, 19 of 33 limbs (57.5%) also had PV reflux. In women, when FV reflux was absent, only 33 of 304 limbs had PV reflux (10.9%). However, when FV reflux was present, 12 of 48 limbs (25%) also had PV reflux. The diameter of the FV was not influenced by the presence or absence of PV reflux alone but if both FV and PV reflux was present, a greater FV diameter was observed in women. In men, the popliteal venous diameter was influenced by presence of FV reflux, and in women, PV diameter was increased in diameter if FV reflux was present and PV reflux absent. A trend toward increased volume and velocity of PV reflux flow was seen in women, but in men, PV volume and velocity of reflux flow were significantly greater if FV reflux was present. Limbs with multiple levels of reflux exhibited a higher clinical class of venous stasis than those with lesser numbers of levels of reflux. Accurate segmental evaluation of venous reflux by duplex scanning allows dissection of the influence of reflux within one venous segment upon another. Further, proximal reflux exhibits a deleterious effect on distal venous function. Correction of femoral venous reflux should be an objective in treating chronic venous insufficiency.
Perioperative Management of Juxtarenal Aortic Occlusion
Authors: Iwai Takehisa , Sato Shoji , Inoue Yoshinori , Takiguchi Noriaki , Sugano Norihide , Takashima Itaru , Aoi Taihei , Konno Susumu , Endo Mitsuo 
Published: June 2007

The authors reviewed the surgical treatment and outcome in patients with juxtarenal aortic occlusion. From 1975 to 1993, 44 patients (37 men) with a mean age of 62.6 years underwent surgery for this condition. The vascular lesions included renal-level segmental aortic occlusion in 2 patients, infrarenal complete aortic occlusion in 30, and high aortic occlusion with a patent inferior mesenteric artery in 12. Four patients had subacute occlusion and 40 had chronic occlusion. In the chronic group, the symptom was intermittent claudication in 31 cases, rest pain in 4, and gangrene or ulceration in 5. Impotence was present in most of the men. Surgical treatment included transaortic thromboendarterectomy in 2 patients, axillobifemoral bypass in 12, and high aortic thromboendarterectomy plus aortobifemoral bypass in 29. Suprarenal aortic clamping was done in 22 patients, with a mean renal occlusion time of 9.3 minutes. Simultaneous renal artery reconstruction was performed in 3 patients. There were 4 operative deaths (mortality rate 9%), with 2 in the subacute group. Late death from unrelated causes occurred in 9 patients within five years. Lower limb ischemia was cured in all patients and impotence cured in 4 cases. Graft patency was satisfactory after both extra-anatomic and anatomic bypass. Transanal Doppler ultrasound monitoring during the surgery was easy to set and gave the authors useful information about accurate visceral circulation in reference to aortic reconstruction.
Transcutaneous Oximetry is Useful in Vascular Pathology If a Cutaneous Reference Map and a Maximal Exercise Test are Used
Authors: Pola P. , Tondi P. , Lago A. Dal , Santoliquido A. , Gerardino L. , Massari I. 
Published: June 2007

The measurement of partial oxygen pressure in arterial blood by use of transcutaneous pulse oximetry (tcPo2) is a technique relatively new to clinical practice. However, there are notable differences of values both in healthy and arteriopathic subjects, depending on which part of the limb the measurement is carried out. The authors define a cutaneous reference map for oximetric measurements in both healthy and arteriopathic subjects. In a group of 200 healthy subjects and a group of 82 subjects affected by obliterative arteriopathy of the lower limbs at the second Fontaine stage, oximetric measurements were carried out under rest conditions. By comparing the oximetric ranges at all examined levels, it can be seen that there is a wide band of overlap between the minimum values of healthy subjects and those of the arteriopathic subjects. In a group of 30 healthy subjects and in a group of 30 subjects affected by obliterative arteriopathy of the lower limbs at the second Fontaine stage, oximetric measurements were taken at I, II, III back levels of the leg during maximal treadmill test. In this case, by comparing the oximetric ranges between the two groups, it can be seen that all arteriopathic subjects present significantly lower values as compared with those of the healthy subjects at each examined level. This permits a confident diagnosis of pathology. The authors conclude that in order to make a correct diagnosis of arteriopathy by using transcutaneous oximetry, it is necessary to consider both the measurements carried out under rest conditions and those carried out during maximal treadmill test.
Renal Revascularization for Uremia
Authors: Rossi Giuseppe , Grossi Robert , Flum David R. 
Published: June 2007

Renal revascularization for uremia has achieved variable success and remains a controversial procedure. The authors retrospectively reviewed their experience with renal revascularization to assess operative morbidity and mortality and to quantify its long-term, beneficial effects on renal function. From 1974 to 1993, 15 patients with renal artery occlusive disease and varying degrees of uremia underwent renal artery revascularization. A retrospective review was conducted of these patients. There were 9 men and 6 women with an average age of 61.5 years (range forty-five to eighty-three years). Preoperative serum creatinine ranged from 1.9 to 10 mg/dL with a mean of 5.07 mg/dL. Three groups were identified: Group A-creatinine 1.9-3.4 mg/dL, Group B-creatinine 3.5-5.2 mg/dL, Group C-patients receiving dialysis. Ten of 15 patients had a solitary kidney. Ten of 15 patients had concomitant aortic reconstruction with renal artery bypass. The mean creatinine went from 5.07 mg/dL preoperatively to 2.22 mg/dL on discharge (P = 0.006). At late follow up (mean 69.1 months) the mean creatinine was 2.62 mg/dL. Late (mean 69.1 months) functional results indicated that 13 of 15 patients (87%) had improved or stabilized renal function. Five of 7 patients who were receiving dialysis preoperatively required no postoperative dialysis because of improvements in renal function. One patient eventually required dialysis although he had not required it preoperatively. There were no operative deaths, but 2 major complications occurred. Mean survival time was one hundred seven months with 80% survival at five years and 60% survival at ten years. On average 63.6 months of dialysis-free survival were noted for the group. Renal revascularization for uremia can be performed with low morbidity and mortality. Long-term follow up indicates a low mortality and a lasting beneficial effect on renal function in the majority of patients. Additionally, this beneficial effect is recognized in patients already receiving preoperative dialysis.
Eversion Carotid Endarterectomy: A Safe, Advantageous Alternative to Conventional Carotid Endarterectomy
Authors: Calaitges John , Kashyap Ajaya , Annest Stephen 
Published: June 2007

Objective: To compare the results and time and cost efficacy of eversion carotid endarterectomy (ECEA) with standard carotid endarterectomy (SCEA). Methods: A retrospective analysis of 88 carotid endarterectomies performed by the residents under the guidance of the senior author between January 1, 1991, and December 31, 1993, was done. Fifty-five patients underwent SCEA (44 vein patch, 11 primary closure) and 33 had ECEA. The two groups were compared for operative time, intraoperative evaluation, cost, immediate and delayed morbidity, and restenosis (≥ 50%). Results: The two groups were found to be similar for age, sex ratio, and associated diseases. The indications for surgery were transient ischemic attack (TIA) (57% ECEA, 64% SCEA), previous stroke with minimal residual deficit (9% ECEA, 17% SCEA), and asymptomatic high-grade stenosis (34% ECEA, 19% SCEA). The average operative time for ECEA was significantly less (99.2 vs 135.2 minutes, P < 0.02). The mean blood loss was also less for ECEA (86 vs 181 cc). Two SCEA patients had immediate postoperative thrombosis resulting in 1 cerebrovascular accident (CVA) (1.8%), and 3 SCEA patients had cranial nerve injuries. In follow-up, 1 patient with SCEA had restenosis and 1 had a CVA unrelated to carotid disease. Morbidity associated with ECEA included 1 unsuccessful ECEA requiring interposition vein grafting and 1 intraoperative repair of an intimal flap. There was no associated residual morbidity. There was no significant difference in stroke rate between the two groups. The operative cost (excluding surgeon fee) was 28% higher for SCEA patients. Conclusion: Eversion carotid endarterectomy is a safe procedure and can be an important addition to a surgeon's armamentarium in efforts to cut costs while maintaining quality.
Impact of Carotid Endarterectomy Critical Pathway on Surgical Outcome and Hospital Stay
Authors: Schneider Joseph R. , Droste Julie S. , Golan John F. 
Published: June 2007

Carotid endarterectomy (CEA) is associated with substantial consumption of hospital days and other resources. Although surgical outcomes in their practice compared favorably with published benchmarks, the authors were concerned that postoperative stays were unnecessarily long and that patients were receiving unnecessary tests and pharmaceuticals. Recent studies suggest that within the bounds of safe practice, efforts to standardize care may increase quality and patient satisfaction and reduce consumption of resources. They examined their practice of CEA in an effort to discover the potential for quality improvement and decreased utilization of resources. A CEA critical pathway (CP) was designed, the primary goal of which was elimination of a possibly unnecessary second postoperative hospital day for most patients and superfluous perioperative testing and medications. Data were recorded prospectively both for Pre-CP patients during the year prior to CP initiation and for subsequent CP patients during the subsequent 13-month period. CP patients were interviewed and the pathway was described prior to surgery. Pre-CP and CP patients were indistinguishable with respect to indications for CEA and medical comorbidities. A single operative death occurred due to myocardial infarction (Pre-CP). Perioperative stroke and other complications occurred in similar numbers of Pre-CP and CP patients. CP resulted in a 0.5-day decrease in hospital stay overall. CP was also associated with a 22% decrease in direct costs. One early readmission for neck hematoma on postoperative day 2 (1 day postdischarge) might have been preventable. A second readmission on postoperative day 2 was secondary to a drug reaction and would likely have occurred prior to initiation of the CP as well. CP resulted in significant decreases in resource utilization and with the possible exception of a single readmission did not appear to adversely affect outcome. Preoperative education and expectation that patients will be ready for discharge 1 day after CEA are critical to patient acceptance and satisfaction. Further modification of the CP may further decrease utilization of resources. CP is an excellent mechanism to understand how surgeons practice and it facilitates quality improvement.
Coagulopathy After Ruptured Abdominal Aortic Aneurysm
Authors: Meissner Mark H. , Chandler Wayne C. , Nicholls Stephen C. 
Published: June 2007

Although potentially treatable, coagulopathy is often included among the predictors of a poor outcome after ruptured abdominal aortic aneurysm (rAAA). The purpose of this review was to define the incidence of coagulopathy among patients presenting with rAAA and to identify the factors contributing to its development. The medical records of 89 consecutive patients presenting with a rAAA were retrospectively reviewed. Laboratory results (international normalized ratio [INR], partial thromboplastin time [aPTT], platelet count, fibrinogen, and fibrin degradation products [D-dimer]) measured on admission and perioperatively were recorded and related to features of the patients' prehospital and hospital course. At least one admission coagulation study was obtained in 70 of 89 patients. All measured coagulation values were within the normal range in only 10 (14%) patients, whereas at least one value was in the coagulopathic bleeding range in 17 patients (24%). Profound abnormalities of the INR (> 2.0) were present in 24%, of the aPTT (> 60 sec) in 12%, and of the platelet count (< 50) in 7% of patients. In a multivariate model, hematocrit was the only significant predictor of an INR > 2.0, while hematocrit and degree and duration of hypotension predicted an aPTT > 60 sec. Fluid volume prior to admission did not independently predict either the INR or aPTT, although it was the only significant predictor of a platelet count <50. Admission D-dimer levels were elevated in 79% of patients and were not significantly associated with either the degree of hemorrhage or volume resuscitation. All coagulation studies showed deterioration following admission, with profound abnormalities observed in 90% and 52% of patients intraoperatively and postoperatively, respectively. Mortality was 74% among those undergoing operation and was significantly associated with advanced age and lowest systolic blood pressure, but not with admission INR or aPTT. The majority of rAAA patients present with disordered coagulation, profound abnormalities being more related to the degree of hemorrhage than to the volume of fluid resuscitation. Evidence of intravascular fibrinolysis is even more common and may be more closely related to the aneurysm itself than to acute hemorrhage.
Implications of Serum Cholesterol Measurement for the Vascular Surgeon
Authors: Wijesinghe Lasantha Dinesh , Ahmed Ishtiaq Mehmood , Gilbey Stephen , Berridge David Charles , Scott David Julian Ashbridge 
Published: June 2007

Objective: To measure the serum total cholesterol in new patients with intermittent claudication and to assess the proportion with ischemic heart disease and untreated hypercholesterolemia. Design: A prospective study with patient history corroborated by a general practitioner telephone questionnaire. Setting: A vascular surgical center in a major teaching hospital. Subjects: Seventy-six consecutive claudicants were studied (median age, 66; range, 46 to 94; 45 men and 31 women), of whom 41 (54%) had ischemic heart disease. Results: The median serum total cholesterol concentration was 6.35 mmol/L (IQR, 5.60 to 7.05 mmol/L). Forty-nine (65%) patients had never had their serum cholesterol assayed before this study despite 24 of them having ischemic heart disease. Conclusions: Previously undiagnosed hypercholesterolemia is commonly revealed in the vascular surgical assessment of patients with intermittent claudication. The cardiac morbidity and mortality of these patients is high and surgeons should therefore be proactive in the instigation of cholesterol-lowering therapy.
Smoking Cessation Reverses Arterial Endothelium-Dependent Relaxation Injury
Authors: Mays Bradley W. , Ripple Timothy , Eginton Mark T. , Seabrook Gary R. , Cambria Robert A. , Towne Jonathan B. , Freischlag Julie A. 
Published: June 2007

Chronic smoking is associated with acetylcholine-dependent endothelial dysfunction, an early marker of atherosclerosis. The purpose of this study was to determine whether this effect of smoke exposure on blood vessel endothelium is reversible. New Zealand White rabbits were placed in a 240 cubic-foot air flow chamber for 3 hours per day, 5 days per week, over a 4-week period and were exposed to smoke produced by a robotic smoke generator. After the 4-week period, rabbits (n=four, Smoked) were killed and their superficial femoral arteries (SFAs) were cut into 3-mm segments. The rings were suspended from tension transducers and the maximal contraction of one ring was recorded following stimulation with norepinephrine (NE). The remaining rings were contracted to 50% of the maximum. Relaxation of these rings was determined by adding increasing doses of acetylcholine. The remaining rabbits were placed in and out of the chamber without smoke exposure for an additional 4 weeks (n=five, Reverse-smoked), and then the SFAs were harvested. Control (n=six) SFAs were explanted from rabbits not exposed to smoke. KCl induced increased contractility in the smoked group when compared with the controls, and NE induced increased contractility in the smoked group when compared with the reverse-smoked rabbits. Acetylcholine-dependent relaxation was significantly reduced in the rings from the smoked rabbits when compared with the controls. The percentage ring relaxation in the reverse-smoked rabbits was similar to the control rings. The impaired acetylcholine-dependent endothelium relaxation in the smoked group verifies endothelial injury. However, the improved relaxation in the reverse-smoked group suggests that endothelial injury is reversible.
Impaired Peripheral Vasodilation in Ischemic and Nonischemic Limbs of Patients with Unilateral Arteriosclerosis Obliterans
Authors: Makita Shinji , Nakamura Motoyuki , Ohira Atsushi , Ito Shigehiro , Yoshioka Kunihiro , Hirose Atsuo , Nakajima Takayuki , Komoda Kenji , Kawazoe Kouhei , Hiramori Katsuhiko 
Published: June 2007

Limb vessel vasodilation plays an important role in the regulation of skeletal muscle blood flow during exercise. However, little documentation is available that describes the vasodilatory response of peripheral vessels in patients with arteriosclerosis obliterans (ASO). This study investigates possible impairment of basal blood flow and response in ischemic and nonischemic legs of patients with ASO, and the effect of revascularization on leg hemodynamics. Basal calf blood flow and reactive hyperemic response to femoral occlusion were measured plethysmographically in 20 patients with unilateral ASO (20 stenotic legs and 20 nonstenotic legs) and eight healthy subjects (eight control legs). Eight stenotic legs underwent percutaneous transluminal angioplasty or surgical revascularization. Basal calf blood flow and peak hyperemic flow was significantly lower in stenotic and nonstenotic legs than in control legs. After revascularization, basal flow was unchanged in stenotic legs but elevated in nonstenotic legs (from 2.5 ±0.3 to 3.4 ±0. 4 mL/min/dL tissue, p<0.01). Peak flow in both legs was significantly elevated (stenotic legs, from 12.8 ± 1.9 to 17.6 ± 1.6 mL/min/dL tissue, p<0.01; nonstenotic legs, from 14.3 ± 1.0 to 20.0 ±1.6 mL/min/dL tissue, p<0.01), although still below control values. Basal blood flow and maximum vasodilatory response of resistance vessels are impaired irrespective of the side of conduit vessel involvement. The vascular response of the nonstenotic side is significantly enhanced after revascularization of the contralateral stenotic lesions. These suggest that neural or circulating vasoacting factor(s) originating from the stenotic limb may contribute to peripheral circulatory disturbance in claudicants.