bluuebunny/crossref_metadata_2025_split huggingface dataset:
Femorofemoral Arterial Bypass: Subcutaneous or Preperitoneal
Authors: Read Raymond C. , Barnes Robert W. , Eidt John F. , Hauer-Jensen Martin , Moursi Mohammed M. 
Published: June 2007

A salutary, long-term result, using preperitoneal placement in a patient transferred after repeated failure of subcutaneous prosthetic femorofemoral bypass, prompted a review of this procedure by the authors. From 1972 to 1996, 61 men and 1 woman, aged 28 to 80 years, received 67 initial or “redo” interpositions for unilateral, predominately-sinistral ischemia, 45% being operated on as emergencies. They were considered unfit for the preferred direct transabdominal reconstruction under general anesthesia because of cardiopulmonary comorbidity. Follow up, extending to 20 years, was complete in 93.5%. Operative mortality was 6.6%, all from cardiogenic shock after atherothromboembolism secondary to transfemoral intraaortic balloon pulsation after myocardial infarction (MI) or coronary artery bypass graft (CABG). Most bypasses were subcutaneous; however, 17% were preperitoneal. The author's cumulative initial patency was similar for those operated on with primary (23) and postaortofemoral bypass graft (post-AFBG) (29) ischemia. Preperitoneal placement (10) was associated with better primary prosthetic patency and less infection than subcutaneous (42) insertion.
Can the Cost of Distal Vascular Reconstruction be Reduced Without Sacrificing Quality? Analysis of 500 Cases
Authors: Choi Daniel S. , Darling R. Clement , Roddy Sean P. , Kreienberg Paul B. , Chang Benjamin B. , Paty Philip S. K. , Lloyd William E. , Shah Dhiraj M. 
Published: June 2007

The goal of clinical pathways is to reduce the cost of the hospitalization while maintaining acceptable results (patency, morbidity, and mortality). Patients who present with lower extremity revascularization pose a difficult problem, for they have significant comorbid medical disease. In this study the authors analyze their results and the treatment cost for patients undergoing lower extremity revascularization before and after the institution of clinical pathways. Data were collected independently by the hospital financial office, and surgical outcomes were derived from the prospectively collected computerized vascular registry. Data were analyzed for 12 months before and after institution of pathways. Cost, length of stay (LOS), and use of ancillary service as well as mortality, morbidity, and patency rates were evaluated. During each period, patients were selectively admitted to the intensive care unit based on perioperative risk factors independent of the pathway. Three hundred ninety-nine patients with distal reconstructions were placed on the path during this time period. These were compared to a group of 286 patients who were not on the path in the year prior. The LOS decreased from 14.3 days to 9.2 days. Electrolyte laboratory panels decreased from 12 draws per patient per admission to two draws per patient per admission. This trend was also seen in complete blood count (11.8 to 6.8), glucose (12.6 to 2.1), and electrolytes (12.2 to 1.8). Perioperative mortality rates were similar (2.5% vs 1.9%) with no change in morbidity rates. Total cost for hospitalization decreased by 27% after institution of the clinical pathway. From these data, the authors can demonstrate that the institution of clinical pathways not only decreased total cost, use of ancillary laboratory tests, and LOS but also did not negatively impact on outcome.
Transaortic Septectomy as Treatment for Chronic Mesenteric Ischemia After Aortic Dissection
Authors: Desai Tina R. , Davidovitch Roy I. , Schwartz Lewis B. , McKinsey James F. 
Published: June 2007

Visceral ischemia can present as an acute or chronic complication of aortic dissection, which is associated with high morbidity and mortality rates, up to 50-87%. Furthermore, the optimal management strategy for this problem is unclear. The authors present a case of chronic mesenteric ischemia complicating a Stanford type A aortic dissection which was treated with transaortic septectomy. A 56-year-old man presented with chronic abdominal pain and a 30-pound weight loss after operative repair of an ascending aortic dissection with replacement of his aortic valve and ascending aorta. Two prior attempts at balloon fenestration of his aortic dissection in the area of his mesenteric vessels had failed to improve his symptoms. Angiography, computed tomography scan, and duplex evaluation of the aorta revealed a 5 cm suprarenal aorta with the false lumen occupying the majority of the diameter. The origins of the mesenteric vessels from the true lumen were compressed by the septum. The patient underwent a septectomy and aortoplasty of his suprarenal aorta via a retroperitoneal approach. A postoperative duplex scan showed widely patent origins of the celiac, superior mesenteric, and renal arteries. The patient's postprandial pain completely resolved before hospital discharge. Aortoplasty and septectomy presents a newly described treatment of complications of aortic dissection and has been utilized in the acute and chronic settings. It allows successful treatment of aneurysmal and occlusive complications in the dissected aorta. The evaluation and operative treatment of a patient with both these complications is discussed.
Clinical Outcome of Patients Developing Transient Ischemic Attacks Following Carotid Endarterectomy
Authors: Mattos Mark A. , Hodgson Kim J. , Ramsey Don E. , Sumner David S. 
Published: June 2007

Little is known about the clinical outcome of patients who develop ipsilateral transient ischemic attacks (TIAs) or amaurosis fugax (AF) following carotid endarterectomy (CEA). This review was undertaken to define the natural history of this group of patients and to formulate a rational approach for the evaluation and treatment of their symptoms. From April 1976 to December 1996, 1,121 CEAs were performed at the authors' institution. They reviewed the short- and long-term outcomes of 33 patients (34 CEAs) who developed ipsilateral AF or TIAs as their initial postoperative neurologic event following surgery. Mean follow-up after CEA was 77.0 ± 57.4 months (range 3-220 months), and 49.9 ±52.2 months after occurrence of the initial episode of TIA or AF. Eleven patients suffered from an early initial ipsilateral TIA or AF within 30 days of CEA, and 23 patients developed late initial ipsilateral TIA or AF during later follow-up. Five secondary neurologic events (15%) occurred after initial ipsilateral TIA or AF. Two patients suffered ipsilateral strokes (one fatal and one nonfatal), one patient developed a recurrent ipsilateral TIA, another a contralateral stroke, and a fifth patient suffered nonhemispheric symptoms following postoperative ipsilateral AF or TIAs. Following the occurrence of initial ipsilateral TIA or AF, 1-, 2-, and 3-year ipsilateral stroke-free rates were 96%, 96%, and 89%, respectively. Recurrent carotid stenosis (>50% diameter reduction) as determined by color flow duplex scanning was present in 10 of 34 (29%) arteries at the time of the initial ipsilateral TIA or AF but correlated poorly with the development of secondary neurologic symptoms. Secondary CEA was performed on six arteries, two for ulcerated carotid lesions < 50%, two for recurrent lesions with 50-79%, and two for recurrent lesions with 80-99% stenosis. All six patients remained free of symptoms following their secondary operation. These results suggest that the majority of patients who suffer initial ipsilateral TIAs or AF following CEA enjoy a favorable neurologic prognosis, are not associated with recurrent carotid stenosis, and enjoy a natural history similar to patients who develop TIA or AF with normal or minimal to mild internal carotid artery disease. The authors conclude that most patients with postoperative AF or TIA can be managed safely with medical therapy and routine clinical follow-up and that few require surgical treatment.
Reversal by Controlled Limb Reperfusion
Authors: Ihnken Kai , Wildhirt Stephen , Ihnken Olaf , Hill Bradley , Meier Andreas , Zarins Christopher , Reitz Bruce 
Published: June 2007

Despite successful surgical revascularization of ischemic limbs, a local and systemic reperfusion injury may occur after normal blood reperfusion. Recent experimental and clinical application of controlled limb reperfusion in Europe has demonstrated superior results, with lower morbidity and mortality. This new surgical technique includes modification of the reperfusate (calcium, pH, substrates, osmolarity, free radical scavenger) and the circumstances of initial reperfusion (time, temperature, pressure). This report describes the first application of controlled limb reperfusion after reperfusion injury. A 16-year-old boy underwent femoral access cardiopulmonary bypass for repeat cardiac repair with an ischemic time of 245 minutes. Postoperatively, severe ischemia/ reperfusion syndrome developed with muscle contracture, immobility, and anesthesia of the right leg with a second ischemic time of about 6 hours. The systemic creatine phosphokinase level was 88,000 U/L; myoglobin was 27,000 ng/mL. He underwent controlled limb reperfusion by withdrawing blood from the aorta and mixing it with a crystalloid solution (calcium-reduced, hyperosmolaric, hyperglycemic, alkalotic, glutamateand aspartate-enriched, and containing a free radical scavenger) under controlled conditions (blood:crystalloid solution 6:1, for 30 minutes, reperfusion pressure < 50 mm Hg, and normothermia) before establishing normal blood reperfusion. Metabolic data from the central and femoral vein demonstrated a significant reduction of all previous elevated enzyme levels, avoidance of hyperkalemia, normalization of acidosis, and avoidance of systemic reperfusion injury with no multiorgan failure. Limb salvage was accomplished and functional recovery almost complete. To the authors' knowledge, this is the first application of controlled limb reperfusion reported in North America. With this surgical technique we were able to prevent metabolic local and systemic reperfusion changes after prolonged ischemia and also reduced previous reperfusion changes. This report confirms former experimental data, and further clinical studies are warranted.
Abdominal Aortic Aneurysm: Association Between Haptoglobin Phenotypes, Elastase Activity, and Neutrophil Count in the Peripheral Blood
Authors: Wiernicki Ireneusz , Gutowski Piotr , Ciechanowski Kazimierz , Millo Barbara , Wieczorek Piotr , Cnotliwy Miloslaw , Michalak Tomasz , Hamera Tomasz , Piatek Jaroslaw 
Published: June 2007

To investigate the role of genetic factors on susceptibility to atherosclerotic arterial disease, the influence of haptoglobin phenotypes (Hp) on serum elastase activity, neutrophil count, and elastin concentration in the aorta was measured in patients with abdominal aortic aneurysm (AAA; n=52) and aortoiliac atherosclerotic occlusive disease (AOD; n=37). Findings (serum elastase activity, peripheral blood neutrophil count) were compared to a control group (CG) of 37 subjects without atherosclerosis. Hp phenotyping performed by starch-gel electrophoresis produced a haptoglobin-hemoglobin complex of three phenotypes: Hp1-1, Hp2-2, and Hp2-1. Distribution of Hp phenotypes was similar in the three study groups (AAA, AOD, CG). Significant increases in serum elastase activity and neutrophil count was measured in Hp2-1 phenotype of AAA patients. Although the aorta wall of aneurysm patients contained less (p<0.001) elastin than that of AOD patients, no significant difference of aorta elastin concentration between the three Hp phenotypes, including Hp2-1, was measured. The postulated association of AAA susceptibility with Hp2-1 phenotype was supported by the study data that demonstrated an increase in serum elastase activity in patients undergoing AAA repair.
Assessment of Gut Mucosal Perfusion and Colonic Tissue Blood Flow During Abdominal Aortic Surgery with Gastric Tonometry and Laser Doppler Flowmetry
Authors: Nakatsuka Mitsuru 
Published: June 2007

The objective of this study was to investigate the effect of infrarenal aortic cross-clamping and unclamping on gut mucosal perfusion by gastric tonometry and on sigmoid colonic tissue blood flow by laser Doppler flowmetry during abdominal aortic surgery. This was a prospective before-and-after intervention comparison study in a university hospital of 8 male patients, aged 57-87, undergoing elective infrarenal abdominal aortic surgery. Each patient was pretreated with ranitidine. Following general anesthesia, a nasogastric tonometer was inserted into the stomach. The balloon of the tonometer was filled with 2.5 mL of normal saline for gas tension and pH analysis. This process was repeated before and after aortic cross-clamping and unclamping. Gastric mucosal pHi was calculated with the Henderson-Hasselbalch equation from the arterial Hco3 and the tonometrically measured mucosal Pco2. A laser Doppler flow probe was placed in contact with the serosa of the sigmoid colon against the mesentery after the abdomen was opened. Sigmoid colonic tissue blood flow (SCBF) was assessed by the laser Doppler flowmeter. Gastric mucosal pHi by gastric tonometry and colonic tissue blood flow by laser Doppler flowmetry were measured before and after aortic cross-clamping and unclamping. Gastric mucosal pHi decreased significantly 30 minutes after aortic cross-clamping (7.37 +0.07) (p<0.0 1), 60 minutes after aortic cross-clamping (7.39 +0.08) (p<0.05), and 30 minutes after aortic unclamping (7.37 ±0.08) (p < 0.01), compared with pHi before aortic cross-clamping (7.50 ±0.06). Gastric mucosal pHi increased to the original level 60 minutes after aortic unclamping (7.46 ±0.08). Since a gastric mucosal pH above 7.35 is considered normal, these mean values of pHi were clinically insignificant. However, gastric mucosal pHi decreased below 7.32 in 5 patients during abdominal aortic surgery. Gastric mucosal pHi decreased further to 7.30 in 1 patient following aortic cross-clamping and below 7.30 in 3 patients 30 minutes after aortic unclamping. SCBF decreased significantly after aortic cross-clamping (28.1 ±4.8 mL/min/l 100 g) compared with the value before aortic cross-clamping (51.9 ± 11.3 mL/min/l 00 g) (p<0.01). Following aortic unclamping, SCBF returned to 41.7 ±7.4 mL/min/100 g. It is concluded that transient episodes of significant intestinal mucosal ischemia may have been encountered occasionally in patients undergoing abdominal aortic surgery, but a sigmoid
The Differential Hemodynamic Effects of Norepinephrine and Methoxamine in Systemic Hypotension Complicating Pulmonary Hypertension
Authors: Ducas John , Bhattacharya Samir , Prewitt Richard M. 
Published: June 2007

The authors investigated the acute cardiopulmonary effects of noradrenaline and methoxamine in a canine model in which systemic hypotension complicated an acute increase in pulmonary vascular resistance. In 13 anesthetized ventilated dogs, glass beads were injected to increase right ventricular afterload and to decrease mean blood pressure to approximately 65 mmHg. In the first 7 dogs, corresponding to the decrease in blood pressure, there was a marked fall in cardiac output, from 4.8 to 1 L/minute (P < 0.01). Subsequently, dogs were treated in sequence with norepinephrine and then with methoxamine. Both drugs caused a similar increase in mean blood pressure, from approximately 66 to 121 mmHg (both P < 0.001) and in right ventricular coronary perfusion pressure. However, only norepinephrine increased cardiac output. To determine whether the differential effects of these drugs on cardiac output was explained by differences in coronary artery flow, in a second group of 6 dogs, right coronary artery flow was measured before and after pulmonary embolization and during infusion of both drugs. Coronary artery flow decreased when blood pressure decreased with embolization. As above, while both drugs caused a similar increase in blood pressure and right ventricular coronary perfusion pressure, only norepinephrine increased cardiac output. Also, values for coronary artery blood flow were similar during infusion of both drugs. Most likely, the improvement in cardiac output with norepinephrine is explained by a direct inotropic effect of this agent.
Prestenotic and Poststenotic Flow Measurement to Assess Severity of Coronary Artery Stenosis
Authors: Altstidl Robert , Dill Harald , Regenfus Matthias , Lehmkuhl Hans , Bachmann Kurt 
Published: June 2007

The purpose of this study was to investigate differences between prestenotic and poststenotic intracoronary Doppler flow velocities and to determine whether these hemodynamic parameters of coronary flow demonstrate a correlation with geometrically measured coronary artery stenosis. A low-profile (0.018-in.) Doppler angioplasty guidewire capable of providing spectral flow velocity data was used to measure blood flow velocities both proximal and distal of 95 coronary artery stenoses ranging from 15% to 82% in diameter. Percent diameter stenoses were analyzed by quantitative coronary arteriography. In comparison with prestenotic measurements poststenotic Doppler flow velocities were markedly reduced in coronary artery stenoses with a diameter reduction greater than 50% in quantitative angiography. In stenoses less than 50% no difference between prestenotic and poststenotic parameters of coronary flow could be found. Prestenotic Doppler data demonstrated no correlation to percent diameter stenosis, whereas poststenotic flow data correlated moderately with percent diameter stenosis. Poststenotic Doppler data of stenoses below 50% differed significantly from stenoses above 50%. In conclusion, intracoronary Doppler flow velocity measurements performed distal to coronary artery stenoses contribute to the evaluation of hemodynamic significances of particular coronary artery stenoses.
Color Doppler Imaging in Adjunct to Contrast Arteriography in Evaluation of Severe Peripheral Vascular Disease
Authors: Alhan H. Cem , Alhan Sibel , Çinar Bayer , Tuygun Abdullah K. , Sezerman Özge 
Published: June 2007

Of the 309 patients operated on for revascularization of lower extremities 29 (9.4%) had a conventional contrast arteriography that failed to opacify at least one vessel that was found to be patent by color Doppler imaging plus surgical exploration. The indication for vascular imaging was rest pain in 12 patients, claudication in 7, nonhealing ulcers in 3, and gangrene in 3; 4 patients had more than one indication. In 20 (69%) of 29 patients infrapopliteal runoff vessels were the cause for misdiagnosis. In all patients with failed arteriography a total occlusion proximal to the misidentified vessel was present. As a common finding, peak systolic velocities were less than 0.5 m/second in misdiagnosed suprapopliteal arteries and less than 0.25 m/second in infrapopliteal arteries. At operation direct surgical exploration confirmed the diagnosis of color Doppler imaging in all 29 patients. The judgment that the operation was successful was based upon intraoperative arteriography, relief of symptoms, warmness of the feet, palpable pulses, and color Doppler imaging performed one month after the operation. Excellent short-term results were obtained in 27 patients; one early and three late graft occlusions were detected in a mean follow-up of twenty months. In conclusion, color Doppler imaging is an excellent and convenient technique for evaluation of patients with peripheral vascular disease. It demonstrates suitable blood vessels for revascularization that are not seen on contrast arteriography. In the authors' opinion, color Doppler imaging is a clinically useful adjunct to conventional contrast arteriography and should be performed in patients in whom arteriography has failed to show any suitable target vessel for revascularization.
Portal Vein Replacement with Expanded Polytetrafluoroethylene (e-PTFE) Graft
Authors: Tanaka Koki , Nishimura Akihiro , Ikoma Akira , Ogata Seiji , Nishida Seigou , Taira Akira 
Published: June 2007

This study was conducted to assess the efficacy of portal vein reconstruction with an expanded polytetrafluoroethylene (e-PTFE) graft. Five patients underwent interposition of the portal vein with e-PTFE graft following en bloc resection of the entire pancreas and the portal vein for advanced pancreatic cancer. The length of the excised vein ranged from 5 to 7 cm and that of the implanted graft (8 or 10 mm in diameter), 3 to 7.5 cm. In 4 of the 5 cases, the graft was patent at five to eighteen months following implantation. One patient died of respiratory failure two months after operation, and partial occlusion of the graft was noted at autopsy. Four patients died of recurrence of the original disease five to eighteen months after operation. The implanted graft taken at autopsy eighteen months after operation was covered uniformly with thin neointima on the internal surface. Microscopic examination showed endothelial cells covering the surface of the neointima, and capillary vessels had developed in the neointimal layer. Experimentally, five grafts, 0.8 cm in diameter and 2.5 cm in length with external ring support, were interposed in the portal vein in pigs. All grafts were patent during a four-month follow-up period. The authors conclude that the e-PTFE graft is a suitable prosthesis for replacement of the portal vein following its resection.
Isolated Iliac Artery Dissection Secondary to Fibromuscular Dysplasia
Authors: Harler Mary Beth , Weyman Albert , Capt. Raymond Bozman, , Sullivan Deborah , Patterson Robert 
Published: June 2007

Among the nonatherosclerotic vascular diseases leading to ischemic complications in young adults, fibromuscular dysplasia (FMD) is relatively common. Manifestations of this abnormality most frequently occur secondary to stenosis, aneurysm formation, or embolization of the renal or internal carotid arterial beds. Although 3 cases of external iliac artery dissection (2 with confirmed FMD) have been reported, no reports exist of isolated dissection of the common iliac artery in the absence of a more proximal aortic entry point. Three otherwise healthy men were diagnosed with acutely symptomatic isolated iliac artery dissection (2 common iliac, 1 external iliac). Two patients required arterial bypass grafting for the relief of ischemia; histologic examination demonstrated FMD. The third patient had early findings on arteriography of associated renal arterial FMD. Although a dissection of the common iliac artery was confirmed in this patient on imaging studies as well as arteriography, he manifested no ischemic symptoms or aneurysmal dilation and is being managed nonoperatively. The diagnosis of arterial dissection secondary to FMD should be strongly considered in the differential diagnosis of young patients with signs and symptoms of lower extremity ischemia. Noninvasive diagnostic modalities (computerized tomography [CT], magnetic resonance imaging [MRI], and duplex scans) will establish the diagnosis, but arteriography remains essential to delineate the extent of involvement. The associated finding of FMD in other vascular beds may help to confirm the diagnosis as well as contribute to the future management of these patients.