bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Surgery in Late Occlusion of Aortobifemoral Bypass Reconstructions
Authors: Deriu Giovanni P. , Ballotta Enzo , Grego Franco 
Published: November 2007

Personal experience of 66 late reoperations following occlusion of aortofe moral bypass procedures of patients operated for occlusive arterial disease of the lower extremities emphasizes that two possibilities exist: either a situation of compensation allowing a deferred evaluation of the problem (55 cases) or an emergency situation (11 cases) due to: 1) acute ischemia of the lower limbs (6 cases); 2) possibility of intestinal infarction (3 cases); 3) ascending thrombosis of the abdominal aorta (2 cases). The aim of the reoperation is to restore a good runoff usually with an endar terectomy of the profunda femoral artery (PFA) and angioplasty of this vessel or, when the profunda femoral artery does not give good reliability, with a fe moropopliteal or femorotibial bypass. Moreover, adequate blood flow must always be guaranteed in at least one of the hypogastric arteries by retrograde flow, reimplantation of the internal iliac artery or, as a last resort, by reimplantation of the inferior mesenteric artery (IMA) . It is necessary to underline that in a patient with occlusion of one graft limb, who had been conservatively treated for unremarkable subjective symp tomatology, the occlusion of the contralateral branch usually requires reopera tion with revascularization of at least one external iliac artery.
Revascularization of the Femoral Artery by Femoro-Femoral Cross-Over By-Pass Utilizing PTFE-Grafts. Hemodynamic Changes During Follow-Up
Authors: Christenson Jan T. , Broome Albert , Qvarfordt Peter 
Published: November 2007

From 1976 to 1981, 48 consecutive patients underwent femoro-femoral cross-over by-pass utilizing PTFE grafts. Indications were severe ischemia (69%) and claudication (31%). All were high-risk patients. Hemodynamic changes (ankle/brachial pressure index) and graft patency was studied during the first postop year. No operative mortality was noticed. Graft thrombosis occurred in 13 cases during follow-up. Successful thrombectomy was done in 7 cases. Graft patency was 80% after 5 years in claudicants and 81% in severe ischemia. The limb salvage rate was 70% at 6 years follow-up. The walking distance increased sig nificantly during the 1st year. There was a good correlation between angiografi cally determined run-off and the ankle/brachial pressure index. In claudicants distal pressure index increased significantly from 0.38 to 0.60, 3 months postop in recipient leg. The same was true in severe ischemia, from 0,10 to 0.48, 3 months postop. No steel phenomena were observed. This procedure is useful for revascularization of a limb with occlusion of the iliac artery, with high graft patency and limb salvage rates and low morbidity and mortality. Even though ankle/brachial pressure index never is restored to normal a gradual increase is observed up to one year after operation. No adverse effects have been demon strated following the procedure. Patients have to be carefully selected for the procedure by preop angiography and hemodynamic evaluation.
Graft-Enteric Fistulas and Erosions, Complications of Synthetic Aortic Grafting
Authors: Salo J. , Verkkala K. , Ketonen P. , Harjola P-T. 
Published: November 2007

Operative results of 12 patients with graft-enteric fistula (GEF) and two patients with graft-enteric erosion (GEE) operated on at our department be tween 1974 and 1984 were analyzed. Preoperative gastrointestinal bleeding was noted in all patients and pre sented as melena in 11 (79%), hematemesis in 10 (71 %), and hematochezia in 7 (50%). Eleven of 14 patients had signs of infection with fever, leukocytosis and hy persedimentation. Preoperative aortography or barium contrast studies were performed in 10 patients, but none of these investigations were diagnostic. Extirpation of prosthesis and closure of the bowel was performed in 10 pa tients. Operative mortality was 64,3%. It is concluded that GEF or GEE must be suspected in all patients presenting with gastrointestinal bleeding after reconstructive aortic surgery. Immediate laparotomy with extensive and careful exploration of the graft region is the best and safest diagnostic procedure. Fibre-optic endoscopy of the upper gastroin testinal tract performed on the operating table is a reasonable investigation to rule out other causes of bleeding. Total graft excision with axillofemoral recon struction gives the best survival rates.
The Role of Local Thrombolysis in Late Vascular Graft Thrombosis
Authors: Pratesi C. , Alessi Innocenti A. , Frullini A. , Matticari S. , Rega L. , Stefani P. , Bertini D. 
Published: November 2007

The authors present their experience of late prosthetic thrombosis in which they performed a local thrombolysis as the first approach, aiming not only to cure the acute obstruction but also to get more information about the most appropriate therapeutic tactic to be used. The therapeutic protocol consisted of: (1) urokinase: 200,000 IU in 15-20 minutes, and after this, 75,000 IU/hour for a maximum of 72 hours, always through the arterial catheter; (2) heparin: 5,000 IU before the thrombolytic treatment is started and then maintenance of a sodium heparin infusion with a pump, the activated partial thromboplastin time being taken at double the ini tial value. They treated 21 late graft thromboses: 18 involved the prosthetic limb of an aorto-bifemoral bypass, and 3 were peripheral grafts in PTFE.
Reduced In-Hospital Mortality Following Intracoronary Streptokinase Treatment of Acute Myocardial Infarction
Authors: Salem Bakr I. , Gowda Siddhesh , Haikal Maged 
Published: November 2007

Reduced short-term mortality following thrombolytic treatment of acute myocardial infarction has been reported by earlier studies. This study was per formed to compare data from our institution with such results. From January, 1984, through January, 1986, a total of 628 consecutive pa tients were admitted with acute myocardial infarction. Ninety-one patients (Group A) underwent intracoronary streptokinase (IC-SK) infusion to the in farct-related vessel with a total dose of 440,000 units. The average timing for this intervention from the onset of chest pain was 4.1 ±2.7 hours. Successful recanalization was achieved in 71 of 91 patients (78%). Patients seventy-five years of age or older were not offered IC-SK infusion. In this group, most candidates suitable for coronary angioplasty or bypass surgery had the proce dure within the same hospital admission. The remaining 537 patients (Group B) underwent conventional medical therapy during their hospitalization. In-hospital mortality for Group A was reported in 4 of 91 patients (4.4%) versus 100 of 537 patients (18.6%) from Group B. These results seem to con form with earlier data that indicate a reduced short-term in-hospital mortality from acute myocardial infarction following IC-SK treatment. Besides recanali zation, this beneficial effect in Group A could also be attributed to earlier inter ventions by revascularization procedures in the majority of patients after recognition of the extent of their coronary artery disease.
Are Noninvasive Doppler Arterial Studies Useful in Predicting Success of Infrainguinal Bypass Grafts?
Authors: Satiani Bhagwan , Biggers Karen , Burns Roger , Porter Robert , Das Mohan 
Published: November 2007

The prediction of success of lower extremity bypass grafts based solely on noninvasive Doppler flow data has been questioned. The prognostic value of preoperative Doppler ankle pressures (APR), ankle/brachial indices (ABI), be low-knee pressures (BKPR), above-knee pressures (AKPR), and segmental pressure gradient indices was examined in predicting immediate (IF), late (LF), and overall failure (OF), as well as amputation (AMP) in 168 infrainguinal bypass grafts. Good runoff (2-3 vessels) was present in only 36%, and vein grafts were used in 60% of limbs. OF occurred in 26.7% (IF 6.5%, LF 20.2%) with a mean follow-up of 16.2 months (range 0-63). Major AMP resulted in 17.2% limbs. In 140 limbs with audible Doppler pedal signals, there was no significant difference in AKPR, ABI, or segmental indices between successful and failed grafts. Successful grafts had a higher AKPR (114.8 ± 38.5 vs 100 ± 30.5, p < .05) and BKPR (87.9 ± 30 vs 72.2 ± 23.5, p < .01) compared with failed bypasses. No significant differences in IF, LF, or OF rates were noted in limbs with ABI < 0.2 vs > .02, < .04 vs > .04 or presence/absence of Doppler pedal signals. Preoperative noninvasive Doppler flow studies are invaluable in the diagno sis, grading, and follow-up of unoperated patients with lower extremity arterial occlusive disease or detection of impending graft failure. They do not reliably predict success/failure of infrainguinal bypass grafts in individual patients. Low ABI or absent Doppler pedal signals do not by themselves preclude successful revascularization.
Hemodynamic Observations Related to in-Situ By-Pass Arteriovenous Fistulae
Authors: Leopold Peter W. , Kupinski Anna Marie , Corson John D. , Shandall Ahmed A. , Shah Dhiraj M. , Karmody Allastair M. , Leather Robert P. 
Published: November 2007

A total of 145 in-situ saphenous vein bypasses were studied postoperatively by Echo Doppler (Duplex) ultrasound scanning. Volumetric blood flow was measured transcutaneously in each case. Five patients did not clinically improve despite patency of their bypasses. Three other patients had persistent edema and arteriovenous fistulae. Surgical ligation of dominant fistulae in these 8 pa tients resulted in significant improvement of distal bypass flow in 7 patients (p < 0.01, Student's paired t-test) with a concomitant decrease in fistula flow and resolution of symptoms in all patients. An occasional patient undergoing in-situ bypass may have a hemodynamic compromise postoperatively that is correctable by fistula ligation.
New Directions in the Use of Carbon as Vascular Graft Material
Authors: Ratto Giovanni B. , Di Primio R. , Romano P. , Truini M. , Badini A. , Zaccheo D. , Motta G. 
Published: November 2007

Carbon has been used to improve the thromboresistance of synthetic vascular prostheses, and for this pur pose, dacron grafts have been coated with carbon. Owing to the contradic tory results reported in the literature, a new kind of vascular conduit, ex clusively textured from carbon fi bers, has been developed. The pres ent research study was undertaken to compare carbon and expanded poly tetrafluoroethylene (e-PTFE) grafts when used as vascular substitutes. Fifty-six experimental animals were divided into four equal groups and underwent substitution of segments of infrarenal aorta or inferior vena cava (IVC), through use of either carbon or e-PTFE grafts. Prosthetic segments were removed fifteen sec onds, or sixty minutes, or seven, fif teen, thirty, sixty, or one hundred twenty days after implantation. Spec imens were examined by light and scanning electron microscopy. Cumu lative patency rates, calculated by the life-table method at 120 days after surgery, were 72% for aortic carbon grafts, 41 % for aortic e-PTFE grafts, and 0% for both carbon and e-PTFE grafts implanted on the IVC. Carbon conduits performed significantly bet ter than e-PTFE conduits when used as small-caliber arterial substitutes (p < 0.05). Fifteen seconds after blood contact, the inner surface of carbon prostheses, regardless of the implantation site, was covered with a thin proteinaceous layer, whereas e- PTFE grafts appeared almost com pletely free from hematic deposits. One hour after implantation, a red thrombus was found to overlay the luminal surface of both carbon and e- PTFE prostheses. This layer ap peared to be thicker on the e-PTFE grafts than on the carbon grafts and thicker on the venous grafts than on the arterial. The endothelialization process of the blood-prosthesis inter face seemed to be slightly more rapid on the carbon than on the e-PTFE aortic grafts. In conclusion, this new carbon graft would appear to possess promising specifications, making it suitable for small-caliber arterial (but not venous) replacement.
Late Vascular Complications of Lumbar Disc Surgery — Case Reports
Authors: Onursal Ertan , Sonmez Bingur , Mehmet Ali Bedirhan  , Kargi Aydin , Cesmeci Suat , Nilgun Ulusoy Bozboga  , Barlas Cemil 
Published: November 2007

Many reports have been published describing different vascular lesions after lumbar disc surgery but the actual incidence is probably higher than has been published. Lesions of vascular structures (aorta, iliac arteries, and veins) close to the spine can arise as a consequence of the removal of disc fragments. In emergency cases, general surgeons are usually called upon to deal with these in the absence of more qualified vascular surgeons. But for an elective case, an experienced vascular surgeon's knowledge of the pathogenesis and ap propriate management of these lesions is mandatory for the proper care of the patients. Herein, 3 additional cases of late vascular complications of lumbar disc surgery, their diagnostic features, and correct treatments are presented.
Iliofemoral Crossover Bypass in High-Risk Patients: Management and Results
Authors: Wandschneider W. , Hauck H. , Denck H. 
Published: November 2007

Between 1982 and 1986, 65 high-risk patients underwent iliofemoral cross over bypass (COBP) for unilateral iliac occlusion or stenosis; 53.8% complained of rest pain, 27.6% showed beginning gangrene, and 13.8% were operated on because of acute iliac occlusion. The proximal anastomosis was placed on the external iliac artery in 76.9%, the distal anastomosis on the profound femoral artery in 89.2%. The authors usually used PTFE grafts placed in the retrorec tal-preperitoneal space. Doppler index rose by 0.3, flow improvement averaged 3 mL/100 mg tis sue/min; no steal phenomenon was observed. Perioperative mortality was 7.6%, limb salvage rate was 93.4%. After a mean interval of 31.3 months, 31.6% had died, and 8 patients had had to undergo major amputations. Cumulative pat ency rate after one year was 81 %, after two years 71 %, and after three years 60%. The authors conclude that COBP is a valid alternative to anatomic iliac re construction in high-risk patients with unilateral iliac artery occlusion or steno sis.
Effect of Endothelial Seeding and Graft Material on the Patency Rate of Venous Grafts
Authors: Vo Nghia M. , Arbogast Loretta , Friedlander Ed , Stanton Paul E. 
Published: November 2007

Because prosthetic grafting to the venous system has a low patency rate, endothelial cell seeding has been used to enhance this rate. The effects of heterologous (porcine) or homolo gous (canine omental) endothelial seeding and of graft material (dacron or polytetrafluoroethylene—PTFE) on the patency rate of venous grafts were evaluated in this study. Fifty-three grafts (10 cm x 8 mm ID) were inserted in dogs' vena cava. All animals were treated with aspi rin. Patency rate was evaluated at day 4 (cavography) or at day 32 (his tology). The authors found that: (1) da cron grafts provided a poor venous conduit for seeding purposes; (2) PTFE grafts, whether seeded with omental canine or porcine endothelial cells, had a consistently high patency rate; and (3) although further studies would be needed, heterologous and homologous cell seeding might repre sent acceptable alternatives to autolo gous seeding.
Alteration in Collagen and Elastin Content in Varicose Veins
Authors: Chello Massimo , Mastroroberto Pasquale , Romano Rossana , Cirillo Francesco , Cusano Tullio , Marchese Antonietta R. 
Published: November 2007

The nature and distribution of venous disease surrounding the development of varicose veins is controversial. Collagen and elastin are important components of the vein walls that affect their function. Collagen provides tensile strength, and elastin provides tissue elasticity The amount of collagen and elastin was studied biochemically and histologically in two groups of human normal and varicose veins. The collagen content was higher in both dilatated and morphologically normal segments of varicose veins when compared with normal veins, whereas the elastin content was markedly decreased only in the dilatated segments of varicose veins. The ratio of thick to thin collagen fibers was almost invariable. These findings were consistent with the morphologic fibrosis that has regularly been described in varicose veins and emphasize the important role of elastin in providing the retractive force that opposes the development of dilatation and tortuosity of the vein wall.
Administration of Heparin by Continuous Intravenous Infusion in the Treatment of Deep Venous Thrombosis
Authors: Erdem Erhan , Uncu Hakan 
Published: November 2007

In this prospective study the authors compared two approaches to heparin therapy, in the treatment of deep venous thrombosis—continuous infusion heparin and intermittent heparin therapy. Each group was comparable with respect to age, gender, risk factors, and etiologic factors. The continuous infusion group (n=60) received a heparin bolus of 150 U/kg followed by continuous intravenous infusion of 750 U/kg/twenty-four hours. The intermittent group (n=60) received a bolus of 5000 U in every four hour period. In the infusion therapy group, the resolution of clinical symptoms was more rapid, so the hospitalization time was shorter, and the hemorrhagic complications and relapses were fewer than with intermittent therapy. The authors conclude that administration of heparin by continuous infusion appears to be effective and safer than intermittent injection therapy.
Mammary Artery: Difference in Structure Since Birth as Compared with Coronary and Renal Artery
Authors: Ferro Maurizio , Forni Marco , Palladin Daniela , Crivello Roberta , Conti Maggiorino , Palestro Giorgio 
Published: November 2007

A light microscopy study was made of the structure of the left coronary, internal mammary, and renal arteries (LCA, IMA, RA) in 11 newborns after autopsy (mean age 22 ±22.6 days). Their intima and media thicknesses were measured. The mean intima/media ratios were: LCA 0.0745 ±0.0621; IMA 0.0837 ±0.0603, RA 0.0699 ± 0.0616. The only significant difference was between the media thicknesses of the LCA and the IMA (P=0.023). The media was thinnest in the IMA, thickest in the LCA. A previous study pointed out in adults, on the other hand, the intima thickness and the intima/media ratio are significantly different in the LCA as compared with the IMA and the RA. The ratio of only the neonatal LCA is significantly different from that of the adult (P=0.005). Media thickness in newborns and intima thickness in the adult are responsible for these differences in the ratio. The conclusion is drawn that the different structures present at birth are altered in function by the stress these arteries are subjected to and, more specifically, in direct proportion to increases in peripheral resistance. Another factor is the greater freedom of nutrition and metabolic exchange offered by the thin media of the IMA. This, indeed, may help to explain the relative immunity to atherosclerosis that has led to the use of this artery in bypass surgery.
Air Plethysmography for the Detection of Acute DVT: New Criteria
Authors: Kalodiki Evi , Nicolaides Andrew N. 
Published: November 2007

In order to determine the value of air plethysmography (APG) in the detection of acute deep vein thrombosis (DVT), the authors studied prospectively 79 consecutive patients referred for suspected acute DVT. All patients were examined with venography and APG. Venography demonstrated acute DVT in 38 patients. In 8 patients the DVT was confined to the calf and in 30 this was in the popliteal and/or more proximal veins. Venography was negative in 41 patients. An outflow fraction value with superficial occlusion of the long saphenous vein at the knee of less than 28% in combination with a venous volume of less than 50 mL identified all patients with acute proximal DVT. There was one false-positive result. However, isolated calf vein thrombi were equally distrib uted, and half of them were not detected. Air plethysmography is a reliable, inexpensive, easy to perform, and accurate nonin vasive test for the diagnosis of proximal acute DVT. It may be a useful screening test when there is a big demand for noninvasive tests, and relatively little time is available on a duplex scanner.
Patient Selection for Nonoperative Management of Popliteal Artery Injuries
Authors: Mohan Chittur R. , Sharp William J. , Hoballah Jamal J. , Boeve Theodore , Kresowik Timothy F. , Corson John D. 
Published: November 2007

A twenty-six-year-old man was involved in a farming accident, whereby a corn head from a combine fell on his legs. He was transported by air care to the emergency room approx imately seventy-five minutes after the accident. Upon examination the patient was alert with a pulse of 100/minute, blood pressure 116/80 mmHg, and respiratory rate 20/minute. There was an anterior dislocation of the left knee with a wound in the popliteal fossa measuring 8 x 6 cm. There was a normal palpable left femoral pulse, but distal pulses were detectable only by Doppler. There was no evidence of an expanding hematoma or bruit. He had a left-sided foot drop with a cold, pale foot with diminished sensation. Roentgenograms of the lower extremities revealed an anterior dislocation of the left knee without any associated fracture. The patient was taken urgently to the operating room, and under general anesthesia a reduction of the anterior dislocation of the left knee, with debridement and irrigation of the wound, was done followed by stabi lization of the knee with an external fixator. The patient had palpable left posterior tibial and dorsal pedis artery pulses following the reduction. Intraoperative arteriography under fluoroscopy was then performed via the left femoral route by the Seldinger technique. This revealed a 50% 5-cm-long smooth stenosis of the left popliteal artery with normal distal runoff. It was decided to manage the patient's popliteal artery injury nonoperatively with anticoagulation and in-hospital serial observations. Duplex examination of the left popliteal artery confirmed the arteriographic findings. The patient was given intravenous heparin therapy for three days followed by warfarin for three months and is currently taking aspirin (325 mg/day). A follow-up duplex examination at one week and at one, six, and fifteen months following the injury revealed a normal healed popliteal artery. Traumatic knee dislocations have a well-known association with popliteal artery injuries. Because of a high amputation rate associated with missed or delayed diagnosis of popliteal artery injuries, early diagnosis and repair of such injuries is the standard of care. The authors describe the nonoperative management of this injury and review the literature on this subject.