bluuebunny/crossref_metadata_2025_split huggingface dataset:
Converting from General Anesthesia to Cervical Block Anesthesia for Carotid Endarterectomy
Authors: Calligaro Keith D. , Dougherty Matthew J. , Lombardi Joseph , Krug Richard , Raviola Carol A. 
Published: June 2007

Between January 1, 1992 and June 30, 1998, vascular and general surgery residents performed 401 carotid endarterectomies (185 cervical block, 216 general anesthesia) under supervision of vascular attending surgeons. In January 1995, cervical block anesthesia was newly instituted. Initially anesthesiologists were randomly assigned to these cases and anesthetic technique was not standardized. At the surgeons' insistence later in the series, three specially trained anesthesiologists routinely administered cervical block anesthesia. As experience grew, surgeons realized that operating time greater than 2 hours and high neck dissections requiring mandibular retraction were poorly tolerated by cervical block anesthesia patients but that repeat carotid endarterectomies could be safely performed. Shunts were selectively inserted if significant electroencephalographic changes occurred or carotid stump pressures were less than 50 mm Hg systolic when general anesthesia was used; neurologic changes occurred when cervical block anesthesia was used; or there was a history of ipsilateral stroke for either anesthetic method. Despite an initial learning curve with cervical block anesthesia, the stroke-mortality rate was similar between the two groups (general anesthesia: 1.9% [four cerebrovascular accidents, two deaths]; cervical block anesthesia: 1.6% [two cerebrovascular accidents, two deaths]). Eight (12%) of the first 66 cervical block anesthesia patients were converted to general anesthesia compared to 2 (1.7%) of the most recent 119 patients with cervical block anesthesia (p=0.03). After cervical block anesthesia was initiated, seven of the first eight repeat carotid endarterectomies were performed using general anesthesia compared to one of the most recent six repeat cases (p=0.02). As surgeons' comfort with cervical block anesthesia increased, 94% (100) of the most recent consecutive 106 carotid endarterectomies were performed using this technique. These results suggest that carotid endarterectomy can be performed as safely using cervical block anesthesia as general anesthesia, specialized anesthesiologists are essential to achieve a successful outcome, selected repeat carotid endarterectomies can be performed using cervical block anesthesia, very cephalad lesions are best treated using general anesthesia, and surgical trainees can safely perform carotid endarterectomy under attending surgeon supervision if the operation is carried out expeditiously.
Does Vascular Stapling Improve Compliance of Vascular Anastomoses?
Authors: Stansby Gerard , Knez Peter , Berwanger Christoph S. , Nelson Karen , Reichert Viktor , Schmitz-Rixen Thomas 
Published: June 2007

Elastic properties of vessel walls are altered by vascular anastomoses. Such alterations may lead to neointimal hyperplasia, which is a common cause of reocclusion following vascular surgery. The severity of paraanastomotic hypercompliant zones and anastomotic compliance drop depend on suturing material and on elastic properties of the anastomotic vessel segments. This study compares paraanastomotic hypercompliance and anastomotic compliance drop when using a new vascular closure system (VCS®) and a conventional, continuous suture line in the preparation of end-to-end anastomoses.Compliance of artery-artery, vein-artery, and polytetrafluoroethylene-artery anastomoses was measured in an artificial circulation system at mean pressures of 60, 90, and 120 mm Hg, comparing conventional suturing and the VCS.When using the VCS for vein-artery anastomoses, significantly less postanastomotic hypercompliance was achieved at mean pressures of 60 mm Hg (14.2 ±3.8% above remote postanastomotic area), compared to suture (55.1 ±14.8%, p < 0.05). At 90 mm Hg, respective values were 1 1.0 ±2.3% for VCS and 54.7 ±10.1% for suture, p<0.01. At 120 mm Hg, in polytetrafluoroethylene-artery anastomoses, the anastomotic compliance drop was significantly less when using the continuous suture line (93.9 ±1.1% below remote postanastomotic compliance), compared to VCS (97.2 ±0.2%, p< 0.05).Compared to conventional suturing, use of the VCS reduced postanastomotic hypercompliance in vein-artery anastomoses.
Leukocyte/Endothelium Activation and Interactions During Femoral Percutaneous Transluminal Angioplasty
Authors: Lüdemann Jörg , Schulte Karl-Ludwig , Hader Oliver , Brehme Stefan , Volk Hans-Dieter , Döcke Wolf-Dietrich 
Published: June 2007

Recent data suggest that leukocyte-endothelium activation/interactions are important for restenosis after percutaneous transluminal angioplasty (PTA). Ten patients with superficial femoral artery occlusive disease (stage Fontaine llb) were examined after a percutaneous transluminal angioplasty (PTA) versus a preceding aortoangiography (AAG). Blood samples from corresponding femoral arteries and veins were obtained before, immediately after, and 4 hours after each procedure. The authors examined the ex vivo respiratory burst and leukocytic expression of adhesion molecules flowcytometrically, adhesion molecule plasma concentrations, and inflammatory mediators concentrations in plasma and in endotoxin-stimulated whole blood cultures by ELISA, and the leukocyte counts. After PTA, venous plasma concentrations of soluble (s)L-selectin (148.2 ± 14.7%, p<0.05 vs 100% baseline ± sem), sP-selectin (130.7 ±6.9%, p<0.01; sE-selectin (117.5 ±8.3%, p<0.05 vs arterial), sLFA-3 (130.7 ±15.8%, p<0.05) were increased. Expressions of L-selectin (93.0 ±5.7%, p<0.05 vs arterial), CD11a (98.8 ±3.8%, p=0.06), CD18 (96.9 ±4.0%, p<0.05 vs arterial), and ICAM-1 (89.1 ±7.7%, p<0.05) on polymorphonuclear neutrophils (PMN), and arteriovenous leukocyte counts (arterial: 103.5 ±5.4%, venous: 91.1 ±3.3%, p<0.05) decreased. Venous ex vivo secretions of oxygen radicals (141.4 ±28.1%, p<0.05 vs AAG), PMN-elastase (173.7 ±35.7%, p<0.05 vs AAG), and interleukin (IL)-8 (226.5 ±56.4%, p<0.001; p<0.0001 vs AAG), as well as PMN-elastase (173.7 ±35.7%, p<0.05 vs AAG) and tumor necrosis factor (TNF)-alpha plasma concentrations (124.1 ±11.9%, p=0.06) rose. Four hours after PTA, a leukocytosis and exhausted TNF-alpha (69.8 ±10.4%, p< 0.05) and IL-8 secretions (72.4 ±4.6%, p<0.01) occurred. PTA induced local leukocyte-endothelium activations (stronger ex vivo mediator productions) and interactions (decreased venous leukocyte counts, increased plasma concentrations, and decreased leukocytic expression of adhesion molecules) with the release of inflammatory mediators (higher plasma concentrations and exhaustions after 4 hours).
Restenosis After Carotid Endarterectomy in Patients with Paired Vein and Dacron Patch Reconstruction
Authors: Archie Joseph P. 
Published: June 2007

This is an analysis of restenosis after bilateral carotid endarterectomy (CEA) with saphenous vein patch reconstruction on one side and Dacron patch reconstruction on the other. The possibility that differences in reconstruction geometry between vein and Dacron patched sides effected restenosis outcomes was evaluated as was the value of serial common carotid wall thickness measurements in predicting restenosis. Between 1990 and 1997, 33 bilateral CEA were performed within one year on 22 men and 11 women using a greater saphenous vein patch on one side and a knitted Dacron patch on the other. Interoperative post-CEA geometry was measured. Follow-up was by duplex scans that included wall thickness measurements in the endarterectomized common carotid bulb. Over a mean follow-up of 43 months 10 (30%) Dacron patched and one (3%) vein patched CEA developed?25% restenosis (p=0.001), seven (21%) Dacron patched and no vein patched CEA developed >50% restenosis (p=0.01) and four (12%) Dacron patched and no vein patched CEA developed >70% restenosis (p =0.1 1). The Kaplan-Meier cumulative >25% restenosis rates for Dacron and vein patched CEA were 22% and 0% at 2 years and 41% and 5% at 5 years respectively (p=0.002). The cumulative >50% restenosis rates for Dacron and vein patched CEA were 16% and 0% at 2 years and 34% and 0% at 5 years respectively (p = 0.003). The cumulative?70% restenosis rates for Dacron and vein patched CEA were 8% and 0% at 2 years and 20% and 0% at 5 years respectively (p = 0.02). For both patients with and without recurrent stenosis the mean within patient between sides differences of the diameters of the internal carotid, internal carotid bulb, common carotid bulb, and common carotid arteries and the lengths of the internal carotid and total patch segments were not significantly different and all were less than 5%. Common carotid bulb wall thickness measured at the time of identification of the nine unilateral Dacron patched CEA restenosis was 1.5 ±0.5 mm compared to 1.4 +0.4 mm (m ± 1 SD) for the contralateral vein patched CEA (p = 0.45 by paired t test). Dacron patched CEA have a significantly higher incidence of mild, moderate and severe restenosis than do saphenous vein patched CEA independent of systemic risk factors. The within patient equality of Dacron and vein patched carotid reconstruction geometry in patients with unilateral restenosis indicates that patch material is the major local risk factor, not adverse hemodynamics produced by variance in geometry. Common carotid bulb wall thickness measurements after CEA are not predictors or indicators of recurrent stenosis.
Carotid Endarterectomy in Patients with Renal Insufficiency: Should Selection Criteria be Different in Patients with Renal Insufficiency?
Authors: Ayerdi Juan , Sampson Lawrence N. , Deshmukh Narayan , Farid Asim , Gupta Sushil K. 
Published: June 2007

The objective of this study was to elucidate the relationship between outcomes from carotid endarterectomy (CEA) in patients with and without renal insufficiency. Carotid endarterectomy is one of the most commonly performed vascular procedures. The role of cardiac comorbidity in carotid endarterectomy has been extensively studied. The relationship between renal failure and surgical outcomes has also been studied for both coronary artery bypass grafting and lower extremity occlusive disease. However, the role of renal insufficiency in relationship to decision making regarding surgical intervention for carotid stenosis is not well defined. The authors hypothesized that the outcomes from CEA were negatively influenced by renal dysfunction. A retrospective review was made of consecutive CEAs performed at their institution from 1990 to 1995. Patients were grouped into 2 categories according to their renal function. Group A, 448 patients (90%) with creatinine level 1.8 mg/dL or less, and group B, 49 patients (10%) with creatinine levels more than 1.8 mg/dL. Data from patients on dialysis are presented but were excluded for the purpose of analysis. Included in the study were 497 patients with a mean age of 70 +8.9 and 74 +8.9 for groups A and B, respectively. Preoperative creatinine was 1.1 (±0.25) mg/dL for group A and 2.5 (+0.81) mg/dL for group B. Outcomes were as follows: perioperative cardiac events 5.4% vs 28.6%, stroke rates 2.7% vs 2.0%, and mortality rates 0.9% vs 8.2%, for groups A and B, respectively. At 60-month follow-up the stroke rates were 7.6% vs 6.1%, and the mortality rates 22.8% vs 59.2%, for groups A and B, respectively. While patients with chronic renal insufficiency have no increased risk of perioperative or long-term neurologic events, perioperative and long-term mortality rates are significantly increased. This significant reduction in survival should prompt a more cautious application of CEA in patients with increased creatinine.
Vascular Complications in Allogeneic Renal Transplantations
Authors: Storck M. , Mickley V. , Hutschenreiter S. , Schilling M. , Abendroth D. 
Published: June 2007

Background. The incidence of vascular complications during allogeneic renal transplantations ranges from 5% to 15%. They may be donor related (additional polar arteries, multiple renal arteries, multiple renal veins, injured arteries or veins), recipient related (severe atherosclerosis, venous thrombosis, previous transplantation), or technical. In a retrospective study of 666 kidney transplantations, the incidence and treatment of vascular complications were analyzed.Patients/Results. All transplantations were performed in end-to-side technique with aortic patch if available; all kidneys were obtained from brain-dead donors. A total of 89 operations included vascular complications (13.4%). In 46 patients (6.9%), the problem arose intraoperatively, 33 complications (5%) occurred within three weeks, and another 10 (0.3%) were seen later after successful transplantation. In 17 kidneys, major additional polar arteries were encountered, 7 of which were reanastomosed, 10 were ligated. Three kidneys were lost owing to insufficient blood supply to the ureter. In 7 patients, intraoperative vascular service operations had to be carried out owing to stenosis of the iliac artery or massive kinking. Early postoperative complications included bleeding after biopsy, anastomotic leakage, and arterial or venous thrombosis (1 successful venous thrombectomy; 18 of 33 organs were removed). As for late complications, the authors observed 9 transplant renal artery stenoses (TRAS); 8 were treated by percutaneous transluminal angioplasty. One patient developed an iliac aneurysm owing to chronic patch rupture.Conclusion. The majority of intraoperative complications were due to injury of the kidney during donor nephrectomy (21/46). Polar arteries should be reconstructed if possible, especially lower polar arteries, because of the danger of ureteral necrosis. In times of increasing donor organ shortage, only experienced surgeons should perform explantation and transplantation of kidneys to avoid technical faults in a considerable number of organs.
Somatization Tendencies in Surgically Treated Neurogenic Thoracic Outlet Syndrome Patients
Authors: Hameed S. Morad , Grewal Raji P. , Urschel John D. 
Published: June 2007

Vascular thoracic outlet syndromes have well-defined objective diagnostic criteria. Most patients diagnosed with neurogenic thoracic outlet syndrome (NTOS) do not have objective neurologic findings or electrophysiologic abnormalities. The authors have subjectively noted somatization tendencies in many of their NTOS patients. A retrospective case control study was done to identify features of somatoform disorders in their surgically treated NTOS patients. Records of patients admitted for NTOS surgery were retrieved. Patients admitted with spontaneous pneumothorax, another common benign thoracic surgical condition, were used as controls. Thirty patients with NTOS were randomly matched by age and sex to 30 patients with pneumothorax. Patients with NTOS had more previous operations for unrelated conditions (NTOS mean 2.9, pneumothorax mean 1.3, P < 0.005) and took more medications (NTOS, 1.2; pneumothorax, 0.6, P < 0.025) than pneumothorax patients. NTOS patients also had more medication allergies (NTOS, 0.7; pneumothorax, 0.4; P < 0.16), but the difference was not statistically significant. The findings suggest either a greater frequency of organic illness or a greater tendency to undergo medical and surgical treatment in the NTOS group. The authors suspect that some patients with NTOS have coexisting somatoform disorders and that surgical intervention in these patients is inappropriate. Because objective quantification of NTOS severity is usually not possible, patient selection for surgery remains difficult.
Spontaneous Spinal Epidural Hematoma After Combined Urokinase and Heparin Thrombolytic Therapy for Deep Venous Thrombosis
Authors: Krieger Nancy R. , Mehigan John Thomas 
Published: June 2007

The literature clearly supports the view that all anticoagulation therapy is associated with a significant risk of hemorrhagic complications. Combining anticoagulation and fibrinolytic therapy further adds to this risk. Moreover, in the treatment of deep venous thrombosis the combined use of heparin and fibrinolytic therapy is not necessarily associated with a better outcome. Close monitoring of the clotting profile has not eliminated the risks since a correlation between laboratory parameters and bleeding complications has not been demonstrated. Furthermore, the appropriate total dose and duration of therapy remain unclear. The authors report an especially devastating complication of spinal epidural hematoma with resultant paraplegia after combined use of heparin and urokinase for iliofemoral venous thrombosis in an otherwise healthy young woman. The dramatic nature of the complications illustrates the need for continued analysis of this therapeutic strategy.
Preliminary Experience writh Cryopreserved Saphenous Vein Allografts as a Conduit for Femoropopliteal Revascularization
Authors: Mastroroberto Pasquale , Chello Massimo , Zofrea Saverio , Cirillo Francesco , Marchese Antonietta R. 
Published: June 2007

The saphenous vein, either reversed or in situ, has become the conduit of choice for femoropopliteal revascularization. In fact the patency rates with use of prosthetic (polytetrafluoroethylene or Dacron) or other autogenous veins (umbilical, cephalic, and basilic) bypass grafts to the inafrageniculate vessels have been disappointing. Cryopreserved saphenous vein allografts have been used as an alternative conduit for arterial reconstruction since the 1960s, and more recently the improvement in treatment and cryopreservation techniques has produced good long-term results. From January 1993 to July 1994 the authors used saphenous vein allografts in 12 patients and 16 extremities with femoropopliteal arterial disease diagnosed angiographically. Allografts were used because the patients had peripheral varicose veins, had had previous saphenous vein thrombophlebitis, had had previous saphenous vein stripping, or had had saphenous vein used for coronary artery bypass grafting. Allograft veins were prepared from selected saphenous veins in isotonic solution, stored at 4°C, and kept frozen until arrival in the operating room. The femoropopliteal bypass grafts were performed as follows: 6 monolateral and 2 bilateral above the knee, and 2 monolateral and 2 bilateral below the knee. Patients received ticlopidine (250 mg/day) after surgery. Duplex ultrasound graft surveillance was routinely performed. There were no early or late deaths. At the follow-up, ranging from one to eighteen months, all the grafts were patent. Although some authors do not recommend the use of cryopreserved saphenous vein allografts, particularly for complex limb-salvage procedures, the present authors believe that these conduits can be used with good graft patency rates in the absence of a suitable alternative. The authors expect that long-term results will supply further information on the graft patency rates and on possibly greater use of venous allografts in arterial surgery of the lower extremities.
Ehancement of the Fibrinolytic Activity of Intact Saphenous Veins by the Luminal Application of Urokinase
Authors: Toma Naoto , Sobel Michael 
Published: June 2007

Could the fibrinolytic activity of autogenous vein grafts be enhanced by the luminal application of a plasminogen activator such as urokinase? To understand the effects of pharmacologic concentrations of urokinase-type plasminogen activator on endothelial fibrinolytic activity, the authors exposed the luminal surface of paired fresh human saphenous veins to urokinase 500 U/mL or control solutions. To measure the fibrinolytic activity of intact endothelium, a new assay system was devised in which vein pieces were suspended in solution and the supernatant was assayed for plasmin activity by use of a chromogenic substrate. Net fibrinolytic activity (including the effects of plasma inhibitors) was estimated by performing the assay in plasma, while total fibrinolytic activity was estimated by using a plasma-free assay with purified plasminogen as the substrate. When veins were briefly exposed to urokinase, their net and total fibrinolytic activities were very significantly increased (P < 0.0001) compared with controls. High versus low molecular weight urokinase showed equivalent effects. These results suggest that the exposure of intact endothelium to exogenous urokinase can significantly enhance the subsequent endothelial-dependent fibrinolytic activity of vein grafts, at least temporarily.
Balloon-Expandable Stent Complications During Endovascular Grafting
Authors: Ombrellaro Mark P. , Stevens Scott L. , Kerstetter Kyle , Freeman Michael B. , Goldman Mitchell H. 
Published: June 2007

Intraluminal stented grafts are currently the focus of much attention and research. Increasing use of balloon-expandable stents in these devices has resulted in a spectrum of deployment associated complications and new technical challenges for surgeons. The various techniques used to overcome problems during intravascular stented graft deployment are reported. Deployment complications occurred in 3 of 19 adult hound dogs subjected to endovascular stented graft placement. The stented grafts consisted of a balloon expandable stent sewn to a 6-cm-long,10.mm-diameter, thin-walled polytetrafluoroethylene graft. Reengaging a nondeployed stented graft that slid off an expansion balloon, managing a partially deployed stented graft with inability to disengage a broken angioplasty balloon, and repositioning a free stent within the aorta are described. Treatment of stented graft complications was associated with no morbidity or mortality and minimal blood loss and added only fifteen to thirty minutes of procedure time. All situations were managed successfully without the need for an open retrieval procedure. Deployment complications associated with intravascular stented grafts may be successfully managed with endovascular techniques using the existing graft delivery system and additional small-diameter balloon catheters.
Major Vascular Injury Secondary to Laparoscopy
Authors: Nault Patrice , Beaulieu R. Claude 
Published: June 2007

Laparoscopic procedures are now performed by almost all surgeons. Major vascular injuries secondary to laparoscopy, which were anecdotal before 1990, are now seen more often. This article focuses on the authors' experience with arterial trauma related to laparoscopic procedures. Their hospital is a regional center with a population base of 350,000 and six peripheral hospitals. Between August 1994 and March 1996, 6 patients inadvertently sustained major vascular injuries in the course of laparoscopic surgery. These incidents were shared by 5 different surgeons in four different hospitals. Three patients sustained intestinal perforation and aortic transection during laparoscopic cholecystectomy, two related to insertion of the veress needle and one to insertion of a trocar. Two of these injuries were repaired by end-to-end anastomosis, while the third one required a synthetic aortic graft. A fourth patient sustained an aortic perforation during laparoscopic tubal ligation. The fifth and sixth patients had an iliac artery perforation-one during laparoscopic appendectomy and the other during abdominal hysterectomy. Blood lost in these patients varied between 3 and 26 liters, and the length of hospital stay varied from six days to three months. No deaths were reported. Major vascular injuries may arise during laparoscopic procedures. The authors' experience suggests these incidents are underreported. By understanding the way they occur, they believe these injuries are preventable.