bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevention of Reocclusion After Prosthetic Bypass Operations in the Femoro-Popliteal Region: A Comparative Study of Pentoxifylline Versus Acetylsalicylic Acid
Authors: Raithel D. 
Published: November 2007

One hundred eighteen patients (88 males, 30 females, mean age 67.2 years, age range 42 to 87 years) with successfully performed synthetic prosthetic by pass operations in the femoro-popliteal area were submitted in an open random ized study of two groups of 59 subjects to oral treatment by 400 mg pentoxifylline in special patented slow-release formulation or 500 mg ASA tid from two days before operation until twelve months after operation (with par enteral administration of both drugs on the day of surgery and two days after surgery). Effectiveness of prevention of reocclusion was assessed by patency rates and drug tolerability. The examinations (clinical status, pulse palpation, Doppler-pressure mea surement, arteriography) were carried out before and on days five or six after operation, and also after three, six, nine, and twelve months of the follow-up period. The life table analysis disclosed no significantly different patency rates (75% for the pentoxifylline-treated group and 74% for the ASA cohort). A significantly superior tolerability was found in the patients treated with pentoxifylline, 6 patients (10%) reporting adverse reactions as compared with 33 (56%) in the ASA-treated group. The side effects consisted mostly of gastric upset, dizziness, and gastric hemorrhage. The medication was discontinued in 6 patients on pentoxifylline and 12 on ASA.
Experience with Ruptured Thoracoabdominal Aneurysms Involving the Visceral Arteries: Three-Year Experience in a Community Teaching Hospital—Case Reports
Authors: Hines George L. 
Published: November 2007

Four patients (3 males and 1 female) with ruptured thoracoabdominal aneu rysms involving the visceral arteries were managed in a three-year period. Ages ranged from sixty-seven to eighty-two years. Two patients had freely ruptured aneurysms and were operated on emergently. Two patients had contained rup tures and were operated on urgently. Hemodynamic monitoring consisting of Swan-Ganz catheters and arterial lines were employed in all patients. Exposure was obtained through a thoraco abdominal approach. A Gott shunt was employed in 1 patient. All patients re ceived intravenous heparin during aortic clamping, and protamine was rou tinely administered to reverse heparin. Standard techniques for vascular reconstruction were employed. There was 1 intraoperative death in an eighty-two-year-old male who suf fered a cardiac arrest after replacement of thoracoabdominal aneurysm with reimplantation of the celiac axis. Three patients survived operation. One patient developed paraplegia and expired forty days postoperatively. One patient had suture line bleeding that required reexploration. He is now alive and well three years postoperatively. The fourth patient did well postoperatively but died nine months after discharge from an acute myocardial infarction. This study indicates that this difficult and life-threatening condition can be managed with satisfactory results even in the setting of a community teaching hospital.
Experience with an Alternate Prosthesis for Chronic Vascular Access
Authors: Sanfelippo Peter M. 
Published: November 2007

Although chronic hemodialysis has been employed for more than twenty-five years, the perfect ap proach to chronic vascular access has yet to be realized. The standard ra dial-cephalic fistulae, although suc cessful in a majority of patients, may not provide suitable vascular access. Their failure may be due to paucity of forearm veins, patient's obesity, or lack of patent veins. Among the alternatives is the car bon transcutaneous access device (CTAD). This paper discusses the four-year experience of one surgeon with the CTAD. Over a four-year period, the CTAD was utilized in 13 selected pa tients. The selection of these patients was based on the failure of many other access techniques. Prior to CTAD, the patients had had from two to fourteen access procedures. The CTADs have provided four to fifty months of satisfactory access. Of the 13 patients, 6 have expired with functional CTADS. Four pa tients have had the CTADs removed. One was removed at thirty-two months when it was decided to con vert this patient to peritoneal dialysis after satisfactory access with the CTAD. Another was removed after four months in a patient who opted to switch to peritoneal dialysis. One was removed at nineteen months after failed function, and one was removed after eight months because of Can dida sepsis. The other 3 patients are living with functional CTADs in use, the longest being in operation fifty months. The major problem has been the formation of a ball-valve thrombus at the base of the port. A nonoperative approach has been successful in re moval of this thrombus. The selection of site for the CTAD is of importance for patient conven ience and for longevity of function. The experience in this pilot group of patients with the CTAD followed up to fifty months on dialysis has proved the CTAD to be a significant tool in the armamentarium of the vascular access surgeon.
Intraoperative Coronary Laser Recanalization: Evaluation of Safety in Ten Patients
Authors: Diethrich Edward B. , Timbadia Ela , Bahadir Ilhan , Carroll Susan , Zenzen Sharon , Coburn Kathy 
Published: November 2007

Ten coronary artery bypass candi dates were selected to participate in a phase I evaluation of the safety of a 1.7-mm argon-powered, metal- tipped, fiberoptic laser probe for re canalization of the coronary arteries. Eleven arteries were selected for lasing based on their inability to jeop ardize the scheduled revasculariza tion procedure. Through an arteriotomy distal to the lesion (or through the distal anastomosis of the bypass graft), the laser probe, at power levels of 10-12 watts, was visu ally monitored for passage across the lesion. Single or multiple pulses of energy were delivered to the tip for from 3- to 23-second intervals, with total lasing times of 9 to 173 seconds. The probe traversed the lesions in 7 (64%) arteries; the remaining 4 (36%) were totally occluded lesions that blocked entry of the probe in 1 and allowed only minimal penetra tion in 3 others. In 1, the distal tip fractured after becoming lodged in the plaque. There was no perfora tion, dissection, or other complica tion to the lasing procedure in this series. One patient died from an un related acute myocardial infarction occurring four days postoperatively. Calcified plaques pose a major problem for this probe design, but it appears to safely open channels in less mature plaques. Phase II of the study will investigate the efficacy of laser-assisted myocardial revascular ization.
Combined Effect of Transfusion and Blood Groups on the Survival of Patients With Breast Cancer. A Clinical Study of 901 Patients †
Authors: Bufalino Rosaria , Morabito Alberto 
Published: November 2007

Previous reports by the authors and by others have shown that trans fusion adversely affects the survival of cancer patients. To delineate fur ther the mechanism of action of blood transfusion on biological behavior of cancer, the authors studied the role of the major blood groups ABO in 901 patients who had all undergone radi cal surgery for operable primary breast cancer and among whom 294 had received at least one unit of whole blood perioperatively. Multivariate analysis using Cox's regression models on life tables was used. It was found that the adverse effect of transfusion on survival was a blood group-related phenomenon manifesting its action in patients with blood groups A and B (P = 0.0006 and P = 0.006 respectively). The most im pressive effect of transfusion was seen in patients whose age was be tween forty-one and fifty (51.9% ten- year actuarial survival in 47 transfused patients compared with 73.9% in 70 nontransfused ones). A hypothesis is presented suggest ing that transfusion exerts its effect on the hemostatic system, promoting clotting in group A and B patients and fibrinolysis in group O and AB patients, and thus affects metastatic cascade, with results that have been presented in this series.
Early Postoperative Inferior Mesenteric Arteriovenous Fistula—A Case Report
Authors: Slutski S. , Peer A. , Abramsohn R. , Weitz E. , Bogokowsky H. 
Published: November 2007

A case of early postoperative inferior mesenteric arteriovenous fistula is de scribed in a sixty-three-year-old man who underwent an anterior resection of the rectum for carcinoma. Six weeks after surgery, he developed increasingly severe rectal bleeding. A single incident of copious bleeding caused him to go into shock and require resuscitation. A selective angiography revealed an arteriovenous fistula of the inferior mesenteric artery, which was managed by embolization of the artery by three spring steel coils. These rare postoperative arteriovenous fistulae are probably caused by the incorporation of an artery and vein in a single stitch or ligature and usually present many years after surgery.
Coronary Endarterectomy in Patients with Diffuse Coronary Disease
Authors: Scheld Hans H. , Moosdorf Rainer , Görlach Gerold , Ewers Jochen , Hehrlein Friedrich W. 
Published: November 2007

Diffuse multivessel disease can limit a complete revascularization in patients undergoing coronary bypass surgery. It is considered that coro nary endarterectomy (CEA) offers a reasonable chance for this special group of patients. Among 2415 patients undergoing coronary bypass surgery, a CEA of the right and/or left coronary system had to be performed in 397 patients with diffuse multivessel disease. Completeness of the procedure was controlled intraoperatively by dye perfusion and angioscopy. One hun dred one patients gave informed con sent to be reinvestigated clinically and by angiography at an average of forty-three months after surgery. The thirty days mortality after additional CEA was slightly in creased at 3.8%. Also the periopera tive infarction rate increased at 9.3 % . The long-term analysis re vealed a late mortality of 5.5%. Cor onary angiography showed a patency rate of the endarterectomized vessels of 81.2 %; 91% of the patients being reinvestigated showed an improved or asymptomatic clinical status. Despite a slightly increased risk, CEA proved to be a feasible therapy in this strictly limited group of pa tients, in whom conventional bypass surgery offers poor chances and who otherwise would even be candidates for transplantation.
Wrapping and Replacement of Thoracic Aorta: Morphologic and Mechanical Properties
Authors: Symbas P.N. , Pfaender L. , Chen H. , Gravanis M.B. 
Published: November 2007

The histologic and mechanical properties of the aorta following its segmental wrapping or replacement was investigated in two groups of dogs. In Group I (5 dogs) a 3- to 4-cm segment of the ascending and of the descending aorta were wrapped with prosthetic graft (2 dogs with woven and 3 with knitted Dacron). In Group II (5 dogs), a 3-cm segment of the de scending aorta was replaced with prosthetic graft. After an average stay of eight months, the dogs were sacrificed and the aorta was submit ted for histologic and tensile strength studies. There was no change in rup ture strength in either the wrapped or the replaced aortas in comparison with normal control aortas. However, the incidence of rupture at the suture line in Group II was significantly greater. The incidence of rupture site in Group I was 43.5% at the normal aortic segment, 17.4% at the junction between wrapped and nonwrapped aortic segment, and 39.1 % at the wrapped aortic segment. The inci dence of rupture site in group II was 28.9% at the normal aortic segment, 68.9% at the suture line, and 2.2% at the grafted segment. In Group I dogs the outer one third to one half of the media of the wrapped aortic segment was replaced with fibrous tissue.
The Dacron EXS Graft for Femoropopliteal Arterial Reconstruction
Authors: Matsubara Junichi , Nagasue Masami , Hosaka Hiroshi , Shimizu Takeshi 
Published: November 2007

The purpose of this study is to clarify the efficacy of the knitted Da cron Velour Externally Supported (EXS) graft in the patency of femoro popliteal, especially below-the-knee femoropopliteal, arterial revascular ization. Through the end of March, 1988, 62 EXS grafts had been implanted for 43 anatomic and 19 extraana tomic bypasses. Of these, 34 grafts in 28 patients were for femoropopliteal surgery. They were 25 men and 3 women with a mean age of 67.4 years. The location of distal anasto mosis was as follows: 17 grafts were to the popliteal artery above the knee and 17 were below the knee. Cumulative patency rates, calcu lated by the life table method, were as follows: 93.1% and 77.8% at one year, for above and below the knee, respectively; 64.4% and 77.8%, re spectively, at two and a half years; and 64.4% at four years for above the knee. The longest case of BK is three and a half years. Therefore, there is no 4-year patency rate for BKs. There were no statistical differences between above- and below-the-knee popliteal anastomosis. Postoperative angiograms show no kinking or ste nosis at the anastomosis site of a be low-the-knee popliteal artery in bending position. These results suggest that the da cron EXS graft is suitable even for below-the-knee femoropopliteal arte rial surgery, showing results similar to those with autologous vein grafts. A longer follow-up period and a larger number of grafts are necessary for firmer conclusions.
The Role of Blood Perfusion and Tissue Oxygenation in the Postischemic Transcutaneous pO2 Response
Authors: Slagsvold Carl-Erik , Stranden Einar , Rosén Leif , Kroese Andries J. 
Published: November 2007

The transcutaneous pO 2 (TCpO2) response following release of tourniquet cuff occlusion is expressed as oxygen reappearance time (ORT) and oxygen recovery index (ORI). In the present study the effects of blood perfusion and tissue oxygenation on ORT and ORI in healthy control subjects and two patient groups with peripheral arterial insufficiency were assessed. In control subjects, ORT reflects diffusion time for O2 molecules from capillaries to the TCpO2 sensor. In patients with claudication, ORT was prolonged probably because of delayed postischemic reperfusion and reduced tissue oxygenation. In patients with critical ischemia, prolonged ORT seems to be attributed more to reduced tissue oxygenation than to delayed postischemic reperfusion. ORI in control subjects and patients with claudication apparently depends more on capillary pO 2 than on magnitude and duration of the postischemic reperfusion. In patients with critical ischemia, ORI is more related to decreased O 2 delivery subsequent to reduced or absent reactive hyperemia response. In addition, increased O2 extraction ("O2 steal") and extensive countercurrent O2 exchange during low flow states may reduce ORT and ORI in severely ischemic skin.
Long-Term Clinical and Duplex Follow-up After Proximal Vertebral Artery Reconstruction
Authors: Van Schil Paul E. Y. , Ackerstaff Robert G. A. , Vermeulen Freddy E. E. , Eikelboom Bert C. , Schepens Marc A. A. 
Published: November 2007

From 1977 to 1989, 28 patients, 18 men and 10 women, underwent 29 proximal vertebral artery reconstructions. Indications were vertebrobasilar insufficiency in 17 patients and TIA or stroke in 6. Five were asymptomatic. Procedures performed were endarterectomy in 20, reimplantation in 5, venous bypass in 3, and decompression in 1 case. Concomitant procedures were coronary artery bypass grafting (6) and carotid, subclavian, or innominate artery revascularization (14). There was no operative mortality. There were 3 early reoperations for occlusion, bleeding, and lymph fistula, respectively. Except for 1 foreign patient recent clinical follow-up was complete. Mean follow-up was 85.6 months (range 17-146). During follow-up 10 patients died. Causes were mainly cardiac (3), carcinoma (3), and stroke (2). Seventeen patients were alive, 13 had no cerebrovascular symptoms, 2 sustained a hemispherical stroke, 1 was only slightly improved, and 1 had a drop attack 131 months after operation. Five and ten-year actuarial survival rates were 85% and 51% respectively. Follow-up with duplex scan was available in 26 patients and was complete in 24. Mean duplex follow-up was 78.6 months (range 3-146). Significant abnormalities were noted in 6 but with symptoms in only 1 patient. Mean time to restenosis was 77.3 months. Late angiographic control in 10 patients correlated well with duplex findings. Proximal vertebral artery reconstruction yields good clinical long-term results, and duplex scan is a useful tool in the follow-up of these patients.
PTA Plus Stent Implantation Versus PTA Alone for Central Venous Stenoses
Authors: Mickley Volker , Friedrich Jean M. , Rilinger Norbert , Storck Martin , Abendroth Dietmar 
Published: November 2007

From 1990 through 1992, 17 severely stenosed central venous segments were diagnosed in 13 patients. In 9 patients, 11 stenoses were detected during follow-up after trans- femoral venous thrombectomy. The other 6 stenoses occurred in the venous outflow tract of 4 hemodialysis shunts. Six stenoses were treated by percutaneous transvenous angio plasty (PTA) alone, and 11 stenoses by PTA plus stent implantation (PTA+S). For PTA+S, a flexible, self-expanding stent was used. Acute procedure-related complications were not observed. After a median follow-up time of eighteen months (three to thirty-six months), all patients were examined clinically, duplex-sonographically, and angiographically. Following PTA alone (n = 6), there was only 1 excellent result, and 5 patients developed high-grade restenoses. Two of these patients had to be reoperated on, and 1 patient underwent another PTA with stent placement. PTA+S (n = 11) for initial treatment of central venous stenoses gave excellent results in 8 cases, a good result in 1 case, and 2 insufficient results caused by intimal hyperplasia within the stent. These restenoses were successfully treated by another PTA.
Determinants of Failure in Superficial Femoral Artery Angioplasty
Authors: El-Bayar H. , Roberts A. , Hye R. , Davis G. , Freischlag J. 
Published: November 2007

Although results of iliac artery balloon angioplasty have been shown to be good, there are much less data regarding initial success and durability of superficial femoral artery (SFA) dilation. The authors retrospectively reviewed the results of 22 patients treated for 27 SFA lesions between 1981 and 1986. Mean age was 64.5 years (fifty-five to seventy-six). Results were analyzed with respect to initial, early ( < twelve months), and late ( > twelve months) angiographic and clinical success. Indications were claudication (22), nonhealing ulcer (3), and rest pain (2). Mean follow-up was 30.9 months; 100% at one year and 92% at two years. Initial failure occurred in 9 (33%) lesions. There were 2 early and 2 late failures for a cumulative patency rate of 90.3% and 78% at one and two years, respectively. Predictors of clinical failure were: (1) initial—age, SFA occlusion, and angio plasty rating; (2) early—age, SFA occlusion, degree of atherosclerosis, and angioplasty rating; (3) late—angioplasty rating. There were 3 complications (11%). The authors conclude that: (1) 33% of attempted SFA angioplasties were initially unsuccessful and that the cumulative patency rate was 78% at two years. (2) Age is predictive of initial and early failure; SFA occlusion, of initial and early failure; degree of atherosclerosis, of early failure; and angioplasty appearance, of initial, early, and late failures. (3) Complications did not result in limb loss or require surgery.
Assessment of Laser Doppler Flowmetry During Abdominal Aortic Aneurysmectomy
Authors: Kouchi Yasuhiro , Esato Kensuke , Fujioka Kentaro , Toyota Syuji , Seyama Atsushi , Zempo Nobuya 
Published: November 2007

The purpose of the present study was to assess the diagnostic utility of blood flow measurements at the sigmoid colon by laser Doppler flowmetry. Methods: A laser-Doppler flow probe was placed in contact with the serosa of the sigmoid colon in 41 patients undergoing resection of infrarenal abdominal aortic aneurysms. Blood flows were measured before aortic clamping, after reconstruction, and after inferior mesenteric artery revascularization. Results: The authors observed a colonic blood flow greater than 18 mL/minute/100 g in all the patients who did not develop postoperative ischemic colitis. Conclusions: The colonic blood flow needed to prevent postoperative ischemic colitis is greater than 18 mL/minute/100 g. The assessment of blood flow at the sigmoid colon by laser Doppler flowmetry is useful for predicting postoperative ischemic colitis.
Retroperitoneal "Mini" Approach for Aortoiliac Reconstructive Surgery
Authors: Weber G. , Jako G.J. 
Published: November 2007

The large vertical midline or transverse transperitoneal approaches used in the conven tional aortoiliac reconstruction are accompanied with a relatively high postoperative morbidity and mortality rate (2% to 5%), even in patients who are good risks under going aortic surgery. The purpose of this study was develop a new technique for aorto bifemoral bypass operation to minimize the operative stress on these patients. Methods: The recommended left paramedian or transmuscular retroperitoneal approach, using 5-6 cm skin incision and a special retractor with three-dimensional vision and with modified surgical instruments directly under eye control, offers the possibility of decreasing the operative stress significantly and of sufficiently controlling the serious bleeding that might occur. If necessary, this exposure can be immediately converted to a conventional approach by simple enlargement of the incision. Results: In the authors' first cases the functional results were very good, and conse quently, hospitalization time and the convalescence period were short. Conclusion: This minimal access approach appears to diminish the catabolic response, and it is hoped that it will be associated with accelerated recovery and virtual abolition of large wound-related complications. It could become the procedure of choice for selected patients with obstructive or aneurysmal aortoiliac disease.