bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Carotid Artery Bifurcation Disease and Risk Factors for Atherosclerosis
Authors: White Douglas B. , Schneider Joseph R. , Hoffman Kevin N. , Size Gail P. , Coats Robert W. , Laubach Maureen , Erickson Elaine J. , Caprini Joseph A. , Golan John F. 
Published: June 2007

Patients referred to the vascular laboratory for carotid duplex scanning may have identifiable risk factors for atherosclerosis. The presence of these risk factors may be associated with a higher risk of significant carotid bifurcation atherosclerosis. Furthermore, physicians have widely varying thresholds for requesting duplex scanning, and patient characteristics are likely to be highly variable from one vascular laboratory to another. The authors examined the relationship between significant carotid disease and atherosclerotic risk factors in patients referred to a community hospital vascular laboratory. Complete information was available for selected atherosclerotic risk factors including gender, diabetes, hypertension, cigarette smoking, cardiac disease, and prior stroke for 68 men and 78 women undergoing initial carotid duplex scanning between 4/1/93 and 11/11/93. The authors examined the possible correlation of these risk factors with the presence of severe carotid disease (> 50% stenosis including internal carotid occlusion) in at least one distal common carotid artery, bulb, or proximal internal carotid. Severe disease was present in 34 (23%) of 146 patients. Patients with severe carotid disease tended to be older (76.2 ± 1.3 vs 73.4 ± 0.9 years, mean ± SEM), but this difference was not significant (P = 0.11). Patients with severe carotid disease tended to have more total risk factors (3.2 vs 2.1, P < 0.01). Hypertension was the best predictor of severe carotid disease (36% with, 10% without hypertension, P < 0.01). Trends toward greater likelihood of severe carotid disease in men, smokers, and in patients with cardiac disease were not significant. Risk factors may be valuable predictors of the presence or absence of significant carotid bifurcation disease. Hypertension and the total number of atherosclerotic risk factors were strong predictors of significant carotid disease in the laboratory. However, patient characteristics in individual vascular laboratories may be highly skewed and vastly different from other vascular laboratories and the population. Individual vascular laboratories should tabulate atherosclerotic risk factors in addition to indications for carotid duplex scanning so that the importance of these risk factors in each laboratory may be determined.
Management of Femoral Lymphatic Complications Following Synthetic Lower Extremity Revascularization: Early and Late Results
Authors: McShannic Joseph R. , O'Hara Patrick J. 
Published: June 2007

Lymphatic complications following synthetic graft placement in the groin may be associated with prolonged drainage leading to the development of wound infection, which may involve the underlying prosthetic graft. To determine associated early and late mortality and morbidity and to develop guidelines for optimal management, the authors reviewed their department's recent experience with this problem. From 1982 to 1996, 32 femoral lymphatic complications (29 lymphocutaneous fistulas and 3 lymphoceles) were treated in 26 patients (16 men and 10 women, mean age 68 years) who had undergone lower extremity revascularization utilizing synthetic graft material. Patients with clinical evidence of graft infection or those with lymphatic complications following autogenous reconstructions were excluded from analysis. Underlying grafts involved the aortofemoral segment in 63% (20/32), the femorofemoral segment in 16% (5/32), the femorodistal segment in 13% (4/32), and the axillofemoral segment in 9% (3/32). Presenting symptoms were wound drainage in 27 limbs (91%), a groin mass in 3 (9%), and both in 6% (2/32). Management consisted of surgical exploration and lymphatic ligation with or without sclerosis in 24 limbs (75%) and local measures only in 8 (25%). Mean late follow-up was 3.6 years (range 0.1-8.9 years), and one patient was lost to follow-up at 3.1 years. There were no 30-day postoperative deaths. One patient died of pneumonia at 34 days after treatment. The median interval from treatment to wound resolution was 5 days for the entire series and was significantly shorter (2 days) for the surgically treated limbs than for those treated conservatively (38 days) (P=0.0001). The median interval from treatment to hospital discharge was also shorter for the surgically treated limbs (11 days) than for those treated conservatively (26 days) (P=0.025). There were no late recurrences, amputations, or graft infections. Cumulative 5-year survival for the entire series was 53%. Surgical repair of groin lymphocutaneous fistulas and lymphoceles following synthetic graft placement is safe and durable. This approach yields significantly shorter intervals from treatment to wound resolution and requires a shorter postoperative hospitalization period than the conservative approach.
Psychological Tolerance to Local Block Anesthesia for Saphenous Vein Surgery: Study of 160 Consecutive Cases
Authors: Ouvry P. A. G. , Perrotte P. , Amarouche A. , Ouvry P. 
Published: June 2007

The objective of this study was to estimate the psychological tolerance to inguinal block anesthesia using a standard stimulus. Subjects studied included 160 consecutive patients in whom an intervention was performed on the greater saphenous vein at the saphenofemoral junction. The ultimate goal was to identify the causes of intolerance to the anesthesia and to define precise contraindications. The setting was the Department of Angiology in the Clinique Saint Pierre in Dieppe. Subjects studied were 160 consecutive patients operated on for saphenofemoral junction dysfunction. The study was done to define those who were tolerant and those who were intolerant of the local block anesthesia. A standard stimulus was applied with an electric stimulator. A determination of the tolerant and intolerant patients was done by a simplified form of the French version of the McGill Pain Institute questionnaire previously edited by F. Boureau.7 Of the 160 patients tested, 87% would choose the block anesthetic once again, and 13% regretted having accepted that form of anesthesia.
Electron Microscopic Luminal Surface Characteristics of Carotid Plaques
Authors: Kasirajan Karthikeshwar , Cornu-Labat Gaston , Turner John J. , Rubin Jeffrey R. 
Published: June 2007

Luminal surface characteristics in symptomatic and asymptomatic patients with carotid artery disease have not been thoroughly evaluated. Carotid artery atherosclerotic plaques were subjected to a scanning electron microscopic (EM) examination to determine plaque surface morphology. Correlation of clinical presentation, including clinical symptoms, risk factors, and macroscopic plaque appearance, with plaque EM appearance was analyzed for 16 patients. Differences between symptomatic and asymptomatic patients and differences among plaque characteristics were analyzed by use of the two-tailed Fisher's Exact Test or the Mann-Whitney U statistic. Two predominant types of surface inhabitants were noted, fibrin/red blood cell clumps and collagen and calcium matrix. In all symptomatic patients (n=12) luminal surface fibrin was noted (P=0.007), and 83% of these symptomatic patients had red blood cell clumps (P=0.06). Among asymptomatic individuals (n=4), 3 patients had plaques with collagen (P=0.007). Although platelets were noted in all patients, platelet clumps and accumulations of atherosclerotic debris were noticeably absent. Atherosclerotic risk factors failed to correlate with luminal surface characteristics. The authors identified specific luminal surface characteristics that correlated well with clinical presentation. Thromboxane inhibitors, such as aspirin, were successful in inhibiting the formation of platelet clumps but were obviously unsuccessful in reducing cellular and matrix accumulations on the luminal surface of carotid arteries.
Ultrasound-Guided Nonsurgical Closure of Postangiographic Femoral Artery Injuries
Authors: Altstidl Robert , Lehmkuhl Hans B. , Voss Eckbert , Herold Christoph , Becker Dirk , Giinter Erwin , Bachmann Kurt 
Published: June 2007

Postcatheterization injuries at the vascular access site include pseudoaneurysms and arteriovenous fistulas. Traditional treatment of this complication has been surgical repair. This study describes a recently developed method for closing femoral pseudoaneurysms and arteriovenous fistulas by using external compression guided by Doppler color flow imaging. Thirty-six femoral artery injuries (31 pseudoaneurysms, 5 arteriovenous fistulas) were detected by color flow imaging in 35 patients with enlarging groin hematomas and/or groin bruits. All patients underwent a full trial of compression therapy, with an extended compression time limit of 240 minutes and a tag-team approach of two operators to overcome manual fatiguing. The mechanical compression was titrated to obliterate the vascular tracts to the aneurysms or of the arteriovenous fistulas and to maintain an adequate flow in the femoral artery, as far as possible. All postangiographic pseudoaneurysms were successfully treated with a compression time ranging from 10 to 110 minutes, even in patients receiving prolonged anticoagulant therapy. Follow-up ultrasound examination the following morning and 4 to 5 days later confirmed a continued closure in all patients, without side effects such as venous thrombosis or ischemia. In arteriovenous fistulas, compression therapy was successful in two cases without complications or recurrences during follow-up. This study demonstrates that Doppler color flow ultrasound-guided compression of postangiographic femoral artery injuries is a safe and technically simple device and may be implemented as a cost-effective, first-line treatment, with a high rate of success in pseudoaneurysms.
Is Impedance Plethysmography a Safe Test After Total Joint Replacement?
Authors: Dixon David J. , Ricci Michael A. , Reid James G. , Possidente Carl , Incavo Stephen J. , Howe James G. 
Published: June 2007

Screening for deep venous thrombosis (DVT) following total joint replacement (TJR) has been recommended as an adjunct to DVT prophylaxis. This study evaluates a structured protocol utilizing impedance plethysmography (IPG) as the primary screening modality. Over a 12-month period all patients undergoing TJR of the lower extremities had an IPG 3 to 5 days after surgery. Patients received primary DVT prophylaxis with warfarin. Minimal follow up of 6 weeks was obtained on all patients. Three-hundred three TJRs were performed. The IPG appeared normal in 220 of 303 patients (73%), obviating further testing. During follow-up, two patients had thromboembolic disease (TED). Of the 83 seemingly abnormal IPGs, 81 were false positive compared to venous ultrasound, with significantly more after knee surgery (p < 0.001). There was one confirmed DVT in the abnormal IPG group and one patient died 2 weeks after discharge with an autopsy-proven pulmonary embolism. There was a low overall rate of TED (1.3%); three fourths of patients with TED presented 2-4 weeks after discharge. These results indicate that it is clinically safe to discharge patients who have had a normal-appearing postoperative IPG. However, the large number of false-positive results reduces the utility of the test, particularly after knee replacement. While IPG is safe and cheaper than venous ultrasound, prophylaxis extended beyond the of hospitalization may obviate the need for screening.
Reoperation for Recurrent Carotid Stenosis: A Ten-Year Experience
Authors: Munn John S. , Jain Krishna M. , Simoni Eugene J. 
Published: June 2007

Owing to the supposed risks of reoperation, carotid stenting has been proposed as a treatment for carotid restenosis. The purpose of this study is to determine the safety and efficacy of carotid reoperation. From March 1988 to March 1997, 40 patients, 18 men and 22 women (mean age: 65 years) underwent a total of 43 redo carotid procedures by our group. Two patients had both sides repaired and one required a second reoperation. Symptomatic recurrent carotid stenosis (>70%) was the indication in 25 reoperations and asymptomatic high-grade stenosis (>80%) was the indication in 18. The initial operation in 35 reoperations was carotid endarterectomy (CEA) with primary closure and in eight it was CEA with a prosthetic patch. The interval to recurrence was less in the 24 reoperations in patients who had myointimal hyperplasia (21 months) compared with 17 reoperations in patients with recurrent atherosclerosis (90 months). The other two reoperations were for an intimal flap 2 months after the original CEA, and for operative dilation of fibromuscular dysplastic bands missed on magnetic resonance angiography (MRA), distal to the site of a previous CEA. The technique of reoperation included redo CEA in two, CEA with vein patch in eight, CEA with prosthetic patch in 22, vein interposition graft in five, and prosthetic interposition graft in five. In addition, operative dilation with an arterial dilator was used in one reoperation. No perioperative strokes or deaths occurred other than one patient who died from cardiac complications following combined CEA and coronary artery bypass grafting. Operative morbidity consisted of pneumonia in one patient, reversible cranial nerve injury in four, and hematoma requiring evacuation in two. During follow-up (mean: 34 months), carotid occlusion resulted in a mild stroke in one patient, there were 10 late deaths not related to carotid disease, one patient required a reoperation, and three patients were lost to follow-up. The authors conclude that reoperation for recurrent carotid stenosis, using standard vascular techniques, is both safe and effective; it should continue to be the mainstay of treatment when intervention is required.
A Comparison of Compression Pumps in the Treatment of Lymphedema
Authors: Bergan John J. , Sparks Stephen , Angle Niren 
Published: June 2007

Purpose: This study was done in order to ascertain which methods of mechanical compression would be optimum in treating patients with primary and secondary lymphedema. Materials and Methods: Thirty-five patients (26 women, 9 men) were enrolled in the study. The women ranged in age from 36 to 82 years (mean 56.9 years). The men ranged in age from 31 to 83 years (mean 56.4 years). Ultimately, 32 patients completed the study. Each patient was treated by random assignment to each of the three types of compression pumps. The treatment arms were as follows: (1) unicompartmental nongradient pump with pressure of 50 mm Hg, (2) a three-compartment pump with segmental, nongradient pressures of 50 mm Hg in each of three cells, and (3) a multicompartmental gradient pressure pump with ten cells ranging in pressure from 80 at the most distal to 30 at the most proximal. There were 35 extremities treated by each of the three methods. Eleven had primary lymphedema and 24 had secondary lymphedema. Results: The mean percentage volume change was +0.4% in the limbs treated with the unicompartmental pump, +7.3% in the three-compartment pump, and -32.6% in the ten-compartment pump. By use of Kruskal and Wallis, one-way ANOVA on ranks, a significant difference between the three treatments was detected (p < 0.001). In treatment of primary lymphedema there was no difference between the subgroups with regard to the effect of the three compression pumps. In treatment of secondary lymphedema, there was no reduction in the size of the limbs treated with the single-compartment, there was a -4.65% reduction in the three-compartment pump treatment, and -28.4% in the tencompartment pump. There were no differences in treatment of secondary limbs with and without radiation. In an analysis comparing primary to secondary lymphedema with and without radiation, the results were not statistically different from one another. Other factors such as severity of lymphedema, gender, duration of lymphedema, history of infection, and presence of radiation could not be implicated as having prognostic significance or having any effect on response to therapy. Conclusions: Mechanical external pneumatic compression can produce a reduction in treated limb volumes in primary and secondary lymphedema. This is best achieved by multicompartment sequential compression. Limb volume reduction by single or three compartment devices is decidedly less effective in treatment of lymphedema.
Comparison of the Resistive Properties of Reversed and Nonreversed Saphenous Veins at Arterial Pressure and Flow: Implications for Optimal Graft Configuration
Authors: Moawad John , Glagov Seymour K. , Loth Francis , Brown Silas , Schwartz Lewis B. 
Published: June 2007

Clinicians continue to debate the hemodynamic advantages of reversed vs nonreversed vein grafts in infrainguinal arterial reconstructions. Vein grafts placed in the reversed configuration do not require valve lysis but have the theoretical drawback of being smaller in caliber at the inflow end than the outflow end. The purpose of this study was to objectively determine the effect of vein valve lysis and flow direction on vein graft hemodynamics by using physiologic levels of pulsatile flow (Q), pressure gradient (AP), outflow resistance (Ro), and longitudinal impedance (ZL). Nine cryopreserved human greater saphenous veins (length=23 ±1 cm) were perfused via an in vitro circuit utilizing a variable pulsatile perfusion pump, Windkessel, and clamp resistor. Levels of Q and AP were chosen to simulate the known physiologic conditions of infrainguinal bypass grafting while holding Reynolds numbers <2,400. Veins were studied in the reversed configuration prior to valve lysis, after valve lysis by use of a catheter-directed valvulotome with 3 mm cutting head, and in the nonreversed configuration. Ultrasonic transit-time flow and proximal and distal intraluminal pressure were continuously recorded while Ro and pump rate were varied. Waveforms were digitally stored at 200 Hz at pump rates of 60, 100, 140, and 180 beats per minute at a Q of 154 ± 1 and 253 ± 1 mL/min while Pprox was maintained at 100 mmHg. Veins were perfusion fixed at 100 mmHg, sectioned at 2 cm intervals, and analyzed morphometrically. Inner diameter (id) and outer diameter (od) were determined by light microscopy after correction for shrinkage artifact by comparing to outer diameter measured by digital calipers at 2 cm intervals at the time of perfusion. Percent vein taper was calculated as (idmax7idmin)/idmax and wall thickness (t) as (od-id)/2. After Fourier transformation, ZL was calculated as AP/Q at each harmonic and the curves compared by use of Wilcoxon signed-ranks test. There were one to four valves per vein (idmean=3.6 ±0.3 mm; range 2.3-6.2) with an average taper of -8 + 12% (range: -46-36%) and mean wall thickness of 0.51 ±0.03 mm (range 0.42-0.68 mm). ZL curves were smooth and reproducible over the measured frequency range. Neither valve lysis nor flow direction had an effect on ZL at any level of Q or Ro, even in veins with a taper >25%. Mean wall thickness correlated with ZL (r2=0.43; p=0.05). In this in vitro system, saphenous vein graft impedance (ZL) was independent of valve lysis, flow direction, and the degree of vein taper but was weakly dependent on wall thickness. In veins of adequate size, hemodynamic considerations should not influence the decision to use the reversed vs nonreversed configuration.
Circadian Variation in the Rupture of Abdominal Aortic Aneurysms
Authors: Meissner Mark H. , Beach Kirk W. , Johansen Kaj H. , Nicholls Stephen C. 
Published: June 2007

Circadian variations in the incidence of myocardial infarction, sudden death, and stroke have been attributed to diurnal fluctuations in catecholamine release, blood pressure, heart rate, fibrinolytic activity, and platelet aggregation. As similar factors could precipitate the rupture of an abdominal aortic aneurysm, a retrospective chart review was undertaken in an effort to define the timing of aneurysm rupture and any associated circadian variation. One hundred forty-three patients with a ruptured abdominal aortic aneurysm (rAAA) and a documented time of presentation were evaluated. Eighty-one patients (56.7%) presented within 2 hours of the onset of symptoms and were examined for diurnal variability in their presentation. The hourly rate of rAAA presentation between 8 AM and 10 PM (4.3 per hour) was more than twice that observed during the night (2.1 per hour, p<0.001). The distribution of presentation times among this group was significantly different from uniform (p=0.05), implying circadian variability to aneurysm rupture. The time-dependent rate of rAAA presentation could be predicted (R2=0.77) with cosinor regression methods, although this model was not statistically significant (F= 4.9, p >0.10). Abdominal aortic aneurysm rupture occurs with a diurnal variation having a peak during waking hours. The relationship of aneurysm rupture to known physiological circadian rhythms may give further insight into the underlying pathophysiology and has implications for patient management.
Quantitative Evaluation of Abdominal Aortic Aneurysm
Authors: Kanaoka Yasushi , Ohgi Shigetsugu , Mori Tohru 
Published: June 2007

Rupture of an abdominal aortic aneurysm (AAA) is usually predicted on the basis of measuring the maximum diameter. However, since the size of a normal aorta varies depending on each individual, this indicator does not seem to be ideal. The authors propose a new indicator for the enlargement of aorta and have started clinical application of this technique. The abdominal aortic diameter was measured by using two-dimensional ultrasonography in 261 adults (aged 20 and over). The control group consisted of subjects with no evident aortic dilatation. Patients with AAA were divided into the nonruptured group and the ruptured group. Analysis of the data from the control group revealed that the abdominal aortic diameter could be defined by the following equation: Diameter (mm) = 0.147 x age (years) + 0.169 x height (cm) - 15.9. The baseline diameters of the abdominal aorta were calculated by applying the age and height of individual subjects in this equation. The measured diameter was divided by the baseline diameter to obtain the aortic expansion index (AEI). If a cut-off value of the aneurysm diameter and the AEI (calculated by using age 20) for the prediction of significant risk of rupture is set at 44.2 mm (= mean - 2SD of the aneurysm diameter in the ruptured group) and at 2.7 (= mean - 2SD of the AEI in the ruptured group), the risk of rupture based on the diameter in the nonruptured group is underestimated in 11% of cases. However, when the risk of rupture is based on the AEI, the risk is not underestimated in any case in the nonruptured group. The authors conclude that the AEI is a useful indicator for quantitatively evaluating the risk of rupture of an AAA.