bluuebunny/crossref_metadata_2025_split huggingface dataset:
Embolectomy in the Elderly
Authors: Ricci Michael A. , Murr Andrew , Bedwell Scott , Deshmukh Narayan 
Published: August 2008

Although Fogarty catheter embolectomy has revolutionized the treatment of peripheral arterial embolism, significant morbidity and mortality may still follow this procedure. To examine the outcome of embolectomy in elderly patients, the authors reviewed 50 procedures in 49 patients; those less than eighty years old (25 patients, Group I) were compared with patients over that age (24 patients, Group II). Overall rates of recurrence, amputation, and death were 22%, 14%, and 10%, respectively. Cardiac disease was prevalent in both groups, although atrial fibrillation was more frequent in the older group (66.7% vs 24.0%, p = 0.002), and prior myocardial infarction was found more often in Group I (32.0% vs 8.3%, p=0.05). Complications were significantly more frequent in Group II than in Group I (58.3% vs 28.0 %; p = 0.02). Special attention to perioperative care is necessary in elderly patients undgergoing embolectomy to minimize complications.
Basilic Vein Thrombosis Near an Arterial-Venous Access Graft Resulting in a Symptomatic Upper Extremity
Authors: de la Torre Roger , Edelman David , Sendzischew Harry 
Published: August 2008

Deep venous thrombosis of the upper extremity is a relatively uncommon condition that normally produces few if any symptoms. However, when this occurs in a patient with hemodialysis access in the same upper limb, significant sequelae may result. Although these may be remedied by the elimination of the arterial-venous loop, the critical importance of vascular access for most patients with end-stage renal disease and the difficulties associated with creating new access make it essential to preserve existing sites. Described is a patient with a left forearm access graft and symptoms in the same extremity arising from outflow occlusion proximal to the venous anasto mosis of the graft. An arteriogram was used to diagnose and locate the occluded area, revealing thrombosis of the basilic vein as the likely cause. This was then bypassed by using saphenous vein, thus salvaging the hemodialysis access. The patient did well postoperatively and was discharged without symptoms and with a functional arterial-venous loop.
Angiographic Findings of Great Vessel Involvement in Behçet's Disease
Authors: Bayraktar Yusuf , Balkanci Ferhun , Dündar Semra , Kansu Emin , Telatar Hasan 
Published: August 2008

Behçet's disease (BD) is a systemic disorder and vasculitis is a common pathologic finding that may give clues in the understanding of the vascular involvement. During the period between 1968 and 1988, 30 patients with BD had vascular complications that were diagnosed by conventional venography (indud ing cavography) (in 15 patients prior to 1985) and then by computed tomography, digital subtraction angiography (DSA), and sonography in the remaining 15 patients for the last four years . The group included 13 patients with superior vena caval obstruction (SVCO), 3 with inferior vena caval obstruction (IVCO), 4 with both SVCO and IVCO, 2 with IVCO and hepatic veins obstruction (Budd-Chiari syndrome, BCS), 1 patient with SVCO, IVCO, and BCS, 1 with BCS, 1 with portal vein and IVCO, 4 patients pulmonary artery occlusion (1 of them also had pulmonary artery aneurysm), and finally, 1 patient with right illiac artery aneurysm. In many cases, classical clinical features of BD were not evident when great vessels were involved. The authors concluded that DSA and sonography are the preferred method in demonstrating vascular complications of BD and that BD should be taken into consideration when a patient presents with a great vessel involvement due to unknown cause.
Sequential Fibrinolytic Treatment with Urokinase and rt-TPA in two Cases of Acute Arterial Thromboembolism—Case Reports
Authors: Cina Gregorio , Ferrante Angela M. R. , Marra Roberto , Storti Sergio , Pagano Livio , Bizzi Bruno , Crucitti Francesco 
Published: August 2008

Thrombolytic drugs may be an alternative therapy for acute limb ischemia in patients who are not surgically treatable. Two cases of acute limb ischemia managed successfully with a sequential intraarterial infusion of urokinase and recombinant-type tissue plasminogen activator (rt-TPA) are reported. The positive results suggest the two drugs have a synergistic action. Further studies are needed to demonstrate the interactions between these thrombolytic agents
Surgery of Carotid Body Tumors: Clinical Experience with 10 Cases
Authors: Geiger Armin , Soeparwata Rasjid , Schmidt Johannes , Scheld Hans H. 
Published: August 2008

Within a population of 1150 vascular patients only a small percentage of the correct preoperative diagnosis of carotid body tumors (synonym chemodectoma) was found (2 patients). Before being treated by a specially trained vascular surgery team 8 patients did undergo inadequate operations. These were performed with high risk of local complications, even though by simple use of intravenous angiography (digital subtraction technique) the typical intercarotid widening with rich vascular filling could have led to the correct diagnosis. Malignancy was detected in 1 case (pulmonary metastasis). In 2 cases concomitant tumors of the jugular vein were seen. Since the blood supply from carotid body tumors is derived nearly exclusively from the external carotid artery, interruption of blood flow in this vessel simplifies the surgical approach substantially. Ligature of the external carotid artery (5 patients) and interposition of venous grafts (10 patients) were employed as surgical therapies. In 1 case extirpation of a larger tumor (18 x 11 x 9 cm) extending from the skull base and almost reaching the left clavicular bone was successfully carried out. At present there is no other satisfactory therapeutic approach to benign carotid body tumors available. For this reason surgical intervention, even in far advanced stages, is always justified.
Microvenous Grafts In Reconstructive Lymphatic Microsurgery: 7 Years' Clinical Results
Authors: Campisi Corradino 
Published: August 2008

The author reports his experience with 32 cases of lymphatic-venous-lym phatic anastomoses (LVLA), an alternative microsurgical solution, personally conceived, proposed for the treatment of chronic lymphedemas of limbs, partic ularly in those cases in which there exists a venous disease associated with the lymphatic one in the same limb and, therefore, in which the most common lymphatic-venous anastomoses (LVA) would not be indicated. The preliminary diagnostic investigations, including lymphoscintigraphy, lymphography, and above all, the venous flowmetry and manometry be Doppler's method, play an important role in a precise choice of the indications for this kind of microsurgical technique, for they allow the investigator to point out, besides the lymphatic stasis, a more or less disguised venous pathology. The author's microsurgical method consists in the interposition of venous grafts, more or less long and with a suitable caliber, between lymphatic vessels placed upon and below the obstacle to the lymphatic circulation of the limb. The results of this personal LVLA microsurgical technique proved to be very satisfactory. All 32 cases treated by this method showed a significant and perma nent decrease of the edema, with a follow-up till five years after operation.
Graft Replacement of Ascending Aortic Aneurysms. Surgical Results in 84 Consecutive Patients
Authors: Karagoz Haldun Y. , Zorlutuna Yaman , Babacan Korhan , Keceligil Tahsin , Tasdemir Oguz , Yakut Cevat , Bayazit Kemal 
Published: August 2008

Between January, 1977, and March, 1990, 84 consecutive patients underwent graft replacement of an ascending aortic aneurysm. There were 22 women and 62 men patients, ranging in age from twenty-two to sixty-nine years (mean 44.3). Surgical procedures employed were as follows: composite graft replacement with coronary reimplantation in 53 cases, supracoronary graft replacement (SGR) in 23 cases, SGR + aortic resuspension in 2 cases, and SGR + aortic valve replace ment in 1 case. Twenty-eight patients (33%) underwent concomitant aortic arch replacement. Five cases were operated on by "elephant-trunk" technique for extensive aneurysms involving the ascending, arch, and descending thoracic aorta. In 71 cases, a shunt was inserted between the periprosthetic space and the right atrium. Hospital (thirty-day) mortality was 15.5%. Contemporary (1987-1990) mortality rate was 8.7%. After a mean follow-up period of 42.6 months (range three to one hundred eighteen), there were 2 late deaths (1.1%/patient-year). Late reoperation was necessary in 2 cases (1.1%/patient-year). Ninety-one per cent of the survivors were in NYHA class I or II. The long-term survival rate was 76% ± 12%. The type of operation (ie, composite graft replacement or SGR) or concomitant aortic arch replacement had no influence on surgical outcome. The periprosthetic right atrial shunt was found to be effective in avoid ing complications related to blood accumulating between the aortic graft and the aortic wraparound.
Ideal Measurement of Cardiac Output: Is Impedance Cardiography the Answer?
Authors: Franko Edward R. , Van De Water Joseph M. , Xiang Wang  
Published: August 2008

The ideal measurement of cardiac output (CO) would be a system that is ac curate, noninvasive, reproducible, continuous, and technician-free. Impedence cardiography (ICG) has the promise of meeting these criteria. The authors have developed a unique ICG system that analyzes the analog signals from an impe dence cardiograph by an original software program. This was compared against standard thermodilution (TD) measurement of CO (CO TD) in patients in the in tensive care and heart surgical units. Simultaneous measurements by COTD and by COICG were performed in 65 patients. A good correlation was noted between COTD and COICG over a range of 2.4 to 9.7 L/min (r = 0.73, p < 0.002). If patients with factors known to inter fere with ICG were excluded, an improved correlation was found (r = 0.89, p < .002). COICG followed a similar trend as COTD even in these excluded pa tients. The reproducibility of the COICG was good (coefficient of variation = 0.071). The COICG was found to be simple and automatic. The results show that it is reproducible and correlates well with COTD. It also has the added advantages of being continuous and noninvasive. Factors such as arrhythmias, severe COPD, and mitral regurgitation were found to interfere with the COICG values. Over all, the versatility of. COICG gives the promise of very good noninvasive monitoring in critical care units and preoperative evaluation in the outpatient setting.
Assessment of Varicocele with Angiodynography (Color-Coded Triplex)
Authors: Ledda A. , Belcaro G. , Laurora G. , Iasonni V. , Tenaglia R. 
Published: August 2008

We evaluated by angiodynography 228 patients with clinical and 107 with subclinical varicocele and 22 normal subjects studying vein dilatation and reflux peak flow velocity (PFV). PFV was 18 cm/sec in subclinical varicocele, significantly lower than in clin ical varicocele (24 cm/sec). The mean reverse flow (reflux) was also significant ly lower in subclinical varicocele. The study demonstrated that there is a good correlation between the mean duration of reflux (in seconds) and the quantity of reverse flow measured by angiodynography. The correlation between descending phlebography and angiodynography, in a randomly selected group of 69 patients was 100% both in clinical and subclin ical varicocele. In conclusion, angiodynography could be considered the best noninvasive technique to evaluate and quantify varicocele and the effects of treatment on venous dynamics.
A Twenty-Year Experience with Axillofemoral Bypass: Analysis of 63 Consecutive Cases
Authors: Mingoli Andrea , Cavallaro Antonino , Sciacca Vincenzo , di Marzo Luca , Agosta Filippo , Maggiore Claudia , Stipa Sergio 
Published: August 2008

The results of 63 consecutive axillofemoral bypass grafts are presented. A computerized analysis of the data was performed according to the possible variables apt to influence the results of the reconstruction: different indications, stage of disease, previous reconstructions, presence of graft infection, unilateral or bilateral revascularization, iliac artery and runoff status, and graft caliber and material. A higher five-year graft patency rate was obtained with bypasses performed in poor-risk patients with occlusive arterial disease (axillounifemoral graft: 53.7%; axillobifemoral graft: 41.6%) than in procedures performed in emergency (p < 0.025) or for infection of previous vascular reconstructions (p < 0.001). There was a similar five-year patency rate in axillounifemoral and axillobifemoral grafts (p = NS) and in the bypasses performed in patients with iliac artery occlusion or stenosis (p = NS). A higher patency rate was obtained when there were two or three patent tibial vessels (p < 0.001). Finally the authors observed a greater infection rate in polytetrafluoroethylene grafts than in Dacron grafts (p < 0.05). Their results confirm the important role of the axillofemoral bypass in revascularizing high-risk patients with severe limb ischemia (rest pain and necrosis) or patients with graft infection, repeated graft failures, and arterial occlusive disease when laparotomy is contraindicated.
Biosynthetic Patch in Carotid Angioplasty
Authors: Pratesi Carlo , Pulli Raffaele , Michelagnoli Stefano , Innocenti Alessandro Alessi , Sabato Alfredo , Bertini Domenico 
Published: August 2008

Since early embolic events and recurrent stenosis are, after intraoperative ischemia, the main problems of carotid endarterectomy (CEA), technical im provements that may reduce the incidence of these feared complications are required. The causes of recurrent carotid stenosis may be related to progression of the atherosclerotic disease, to myointimal hyperplasia at the site of endar terectomy, or to technical mistakes during intervention. The choice of patching material seems to be important in preventing late complications. The authors present their original experience with a biosynthetic ovine patch in carotid surgery. In the period from January, 1988, to June, 1989, 211 carotid endarterectomies were performed for atherosclerotic disease at the carotid bi furcation in 176 patients. A primary closure of the carotid arteriotomy was performed in 82 cases and a patch angioplasty was employed in 129. As the material employed in the patch angioplasty, the authors used the biosynthetic ovine patch in 30 cases. No deaths and no permanent neurologic deficits were registered in this series during the awakening and during the postoperative care. One patient died one month after the surgical procedure because of myocardial infarction without neurologic symptoms. These patients were admitted to the prospective study for the evaluation of the carotid that was operated on. The study was performed with clinical and instrumental examinations (duplex scanner). Each patient was seen at months 1, 3, 6, and 12 after surgery. All the patients except 3 had a twelve-month follow-up; by echo tomography a case of nonhemodynamic restenosis was detected in an asymptomatic patient six months after CEA. The authors' preliminary experience with this biosynthetic graft as patching material has been satisfactory. They conclude that this biosynthetic graft, be cause of its handling and particularly its healing characteristics, can be consid ered as a graft material for patching at the carotid level.
Elective Arterial Reconstruction for Intermittent Claudication is Justified
Authors: Esato Kensuke , Zemp Nobuya , Fujioka Kentaroh , Ohara Masaki 
Published: August 2008

This study evaluates the appropriateness of performing arterial reconstruc tion in patients with intermittent claudication due to arteriosclerosis obliterans. Among 163 symptomatic patients, 175 limbs in 130 patients underwent surgical revascularization as the primary mode of therapy. There were 3 operative deaths and 21 late deaths after an average of 3.5 years of follow-up. The most common cause of death was heart failure, including ischemic heart disease. The five-year cumulative patency rate was 92.5% for aortoiliac, 70.6% for femorodistal, and 82.0% for aortofemorodistal reconstructions. The long-term symptom free rate was 87.3% for aortoiliac, 57.7% for femorodistal, and 86.7% for aorto femorodistal reconstructions. The authors conclude that intermittent claudication is an appropriate indi cation for surgery in patients with lower extremity ischemia to enhance the quality of life, except in patients with serious concomitant medical illness.
A New Approach to Vascular Access for Endovascular Procedures
Authors: Sanfelippo Peter M. 
Published: August 2008

This study examined a new approach to vascular access for endovascular procedures employing an expandable access catheter (EAC). The experience in 6 patients and 7 procedures was evaluated. There were no complications related to the EAC. The EAC permitted simul taneous introduction of diagnostic and therapeutic devices, decreased blood loss from the site of insertion, and decreased the volume of irrigant used for satis factory visualization during angioscopy by obstructing collateral inflow.
New Horizons in the Operative Treatment of Deep Venous Incompetence of the Lower Limb
Authors: Psathakis Dimitrios N. 
Published: August 2008

Venous incompetence of the lower limb is necessarily connected with a popliteal reflux accounted for by valvular incompetence of the popliteal vein, the presence of which must be clarified. The investigation of the deep venous system will begin by Doppler ultrasound. Only patients with popliteal reflux de tected by Doppler ultrasound are furthered examined by venous pressure meas urements and by phlebography. An operation in the deep veins is admissible only when a popliteal reflux of more than 40%, an ambulatory venous pressure more than 60 mmHg, a refilling time of less than fifteen seconds, a venous insuffi ciency of more than 20%, and a patency or recanalization of the deep veins of more than 70% have been confirmed. In a series of 46 patients (61 limbs) operated on the last two years the selec tion for operation was successfully made only by Doppler ultrasound. The substitute "valve" operation by Technique II designed to overcome reflux in the popliteal vein was performed on 191 patients (221 limbs) with deep venous incompetence of the lower limbs, primary or postthrombotic. Results were as sessed clinically, by Doppler ultrasound, by venous pressure measurements, and partially by phlebography. In the above series of 46 patients (61 limbs) the results were assessed only by Doppler ultrasound, which correlated with the clinical con dition, consisting of abolition or minimizing of the popliteal reflux. In our pa tients clinical improvement in 209 of 221 limbs was associated with reduction of ambulatory venous pressure and prolongation of refilling time with interrup tion of the popliteal reflux as assessed by Doppler and by phlebographic evi dence of the valve-like effect of the silastic tendon on the popliteal vein.
Infection Prophylaxis and Infection Control in Vascular Access Surgery
Authors: Keferstein Rolf D. , Fiedler Cornelia , Pelster Fritz W. , Reers Berthold 
Published: August 2008

This review of 133 arteriovenous (AV) fistulas, created by implantation of polytetrafluoroethylene (PTFE) graft material, reports an infection rate of 16.4% in the first period from 1982 to 1985. The infection rate decreased to 5.6% in the period from 1986 to 1990. Graft infections occurred at a higher rate of 46.2% versus 20% when reoperations because of malfunction, occlusion, aneurysm, or bleeding were necessary. Graft infections can be reduced by the development of standard surgical procedures, by the local and systemic application of antibiotics, and by a careful puncture technique. The treatment of septic graft complications after primary operations resulted in a maintenance of graft function in 50%. After secondary operations the graft had to be excised in all but 1 case.
Ten-year Follow-up of Femoropopliteal Bypass Grafts: Comparative Review of Late Patency Rates of PTFE and Saphenous Vein Grafts for Lower Extremity Ischemia
Authors: Dayioglu Enver , Barlas Semih , Onursal Ertan , Kargi Aydin , Barlas Cemil 
Published: August 2008

Between January, 1987 and June 1988, 335 femoropopliteal bypass (FPBP) operations were performed on 308 patients who had limb ischemia caused by femoropopliteal occlusion. The greater saphenous vein graft (SVG) was used whenever possible (165) and polytetrafluoroethylene (PTFE) prosthesis was used in 165. In addition, 4 Dacron grafts and 1 umbilical vein graft were used in 5 operations but were excluded from comparison in this study. The two groups did not differ significantly regarding stage of peripheral ischemia, preoperative indication, distal popliteal anastomotic site, and number of patent runoff ves sels. Overall cumulative patency rates according to occlusive criteria alone were calculated by the life table method. Graft occlusion was determined by angiog raphy, Doppler assessment, loss of previously palpable pulses, or return of symp toms. Diabetes mellitus was associated with a significantly lower patency rate. It is concluded from this study that the saphenous vein is superior to PTFE as femoropopliteal bypass.
Effects of Prostacyclin on Heparin Reversal with Protamine
Authors: Katircioglu S. Fehmi , Küçükaksu D. Süha , Bozdayi Mithat , Saydam Gül , Zorlutuna I. Yaman , Taşdemir Oguz , Bayazit Kemal 
Published: August 2008

This study was planned to show the beneficial effects of prostacyclin (PGI2) utilization on adverse effects of protamine. PGI2was administered at a rate of 5 ng/kg/min. Twenty patients entered this study. Half of them received PGI2whereas the others did not.Right ventricular end-diastolic volume index and right ventricular stroke work index were 72 mL/m2and 2.2 g.m/m2, respectively, after patients were weaned off the bypass and 79 and 1.5, respectively, at five minutes after pro tamine administration in the control group; these values were 88 and 3.2, re spectively, and 86 and 3, respectively, in the PGI2group. Left ventricular stroke work index (g.m/m2) was 27.9 in the control group and 36.7 in the PGI2group (p < 0.05) after protamine administration.Thromboxane B2levels (pmoL/mL) in coronary sinus (CS) blood were 251 in the control group and 90 in the PGI2group at five minutes after protamine administration (p < 0.05). Myocardial blood flow was 174 mL in the control group and 245 mL in the PGI2group at five minutes after protamine adminis tration (p < 0.05). Cyclic adenosine monophosphate (cAMP) and cyclic guano- sine monophosphate (cGMP) levels in CS blood were 17 pmoL/mL and 2.1 pmoL/mL, respectively, in the control group and 36 and 0.3, respectively, in the PGI2group at five minutes after protamine administration. Leukotriene B4level was 129 and 57 pmoL/mL in the control and PGI2groups, respectively (at the same time as the cAMP measurement) (p < 0.05).From the results of this study the authors conclude that adverse effects of heparin reversal with protamine can be reduced with the use of PGI2.