bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative Duplex Ultrasound During Carotid Endarterectomy
Authors: Panneton Jean M. , Berger Mark W. , Lewis Bradley D. , Hallett John W. , Bower Thomas C. , Gloviczki Peter , Cherry Kenneth J. 
Published: June 2007

The purpose of this study was to examine the technical aspects of intraoperative duplex ultrasound (DUS) following carotid endarterectomy (CEA), suggest criteria to differentiate significant lesions requiring immediate surgical revision from normal or benign defects, and evaluate how frequently intraoperative DUS provides useful or unsuspected information. A retrospective study was performed on all patients who had both CEA and intraoperative carotid DUS between January 1,1990. and January 1,1995. A total of 155 DUS examinations were performed in 149 patients. Findings were grouped into three categories: normal; minor/insignificant lesions; and hemodynamically significant lesions based on the presence or absence of elevated peak systolic velocities, visible stenosis/thrombus, or intimal flap/dissection. Postoperative status was correlated with intraoperative DUS findings. Ninety-one (59%) examinations performed on 87 patients produced normal findings. Forty-seven (30%) examinations performed on 45 patients showed minor abnormalities consisting of insignificant residual plaque, residual external carotid artery stenoses, small intimal flaps, elevated velocities with no associated anatomic lesion, or an arterial kink. Fourteen patients (9%) had significant findings requiring immediate surgical revision. These consisted of large intimal flaps or dissection in six patients, marked residual plaque and significant stenosis in five patients, thrombus in two patients, and a kink in one patient. Three additional patients (2%) had significant findings but were not revised for various reasons. No significant difference was identified in morbidity or mortality rates between those patients with normal findings, those patients with minor technical defects, and those patients with significant abnormalities undergoing immediate surgical revision. However, two of three patients who had significant abnormalities within the common carotid artery that were not revised suffered perioperative ipsilateral strokes. Intraoperative DUS is a safe and accurate method to assess the technical adequacy of CEA. Intraoperative DUS showed significant lesions in 11% of patients. Identification and immediate repair of significant technical defects may decrease perioperative complication rate and long-term restenosis rate.
Could Gut-Liver Function Derangements Cause Chronic Venous Insufficiency?
Authors: Cordts Paul R. , Kaminski Mitchell V. , Raju Seshadri , Clark Melanie R. , Woo Katharine M. S. 
Published: June 2007

Upregulation of adhesion molecules and neutrophil infiltration of venous valve cusps may be risk factors for chronic venous insufficiency. But studies that focus on the target organ (vein) fail to consider the influence of systemic inflammation on WBC behavior in the microcirculation. This study probes the gut-liver axis as a potential source of gut-derived oxidative stress and free radical production leading to white blood cell activation in chronic venous insufficiency. Venous hemodynamics (ambulatory venous pressure, air plethysmography, duplex) and gut-derived oxidative stress markers were studied in nine patients with chronic venous insufficiency (group I) and nine age and sex-matched control subjects with no venous disease (group II). Group I had healed venous ulcers (class 5, CEAP) but near-normal ambulatory venous pressure, to eliminate high ambulatory venous pressure as a chronic venous insufficiency risk factor. Markers of gut-derived oxidative stress included: stool analysis; intestinal permeability; hepatic detoxification challenges with caffeine, salicylate, and acetaminophen; and urine lipid peroxides. Ambulatory venous pressure did not significantly differ (group I, 42.5 ±5.3 mm Hg; group II, 35.5 ±5.5 mm Hg; p = NS). Candida overgrowth in stool distinguished group I from group II (7/9 pts vs 1/9 pts, respectively; p=0.015). Increased intestinal permeability (lactulose/mannitol ratio) was prevalent in both groups (group I 0.07 ±0.02, group II 0.17 ±0.08, p=NS; normal range, 0.01-0.03). Both groups showed similar incidence of elevated urine lipid peroxides (5/9 pts vs 6/9 pts, respectively; p = NS), yet group I exhibited underfunction of both sulfation (group I 16.8 ±2.9%, group II 43.3 ±11%, p<0.03; normal acetaminophen recovery 16-36%) and glucuronidation (group I 30.4 ±4.1%, group II 64.1 ±14.4%, p<0.04; normal acetaminophen recovery 27%-56%) relative to oxidative stress, perhaps an indicator of diminished antioxidant capacity in patients with chronic venous insufficiency. Gut dysbiosis (as indicated by stool yeast) and hepatic detoxification challenge pathway exhaustion may lead to subclinical, systemic inflammation and peripheral white blood cell adhesion in chronic venous insufficiency. Further exploration of the relationship between oxidative stress and venous disease is needed.
Selection of Patients with Lower Limb Arterial Occlusive Disease for Endovascular Treatment of the Iliac Arteries with Duplex Scanning
Authors: Bostrdm Annika , Karacagil Sadettin , Löfberg Ann-Marie , Ljungman Christer , Nyman Rickard , Logason Karl , Hellberg Anders 
Published: June 2007

The aim of this study was to evaluate the role of duplex scanning in selection of patients with lower limb arterial occlusive disease for endovascular treatment of the iliac arteries. From January 1995 through May 2000, 183 patients having chronic lower limb arterial insufficiency who underwent duplex scanning of the lower extremity arteries with available aortoiliac scans within 3 months before conventional aortoiliac diagnostic angiography and/or endovascular intervention of the iliac arteries were studied retrospectively. The findings obtained from duplex scanning and angiography were analyzed in a blinded manner by 2 investigators. Limbs having category 1, 2, and 3 lesions according to duplex scan findings were interpreted as being suitable for endovascular intervention. The comparison between duplex scan findings and angiography was analyzed by the third investigator. During 93 percutaneous transluminal angioplasty (PTA) procedures, 133 arterial segments, common or external iliac, were dilated with stent placement in 70. Bilateral interventions were performed in 25 cases, and of 68 unilateral interventions, 57 were at only 1 arterial segment. The accuracy, sensitivity, specificity, and negative and positive predictive values of duplex scanning to appropriately categorize the iliac artery lesions into suitable or unsuitable for endovascular intervention were 90%, 95%, 83%, 90%, and 92%, respectively when the inconclusive duplex scans were excluded (11%). In 6 patients with lesions suitable for PTA according to duplex scanning and angiography, PTA was not performed owing to clinical reasons. The accuracy of duplex scanning in predicting the performance of endovascular intervention was 88%. It is concluded that iliac artery endovascular procedures in limbs with chronic occlusive disease can be reliably planned according to duplex scan findings.
Cerebral Hyperperfusion Syndrome
Authors: Rippy Elisabeth E. , Wolfe John H. N. 
Published: June 2007

Cerebral reperfusion following carotid endarterectomy occasionally causes cerebral hyperperfusion syndrome. This is a rare but important complication and this case report acted as a stimulus for a literature review of this problem. A 60-year-old businessman had a right carotid endarterectomy for a severe stenosis which had caused recurrent attacks of amaurosis fugax. The left internal carotid artery had occluded asymptomatically. The operation and his immediate postoperative recovery were entirely uneventful but he developed right-sided headaches and focal sensory motor seizures. He subsequently recovered. Hemodynamically compromised patients appear to be at greater risk and as the mortality of the operation is reduced and more complex patients are treated, it is likely that this unusual complication will increase in incidence.
Effect of Normovolemic Hemodilution on Fatal Postoperative Pulmonary Embolism in Major Elective Orthopedic Surgery. A Retrospective Analysis on 4653 Patients
Authors: Bombardini Tonino , Borghi Battista , Montebugnoli Milena , Picano Eugenio , Caroli Gian Carlo 
Published: June 2007

It has been suggested that the benefits of transfusion are currently greatly overrated, with physicians reflexively administering blood in the nearly unchallenged view that failure to transfuse would have dire consequences. As a matter of fact, the tolerability and safety of normovolemic anemia have been well documented for many years in several anesthesiologic settings. Objective: To assess the impact of normovolemic hemodilution on blood bank resources and in-hospital mortality in major elective orthopedic surgery. Methods: The authors therefore retrospectively analyzed in-hospital mortality of patients submitted to elective surgery for total hip replacement in the Rizzoli Institute since 1979. From 1979 to 1983, 1488 patients underwent a standard treatment (without normovolemic hemodilution), whereas 4653 patients submitted to surgery from 1984 to 1993 underwent normovolemic hemodilution-up to extreme accepted values of hemoglobin > 6 g/dL. Results: Homologous blood transfusion was required in 1220/1488 patients of Group I and in 977/4653 patients of Group II (82% vs 21%, P < .001). The number of blood units required for each transfused patient was 2.8 in the 1220 transfused patients of Group I, and 2.1 in the 977 transfused patients of Group II (P < .001). There were 6 deaths in Group I and 7 deaths in Group II (0.4% vs 0.15%, P < .05). The overall incidence of fatal pulmonary thromboembolism was 4/1488 in Group I and 1/4653 in Group 11 (0.27% vs 0.02%, P < .001). Conclusions: Normovolemic hemodilution was extremely well tolerated in patients undergoing major elective orthopedic surgery and allowed substantial sparing of blood bank resources. It had no detectable unfavorable effect on surgical outcome, but rather it was associated with a dramatic decrease in perioperative mortality of patients under-going total hip replacement, owing to a thirteen-fold reduction in fatal pulmonary thromboembolism.
A New Less-Invasive Method to Estimate the Viability of Severely Ischemic Skeletal Muscle
Authors: Asami A. , Orii M. , Shirasugi N. , Yamazaki M. , Akiyama Y. , Kitajima M. 
Published: June 2007

Estimation of the viability of ischemic tissue is important for appropriate revascularization. In the present study, microdialysis combined with HPLC (high performance liquid chromatography), a new, simple less invasive method, was used to estimate the viability of anterior tibial muscle of rat hind limb (n= 18). Purines, adenosine triphosphate (ATP) degradation products, were continuously measured by this method during the ischemic period. Purines were measured by analyzing the dialysate from a needle-type microdialysis probe inserted into the muscle. The purine concentration of the dialysate reflected that of the interstitial fluid of the muscle. Hypoxanthine and inosine in the muscle increased to 2.34 ± 1.16 and 1.79 ± 0.62 times the preischemic levels, respectively, after five hours of ischemia. Thereafter hypoxanthine continued to increase to 6.53 +2.28 times the preischemic level at ten hours of ischemia, but the inosine level decreased gradually. As a result of the depletion of inosine and the continuous increase of hypoxanthine, the inosine/hypoxanthine ratio decreased significantly after five hours of ischemia, and went down to one eighth of the preischemic level at nine hours of ischemia. A depletion of inosine means a depletion of ATP, the source of inosine in purine metabolism and an essential factor for maintaining cell function. These results showed a good correlation with the TTC (triphenyl tetrazolium chloride) assay, an established method. Microdialysis, a new, simple, and less invasive method, is useful for the estimation of ischemic damage and viability of ischemic skeletal muscle.
Leiomyosarcoma of the Inferior Vena Cava
Authors: Herman Paulo , Pugliese Vincenzo , Machado Marcel Cerqueira Cesar , Vianna Maria Regina , Pinotti Henrique Walter 
Published: June 2007

Inferior vena cava leiomyosarcoma is a rare tumor with a recent increase in incidence. The authors describe 2 cases and discuss clinical features, diagnosis, and treatment. With recent advances in imaging methods and surgical procedures an early diagnosis and radical resection might be possible, leading to a better prognosis or even the cure of the disease.
Does the Geometry of a Distal Vein Graft Anastomosis Affect Patency?
Authors: Hoballah Jamal J. , Mohan Chittur R. , Chalmers Roderick T. A. , Schueppert Michael T. , Sharp William J. , Kresowik Timothy F. , Corson John D. 
Published: June 2007

Between January, 1988, and December, 1992, 336 autogenous vein bypasses were performed on the vascular service at The University of Iowa Hospital. Routine color duplex surveillance (CDS) identified 25 bypasses with a significant distal anastomotic stenosis that developed between one and thirty-one months postoperatively (mean nine months). These 25 „failing bypasses” underwent a revisional procedure following arteriographic confirmation of the location and severity of the lesion. The intraoperative completion arteriograms performed at the time of the original bypass procedure of these revised bypasses were critically analyzed. The length of the distal anastomosis, as well as the diameter of the distal vein conduit and artery (proximal and distal to the anastomosis) were measured in each case. In addition any anastomotic defect seen on the original intraoperative completion arteriogram was also noted. This same analysis was done for 50 consecutive vein bypasses that have remained primarily patent for two years or more and had normal duplex surveillance studies. Vein/artery diameter, anastomotic length/artery diameter, anastomotic length/vein diameter ratios were calculated for both the groups. Demographic characteristics, risk factors (diabetes mellitus, hypertension, coronary artery disease, renal failure, chronic obstructive pulmonary disease), indications for surgery, type of venous bypass conduit, and the outflow of the bypasses were comparable between these two groups. The results are depicted in the following table: [Table: see text] These data indicate that the geometry of the distal anastomosis does not play a significant role in the development of distal anastomotic stenosis. An uncorrected anastomotic defect on the completion arteriogram is a risk factor for bypass failure. Hence, patients with such defects should have these lesions corrected when they are initially identified at the time of the initial bypass procedure.
Treatment of Recurrent Carotid Disease
Authors: Plestis Konstadinos A. , Jiang Zhidong , Appel Hope , Howell Jimmy F. 
Published: June 2007

The purpose of this study was to determine whether repeat carotid endarterectomy (CEA) poses a greater risk than first-time CEA. The authors analyzed data from 893 consecutive CEA cases (1981-1993). Thirty-three patients (3.7%) had repeat CEA, and 860 (96.3%) had first-time CEA. There were statistically significantly higher incidences of hypertension (60.6% vs 44.6%), smoking (84.8% vs 55%), hypertriglyceridemia (33.3% vs 16.2%), and coronary artery disease (66.6% vs 36%) in the repeat CEA group than in the first-time CEA group. Symptomatic disease was present in 25 (75.8%) patients in the repeat group and in 576 (67%) patients in the first-time group (P>0.05). The cause of recurrence was atherosclerosis in 25 patients (76%), myointimal hyperplasia in seven patients (21.2%), and intraluminal thrombus without an underlying lesion in one patient (3%). Redo CEA with vein patch angioplasty was performed in 27 patients (82%), vein patch angioplasty alone in five patients (15%), and interposition vein graft in one patient (3%). The hospital operative mortality was 0% (n=0) in the repeat CEA group and 0.6% (n=5) in the first-time CEA group (P>0.05). The incidence of postoperative stroke was 0% (n=0) in the repeat group and 1.2% (n= 10) in the first-time group (P>0.05). There was one case (3%) of transient ischemic attack (TIA) in the repeat group, and two cases (0.2%) of TIA in the first-time group. There was no difference in the incidence of cranial nerve dysfunction between the repeat group (n=2, 6%) and the first-time group (n=41, 4.8%; P>0.05). Late follow-up data were obtained for 30 patients (mean: 61.4 months, range: 5-158 months) in the repeat CEA group and 501 patients (mean: 55.8 months, range: 17-168 months) in the first-time CEA group. The incidence of late failure (ipsilateral stroke or TIA) was 3.3% (n= 1) in the repeat group and 3.2% (n= 16) in the firsttime CEA group; P>0.05. The overall late mortality was 20% (n=6) in the repeat CEA group and 14.6% (n=73) in the primary CEA group; P>0.05. Repeat CEA can be performed safely in individuals with severe recurrent carotid stenosis, and perioperative and long-term mortality and neurologic morbidity rates are similar to those for patients undergoing first-time carotid endarterectomy.
Evaluation of Efficacy and Safety of Valvulotomes in an “Ex-vivo” In-situ Bypass Model
Authors: Schanzer Harry , Skladany Milan 
Published: June 2007

A critical step in the performance of in-situ bypass is to produce incompetence of the venous valves. Currently, there are several commercially available valvulotomes designed to fulfill this task. The purpose of the present work was to evaluate, in an ex-vivo system simulating an in-situ bypass, the efficiency of valve cutting and the degree of luminal damage produced by four of the most commonly used instruments (Reusable LeMaitre, Expandable LeMaitre, Gore Eze-Sit, and Mills). Cryopreserved cadaveric veins (2.5-6 mm diameter) were mounted in a perfusion chamber and submerged in Ringer's lactate. The same buffer containing 0.6% papaverine was infused at a pressure of 100 mm Hg through a catheter inserted into the proximal end of the vein. The valvulotome to be evaluated was introduced through the distal end of the vein, advanced beyond the most proximal valve and withdrawn at a rate similar to that used clinically through the full length of the vein. The vein was opened longitudinally and the efficacy of valve cutting (expressed as percent of individual valve cut) and presence of luminal damage were carefully evaluated by means of a dissecting microscope. Thirty-three valves in seven segments of veins (mean size 4.35 ± 0.86 mm) were tested with the Reusable LeMaitre valvulotome. The percent of valvular cutting was 29.9 ± 33.4. The Expandable LeMaitre valvulotome was tested in 22 valves contained in five segments (vein diameter 4.07 ± 1.04 mm) and the percent of valvular cutting was 89.2 ± 15.7. The Gore Eze-Sit valvulotome produced a 80.6 ± 25.5% of cutting in the 32 valves contained in the seven venous segments tested (vein diameter 3.67 ± 0.42 mm). The Mills valvulotome was tested in five segments of vein containing 20 valves and there was a 82.1 ± 24.0% of valve cutting after valvulotomy (diameter 3.67 ± 0.57 mm). Statistical analysis demonstrated a significant difference with less cutting (p < 0.0001) when the results of the Reusable LeMaitre valvulotome were compared against each of the other three valvulotomes. Luminal damage was detected in one instance after use of the Mills valvulotome. The Expandable LeMaitre, Gore Eze-Sit, and Mills valvulotomes demonstrated consistent efficacy in valve cutting, the Mills valvulotome producing injury to the wall in one occasion. The Reusable LeMaitre valvulotome gave significantly poorer results, most likely related to failure of engagement of the circular blade. Because of the presently demonstrated safety and efficacy, and avoidance of need for long skin incisions, the Expandable LeMaitre and Gore Eze-Sit are the most promising of the four tested valvulotomes.
A New Nd: YAG Laser-Bearing Angioscope is Useful for Visualizing and Treating Lesions of the Superior Vena Cava and the Right-Sided Chambers of the Heart
Authors: Fujisawa Takehiko , Yamaguchi Yutaka , Saitoh Yukio , Sekine Yasuo , Takeda Tsunehiro 
Published: June 2007

The utility of a prototype Nd:YAG laser-bearing angioscope was evaluated for the diagnosis and treatment of neoplastic lesions of superior vena cava (SVC) and right-sided chambers of the heart in dogs. The angioscope had a balloon tightly fixed to the tip with heat shrink tubing and suture ligation. Approximately 96% of the Nd:YAG laser energy penetrated the balloon without rupture when the balloon was inflated with saline solution and was in direct contact with the target. The internal surfaces of the SVC, inferior vena cava, right atrium, tricuspid valve, right ventricle, and main pulmonary artery were visualized clearly by this angioscopic technique. The Nd:YAG laser was guided successfully under direct vision and a surgically transplanted neoplasm in the SVC was irradiated. Tumor coagulation was confirmed macroscopically and microscopically. This new angioscope requires further improvement, specifically, to decrease its diameter and improve the durability of the balloon.
Carotid Replacement Grafts for Extracranial Atherosclerotic Disease
Authors: Madera Freddy A. , Razzino Richard A. , Orecchia Paul M. , Calcagno David 
Published: June 2007

Carotid artery reconstruction using interposition grafts is usually indicated for management of recurrent stenosis where endarterectomy cannot be performed, where quality of the carotid artery is unsatisfactory following endarterectomy, or where there are aneurysmal changes in the artery. The purpose of this study was to evaluate the perioperative and long-term results in patients who underwent carotid replacement grafts. The authors conducted a retrospective chart review of 758 operations performed for extracranial carotid disease between August 1987 and February 1995. In 10 of these cases, the quality of the carotid artery following endarterectomy was so thin or had such an irregular surface that replacement grafts were necessary. In three of these 10 patients, surgery had been performed for recurrent carotid stenosis. Autogenous vein was utilized in seven cases, and prosthetic material was used in three cases (polytetrafluoroethylene [PTFE] in two cases and Dacron in one case). Follow-up was complete in all patients and ranged from 16 to 87 months (mean, 47 months). Serial duplex scans were performed in all cases. All grafts remained patent, but duplex scanning detected severe stenosis in two of the 10 grafts at 7 and 39 months, respectively, after the initial reconstruction. In both cases, contrast angiography confirmed the findings. In both patients, the areas of stenosis occurred in the midportion of a reversed vein graft at a valve site. The stenoses were corrected without further restenosis. There were no postoperative stenoses in the three cases where prosthetic material was used. There were no early or late strokes or deaths. The late secondary patency of carotid artery replacement grafts is excellent. Intraoperative detection and ablation of venous valves or choosing a vein segment without valves when autologous grafts are used may decrease the incidence of secondary stenosis. Serial duplex scanning is recommended for both short-term and long-term follow-up.