0000000000005249
AUTHOR
Achim Neufang
Below knee femoropopliteal bypass with glutaraldehyde-tanned modified human umbilical vein (Dardik-Biograft) – experience with the modified prosthesis
Fur den kniegelenkuberschreitenden peripheren Bypass ist die V. saphena magna des Transplantat der ersten Wahl. Bei fehlender autologer Vene ist die denaturierte humane Umbilikalvene (HUV) neben rein synthetischen Gefasprothesen eine selten erwogene Alternative zum autologen Gefasersatz. Zur Beurteilung ihrer langfristigen Bypassfunktion und degenerativer Veranderungen erfolgte bei nicht geeigneter V. saphena magna die Verwendung der denaturierten humanen Umbilikalvene bei kniegelenkuberschreitenden femoropoplitealen Bypassoperationen. Bei 54 Patienten wurden 55 kniegelenkuberschreitende femoropopliteale Bypassoperationen mit Umbilikalvene durchgefuhrt. Die Operationsindikation bestand uber…
External polytetrafluoroethylene reinforcement of varicose autologous vein grafts in peripheral bypass surgery produces durable bypass function
Abstract Objective Use of autologous veins as peripheral bypass graft may become critical in the presence of significant varicose degeneration of the harvested vein. External support of such dilated veins with standard polytetrafluoroethylene (PTFE) prostheses was recommended as an option to use these veins for peripheral bypass. A single-center experience with this technique regarding long-term graft function, secondary reinterventions, and potential graft degeneration is presented. Methods Between January 1995 and January 2006, there were 54 patients with varicose veins who underwent 57 consecutive infrainguinal vein bypass operations with PTFE reinforcement in 57 limbs. Indications for s…
Intérêt des fistules artérioveineuses pour les pontages distaux à haut-risque d’échec précoce
Les resultats des fistules arterioveineuses adjuvantes (FAV) dans la chirurgie de pontage en cas de mauvaise artere receveuse, de flux peroperatoire severement altere, ou de revision pour defaillance precoce et restauration du flux ont ete analyses dans une etude retrospective. De janvier 1998 a decembre 2006, 24 FAV adjuvantes ont ete construites sur la veine autologue ou des pontages distaux composites ayant un mauvais debit peroperatoire, une mauvaise artere pedieuse, ou en cas de reprise precoce de pontage reussie pour empecher un echec de pontage. Toutes les revascularisations sous-inguinales etaient enregistrees dans une base de donnees automatisee prospective. Les pontages distaux av…
CT-Angiographie bei arterieller Verschlußkrankheit: Vergleich von 3 Rekonstruktionsverfahren
Purpose To evaluate different rendering techniques of CT data for the assessment of long vessel segments in peripheral vascular occlusive disease. Material and methods 40 CT angiograms (aortoiliac: n = 20, leg arteries: n = 20) were viewed using three different rendering techniques: 1, maximum intensity projection (MIP); 2, volume rendering (VR); 3, shaded surface display (SSD). CT angiograms were obtained in 6 or 8 projections. Axial cross-section images were analysed using an interactive cine mode. Intraarterial DSA was the standard in all cases. Results The sensitivities for the diagnosis of occlusive disease were 100% (cross-section images), 94% (MIP), 91% (VR) and 93% (SSD). The specif…
Patency of renal and visceral vessels after open thoracoabdominal aortic replacement.
Objective In thoracoabdominal aortic aneurysms (TAAAs), a paradigm shift is observed from open surgery toward total endovascular aortic repair using fenestrated and branched endografts. Whereas outcome after open replacement in terms of mortality and paraplegia has been evaluated extensively, no studies exist addressing long-term patency of visceral and renal vessels. To enable comparison of target vessel patency between open and endovascular treatment, we analyzed our series of open TAAA replacements. Methods Our vascular surgery database was screened for patients who received open TAAA replacement between 1998 and 2012, and patient records were analyzed retrospectively. All available imag…
Pedale Bypasschirurgie bei diabetischen Fußsyndrom: Indikation, Technik und Ergebnisse
Die periphere arterielle Verschlusskrankheit des diabetischen Patienten ist bevorzugt durch einen langstreckigen Verschluss der Unterschenkelarterien uner teilweiser Aussparung der Fusarterien gekennzeichnet. Aufgrund der begleitenden Polyneuropathie und der erhohten Infektanfalligkeit besteht fur diese Patienten ein dramatisch erhohtes Amputationsrisiko. Dieses Verschlussmuster ermoglicht aber die Anlage pedaler Venenbypasse speziell auch unter Uberbruckung kurzerer Distanzen als sog. “distal origin bypass”.
Endovascular treatment of acute bleeding complications in traumatic aortic rupture and aortobronchial fistula.
Objective: Herein we report our experience in placement of endovascular stentgrafts in the descending aorta in patients with acute bleeding complications due to traumatic rupture or aortobronchial fistula. Methods: Six patients (one woman, five men, mean age 47 ^ 19 years) were treated from September 1995 to February 2000 by implantation of endovascular stentgrafts in the descending aorta. Indications included traumatic ruptures of the aortic isthmus (na 3) and aortobronchial fistulas (na 3). All procedures were performed under general anaesthesia. The implants were introduced under fluoroscopic guidance via the aorta (na 1), the iliac (na 4) or femoral (na 2) artery, respectively. Results:…
Klassifikation und Therapie von Endolecks nach endovaskulärer Behandlung von abdominellen Aortenaneurysmen
This article describes the classification of endoleaks after endovascular treatment of abdominal aortic aneurysms, thereby summarizing the most important problems of this endovascular technique. The correct classification of endoleaks is a prerequisite for interdisciplinary discussion. It is indispensable for professional reporting of the pathological findings and for the decision making as to the adequate treatment of endoleaks. Irrespective of the types of stent graft and property of the material, five endoleak types are defined in the literature: leakage at the anchor sites (type I); leakage due to collateral arteries (type II); defective stent grafts (type III); leakage due to porosity …
Arterial Embolism to the Upper Extremity in a Patient with Factor V Leiden Mutation (APC Resistance)
Factor V Leiden mutation has emerged as one of the leading abnormalities in inherited blood coagulation disorders, resulting in a markedly increased risk for deep leg vein thrombosis. A 24- year-old woman presented with acute onset of critical ischemia of her left thumb and index finger. Intraarterial angiography revealed an embolus in the distal radial artery and a thrombotic occlusion of the digital artery of the thumb and index finger. Immediate therapy encompassed a selective surgical embolectomy of the distal radial artery followed by a local intraarterial lysis that was continued for 3 days. Additionally, therapeutic anticoagulation and vasodilating drugs (prostaglandin E) were admin…
Das Popliteaaneurysma: Klinik und Diagnostik
PURPOSE To identify clinical and radiological features allowing an early diagnosis of popliteal aneurysms. MATERIAL AND METHODS History, clinical features and radiological findings of 23 patients with 37 aneurysms were reviewed. RESULTS 14 patients presented with a history of a sudden onset of rest pain localised in the calf or foot. Arteriography found popliteal artery occlusion in 12 of them. Amputation was necessary in one patient in spite of immediate diagnosis and therapy. In two cases embolisation of the tibial vessels caused intermittent claudication. In at least 7 patients the underlying disease was not suspected until arteriography was performed. In 16/23 patients the presence of t…
Extremitätenerhalt durch pedalen In-situ-Bypass beim diabetischen Fußsyndrom
INTRODUCTION: Treatment of the ischemic diabetic foot syndrome still represents a medical and economic challenge. Contrary to the aims of the Saint Vincent declaration a dramatic reduction of major amputations in Germany was not noted, although in the diabetic patients the predominant type of tibial artery occlusion allows construction of pedal bypasses for limb salvage. METHOD: In patients with ischemic diabetic foot syndrome following angiographic evaluation of the ischemic limb, the indication for surgical revascularisation of patent pedal arteries was established. The in-situ technique was preferred in the presence of a suitable ipsilateral greater saphenous vein whenever possible. Reva…
VS07�EXCELLENT LATE OUTCOME WITH DENATURATED HUMAN UMBILICAL VEIN (HUV) IN FEMOROPOPLITEAL BYPASS SURGERY - A GOOD EXAMPLE FOR THE IMPORTANCE OF BIOLOGICAL MATERIALS IN VASCULAR SURGERY
Purpose: Femoropopliteal bypass with autologous vein provides excellent long term results in lower limb bypass. In case of unsuitable vein generally synthetic PTFE prostheses are preferred. Denaturated human umbilical vein was used as femoropopliteal bypass graft when autologous vein was not available. Long term results of a consecutive single center series are presented. Methodology: HUV was implanted in femoropopliteal position in case of unavailable vein for symptomatic peripheral vascular disease or popliteal aneurysm. Follow-up examinations were performed after 3, 6, 12, 18, 24 months and annually thereafter. Duplex scan was used for detection of potential biodegeneration of the HU…
CT angiography versus intraarterial digital subtraction angiography for assessment of aortoiliac occlusive disease.
The purpose of this study was to evaluate the accuracy of CT angiography (CTA) with a single helical acquisition for assessment of stenoses and occlusions of the iliac arteries.In our prospective study, intraarterial digital subtraction angiography and IV CTA were performed from the suprarenal aorta to below the femoral bifurcation in 30 patients with vascular occlusive disease. Maximum-intensity-projection images in multiple views were also obtained. The accuracy of CTA with and without analysis of axial images was determined.Sensitivity and specificity of CTA were 100% for iliac artery occlusions with a confidence interval 85-100% and 97-100%, respectively. When axial scans were interpret…
Use and durability of femoral vein for autologous reconstruction with infection of the aortoiliofemoral axis.
Objective To analyze early and late mortality, venous morbidity, reinfection, and freedom from reintervention after using the femoral vein (FV) for vascular reconstruction with infection of the aortoiliofemoral axis. Methods By reviewing our database, 86 patients could be identified with implantation of FV grafts in infected fields between November 1995 and July 2012. The patient records were retrospectively analyzed and follow-up information obtained from patients or their general physician. Seventy-one patients presented with prosthetic graft infection and 15 with an infected aneurysm. For data analysis, patients were divided into an aortoiliac (n = 67) and a femoral group (n = 19). Study…
Questionable Value of Adjuvant Arteriovenous Fistula in Pedal Bypass at High Risk for Early Failure
Results of an adjuvant arteriovenous fistula (AVF) in pedal bypass surgery in the presence of poor status of the recipient artery, severely impaired intraoperative runoff, or revision for early failure and flow restitution were analyzed in a retrospective study. From January 1998 to December 2006, 24 adjuvant AVFs were constructed in autologous vein or composite pedal bypasses with low intraoperative bypass flow, poor status of the pedal artery, or during successful early bypass revision to prevent graft failure. All infrainguinal bypass operations were registered in a computerized database and prospectively followed. Pedal bypasses with adjunctive AVF were reviewed for fistula function, gr…
Ergebnisse der kontrastverstärkten MR-Angiographie der aortoiliakalen Gefäße mit einem 1-molaren Kontrastmittel bei 1,0 T: Vergleich zur i. a. DSA
PURPOSE To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) using a 1.0 molar contrast agent at 1.0 T for the diagnosis of abdominal aortic aneurysms and stenoses of renal or iliac arteries in comparison to intraarterial digital subtraction angiography (DSA). MATERIALS AND METHODS A total of 19 patients with the suspicion of abdominal aortic aneurysm or stenosis of renal or iliac arteries were examined with CE-MRA at 1.0 T. Intra-arterial DSA served as reference in all cases. After test bolus tracking, 10 or 8 ml of the 1.0 molar contrast agent Gadobutrol corresponding to a dose of 0.1 - 0.15 mmol/kg bw were injected and imaging performed using a FLASH-3D sequen…
Druckentlastung im Aneurysmasack nach endovaskulärer Therapie von Aortenaneurysmen*
PURPOSE Stent grafting of aortic aneurysms should result in relief of pressure within the excluded aneurysmal sac, however confirming data are not available. This study evaluates the intra-extraluminal pressure translation and translation of maximum pressure increase (dp/dtmax) into the excluded aneurysmal sac after endovascular treatment of experimental aortic aneurysms. MATERIALS AND METHODS Experimental autologous aneurysms were created surgically using a patch from the sheath of the rectus abdominis muscle in 12 mongrel dogs. After 12 weeks reconvalescence, endovascular treatment was performed viafemoral access using dacron-covered nitinol stents. Spiral CT and angiography were performe…
Pathophysiologie des diabetischen Fußsyndroms (DFS)
Beim diabetischen Fussyndrom (DFS) werden verschiedene Formen unterschieden, das polyneuropathische Plantarulkus, die ischamische diabetische Gangran, die Osteoarthropathie und Mischformen. Gerade die ischamische Gangran und die ischamisch/polyneuropathische Mischform werden haufig unzureichend diagnostiziert und therapiert. Eine effektive Behandlung leidet unter der weit verbreiteten irrefuhrenden Annahme der Existenz einer Mikroangiopathie, wie sie z. B. in der Niere oder Retina beobachtet wird. Eine obliterierende Mikroangiopathie ist am diabetischen Fus nicht nachweisbar. Es sind makroangiopathische Veranderungen (AVK), die zum ischamischen DFS fuhren und die einer gefaschirurgischen Re…
CT-Angiographie versus intraarterielle DSA bei Bauchaortenaneurysmen
PURPOSE To evaluate if CT angiography is able to image all features necessary for the preoperative planning of abdominal aortic aneurysms (accessory renal arteries, stenoses or occlusions of renal and iliac arteries, patency of inferior mesenteric artery). METHODS CT angiography and DSA were performed on 27 patients with abdominal aortic aneurysms. CT angiography was performed using a protocol that covered the abdominal aorta and the pelvic arteries with a single spiral acquisition (contrast dose: 150 ml, collimation: 5 mm, table feed: 7.5 mm/s, increment of reconstruction: 2 mm). Maximum intensity projections (MIP) and axial scans were compared with the results of intraarterial DSA. RESULT…
Infrapopliteal Composite Bypass with Autologous Vein and Second Generation Glutaraldehyde Stabilized Human Umbilical Vein (HUV) for Critical Lower Limb Ischaemia
Objective. To audit a single center consecutive series of infrapopliteal composite bypasses with second generation glutaraldehyde stabilized human umbilical vein. Design. Retrospective study. Patients. From January 1996 to July 2006 89 femoro-distal bypasses were constructed in 85 patients with HUV and residual vein segments as composite grafts in the absence of sufficient length of autologous vein. Methods. All patients with infrainguinal bypass operations were registered prospectively. Bypasses to infrapopliteal arteries performed with HUV-composite grafts were reviewed for graft patency, limb salvage, patient survival and possible biodegeneration of the HUV. Results. Early graft thrombos…
Diabetes and Peripheral Arterial Occlusive Disease
The purpose of this study was to compare contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography (DSA) for identifying and evaluating arteries of the distal calf and foot in diabetic patients with severe arterial occlusive disease who will undergo distal bypass surgery.Twenty-four feet of 24 consecutive patients with diabetes and limb-threatening lower extremity ischemia were prospectively imaged using an ultrafast three-dimensional fast low-angle shot sequence on a 1.5-T MR scanner. All patients also underwent DSA of the diseased extremity within 5 days. Images were interpreted in a randomized manner by two observers in conference. Each lower ex…
Wie wichtig ist die Arteria iliaca interna, wie schwierig ist ihre Rekonstruktion?
Die Arteria iliaca interna zieht nach der Aufzweigung der A. iliaca comm. in das kleine Becken und teilt sich meistens in einen vorderen und einen hinteren Stamm. Der vordere Stamm entsendet Aste zur vorderen Beckenwand, zu den Adduktoren des Oberschenkels, zur Genitoanalregion und zur Gesasgegend und viszerale Aste zu den Beckeneingeweiden. Aus dem hinteren Stamm treten parietale Aste zur dorsolateralen Beckenwand und Gesasregion.
Utilidad cuestionable de la fístula arteriovenosa auxiliar en el bypass distal de riesgo
En un estudio retrospectivo se analizaron los resultados de la colocacion de una fistula arteriovenosa (FAV) auxiliar en la cirugia de bypass distal en presencia de una arteria receptora de mala calidad o con severa alteracion de la circulacion colateral. Desde enero de 1998 hasta diciembre de 2006, se crearon 24 FAV auxiliares en venas autologas o en bypass distales mixtos que presentaban un flujo intraoperatorio bajo, arteria distal de mala calidad, o durante la revision inicial de un bypass para prevenir su fracaso. Todas las cirugias de bypass infrainguinal se registraron en una base de datos informatizada y se realizo su seguimiento de forma prospectiva. En los bypass distales con FAV …
Der kurze popliteodistale Venenbypass beim diabetischen Fußsyndrom DFS
Purpose: World wide increase of diabetes compound with diabetic foot syndrome becomes a challenge in vascular surgery to avoid limb loss. In diabetics a special pattern of atherosclerosis is prevalent with disease limited to the infrageniculate arteries but sparing inflow vessels and distal tibial and pedal arteries. This provides short bypass grafting from popliteal to tibial and pedal arteries, a concept first described by F. Veith in 1981. Methods: Diabetics with severe atherosclerotic disease and limb-threatening ischemia got general evaluation and vascular imaging. Falling in this special category the patients underwent short vein bypass grafting originating at the first or third popli…
Durability of open popliteal artery aneurysm repair
Objective The objective of this study was to analyze our long-term results after open surgery for popliteal artery aneurysm. Methods Records of patients who received surgery between 1998 and 2010 were retrieved from a computerized database and analyzed retrospectively. End points of the study were perioperative mortality and morbidity and patency and limb salvage rate. Results Two hundred and six popliteal aneurysms (median diameter, 30 mm; interquartile range, 18 mm) were treated (161 elective, 45 emergent) in 154 patients (mean age, 67 ± 11 years) using vein grafts (82%) via the medial approach (92%). Above-knee popliteal artery (45%) and below-knee popliteal artery (65%) were the predomi…
Endovaskuläre Behandlung akuter Erkrankungender thorakalen Aorta
Purpose To investigate the safety and efficacy of emergency treatment of acute aortic diseases with endovascular stent grafts. Methods In 11 patients (median age 55 years, range 18 - 85) with acute complications of descending aortic diseases endovascular emergency treatment was performed: traumatic aortic rupture (n = 4), penetrating ulcer with aortobronchial fistula or hematothorax (n = 4), acute type B dissection (n = 2, one with penetration, one with subacute mesenteric ischemia), and symptomatic aneurysm of the thoracic aorta (n = 1) with pain and diameter progression. 15 stent grafts were implanted (Talent n = 11, Vanguard/Stentor n = 4). Stent extension was necessary in 4 cases. In 2 …
External reinforcement of varicose veins with PTFE prosthesis in infrainguinal bypass surgery -- clinical results.
OBJECTIVE Segmental varicose degeneration of the autogenous greater saphenous vein may limit its use in infrainguinal bypass surgery. Wrapping a PTFE prosthesis around dilated veins has emerged as an option to create externally reinforced vein bypasses. Results regarding graft patency and limb salvage were analyzed. METHODS Between September 1995 and January 2001, 35 infrainguinal bypass operations in 33 patients were performed with greater saphenous veins exhibiting segmental varicose dilatation. Grafts were followed by duplex scan and retrospective analysis of graft patency and limb salvage was performed. RESULTS One bypass prompted successful revision for early occlusion. Four bypasses r…
Die interdisziplin�re Therapie des diabetischen Fu�syndroms
Noch immer werden in Deutschland 28.000 Amputationen/Jahr bei Patienten mit diabetischem Fussyndrom (DFS) durchgefuhrt.Bei gleichzeitig haufig vorhandener ischamischer und osteomyelitischer Komponente fuhrt ein operatives Vorgehen in der Regel zu Wundheilungsstorungen,Nachamputationen und oft auch Extremitatenverlust.Die Ergebnisse eines interdisziplinaren Therapieregimes werden evaluiert und im Literaturvergleich bewertet. Nach Diagnostik hinsichtlich des Vorliegens einer Polyneuropathie,Osteomyelitis und vor allen Dingen einer pAVK hat nach Infektkontrolle die primare distale Bypasschirurgie hochste Prioritat, ihr Erfolg ist richtungsweisend fur den weiteren Verlauf der Erkrankung.Die spa…
Autogenous Reconstruction of Infected Arterial Prosthetic Grafts Utilizing the Superficial Femoral Vein1
BACKGROUND Prosthetic infection after reconstructive vascular surgery is a most serious complication, associated with high mortality and amputation rates. Following excision of the infected graft, several methods of reconstruction are available. We present here our experience with autogenous reconstruction of infected prosthetic arterial grafts using the superficial femoral vein (SFV). METHODS From November 1995 to December 1999, we used the SFV in seven patients (mean age 70 years) for reconstruction of an infected aortobifemoral (n = 2), aortoiliac (n = 1), femorofemoral bypass (n = 1), femorotibial (n = 2) and carotid crossover bypass (n = 1). Treatment encompassed complete prosthetic ex…
Interdisziplinäre Diagnostik und Therapie des ischämisch-osteomyelitischen diabetischen Fußsyndroms
Fortgeschrittene Stadien des diabetischen Fussyndroms (DFS) mit ischamischer und osteomyelitischer Komponente fuhren im Rahmen gangiger Versorgungsstrukturen regelhaft zur Minoramputation, gefolgt von ischamisch bedingter Wundheilungsstorung und Extremitatenverlust. Selbst in spezialisierten Behandlungseinrichtungen stellen periphere arterielle Verschlusskrankheit (pAVK) und Osteomyelitis die groste Herausforderung im Bemuhen um den Extremitatenerhalt dar. Wahrend die Behandlung von polyneuropathischen Fuslasionen in den Handen von Diabetologen zur erfolgreichen Domane der konservativen Medizin geworden ist, ist fur die Therapie von fortgeschrittenen, ischamisch und osteomyelitisch komplizi…
Sequential Femorodistal Composite Bypass with Second Generation Glutaraldehyde Stabilized Human Umbilical Vein (HUV)
Abstract Objective To evaluate the performance of sequential composite bypasses with second generation glutaraldehyde stabilized human umbilical vein (HUV) and autologous vein. Design Retrospective study of consecutive patients, in a single centre. Patients From January 1998 to December 2003, 54 femoro-distal HUV-autologous vein sequential composite bypasses were constructed in 52 patients with critical leg ischemia and absence of sufficient length of autologous vein. Methods All infra-inguinal bypass operations were registered in a computerized database and prospectively followed. Bypasses using sequential HUV-composite technique were reviewed for graft patency, limb salvage and patient su…
Outcomes of complex femorodistal sequential autologous vein and biologic prosthesis composite bypass grafts
Objective Femorodistal autologous vein bypass proves to be the preferred surgical therapy for long arterial occlusions and provides excellent early and long-term results in critical lower limb ischemia. Whenever vein length was insufficient and two distal outflow arteries were present, a sequential composite bypass configuration was chosen with human umbilical vein (HUV) or ovine collagen prosthesis (Omniflow II; Bio Nova International Pty Ltd, North Melbourne, Australia) as the proximal prosthetic part of the bypass. Single-center experience with this technique regarding limb salvage, graft function, secondary reinterventions, and biodegeneration is presented. Methods Between January 1998 …
Therapie thrombembolischer Verschlüsse der Unterschenkelarterien: Klinische Erfahrungen mit dem Angiojet®-Thrombektomiekatheter
UNLABELLED To investigate the clinical impact of a new hydrodynamic thrombectomy catheter in thromboembolic occlusion of tibial arteries. METHOD 10 patients with thromboembolic occlusion of all tibial arteries were treated with the Angiojet thrombectomy device in order to reestablish blood flow. Depending on angiographic and clinical results of thrombectomy, additional thrombolysis, PTA, recanalization, or surgical bypass grafting was performed. RESULTS Antegrade blood flow in at least one tibial artery was reestablished in 6 cases with the thrombectomy device. However, additional treatment modalities were used in order to improve the outcome and to resolve adherent thrombi or to treat vess…
Femoropopliteal prosthetic bypass with glutaraldehyde stabilized human umbilical vein (HUV).
Objective Femoropopliteal bypass still is the standard surgical therapy for disabling claudication and critical ischemia. When autologous vein is not suitable synthetic or biological prostheses may be considered. Second generation glutaraldehyde tanned human umbilical vein (HUV) graft was chosen for above and below knee femoropopliteal bypass when autologous vein was not available. A single center experience regarding long-term graft function, secondary reinterventions, and potential biodegeneration of the HUV is presented. Methods Between January 1994 and January 2005, 211 consecutive femoropopliteal bypass operations with HUV (65 above knee and 146 below knee) were performed in 197 patien…
Die Eversions-Endarterektomie der A. carotis interna als Simultanoperation in der Koronarchirurgie
Im Zeitraum von Oktober 1993 bis Oktober 1996 wurde bei 27 Patienten simultan zur Koronaroperation eine Eversions-Endarterektomie (EEA) der A. carotis interna durchgefuhrt. Praoperativ hatten 2 Patienten eine Hemiparese erlitten, 3 Patienten hatten uber transitorisch ischamische Attacken (TIA) berichtet. Bei den ubrigen Patienten mit asymptomatischer Karotis-Interna-Stenose wurde die Operationsindikation aufgrund einer hochgradigen, wenn auch klinisch asymptomatischen Stenosierung (>90%) gestellt. Bei 23 Patienten lag eine einseitige Karotisstenose vor, bei 4 Patienten war auch die Gegenseite bis maximal 70% stenosiert, wobei sich die Wahl der Operationsseite nach der klinischen Symptomatik…
Endovaskuläre Aneurysmatherapie - Langzeitergebnisse nach 7 Jahren
Hintergrund: Seit der Entwicklung von Stentprothesen und deren kommerzieller Verfugbarkeit 1994 gibt es eine neue, sich zunehmend verbreitende endovaskulare Methode der Aneurysmatherapie.
Krurale und pedale Bypasschirurgie bei kritischer Isch�mie und nicht heilenden Fu�l�sionen
Die Ischamie ist der haufigste Grund fur nicht heilende Lasionen an den Fusen. Mit der weltweiten Zunahme vaskularer Erkrankungen und insbesondere des diabetischen Fussyndroms steigt auch die Zahl der Patienten, die durch eine Revaskularisation geheilt werden konnen, momentan aber uberwiegend (25.000/Jahr in Deutschland) amputiert werden. In den letzten Jahrzehnten sind in der Gefaschirurgie subtile Methoden entwickelt worden, die auch eine Revaskularisation und Bypassoperationen bei Patienten mit einem distalen Verschlusstyp, der immer haufiger und gerade beim Diabetiker angetroffenen wird, zulassen. Eine besondere Rolle spielt hier der Venenbypass aus V. saphena magna oder alternativen Ve…
Minimum cause--maximum effect: the travelogue of a bullet.
This case report involves a 57-year-old male, accidentally shot in the chest with a small bore firearm. The bullet entered the left hemithorax, disrupting the left internal mammarian artery. It then penetrated the anterior wall of the right ventricle causing a pericardial tamponade. After leaving the base of the right heart it perforated the diaphragm, the liver, the spleen and the pancreas. Finally, it penetrated the abdominal aorta 3 cm proximally to the coeliac trunk and reached its final position paravertebrally. This case report illustrates that the management of even minimum gunshot wounds requires a maximum variety of surgical skills. Keywords: Thoracoabdominal injury; Shotgun wound;…
Endovaskuläre Therapie aortaler Aneurysmen: erste klinische Ergebnisse
PURPOSE A clinical study aiming at examining the implantation technique and the clinical results of a new vascular prosthesis in endovascular therapy of aneurysms of the aorta. MATERIAL AND METHODS In 21 patients (20 men of 55 to 87 years of age, average age 70 years) with aneurysms of the infrarenal abdominal aorta (AAA n = 19) and the thoracic aorta (n = 2), a self-expanding nitinol stent with outer Dacron sheath (tubular prosthesis n = 4; bifurcation prosthesis n = 17) was implanted by means of an F-18 introductory set after surgical opening of the inguinal artery. RESULTS By means of the 4 tubular prostheses and 13 of the 17 bifurcation prostheses the aneurysm was bypassed completely. I…
Diagnosis of perioperative myocardial necrosis following coronary artery surgery — a reappraisal of isoenzyme analysis
Although the routine determination of CK-MB activity is widely used after coronary artery bypass grafting (CABG), the diagnosis of a perioperative myocardial necrosis remains arbitrary. The intention of the present study was to develop discriminative enzymatic parameters of CK-MB activity in a collective of 710 patients following CABG. Patients were grouped according to their postoperative electrocardiogram (ECG). For each patient, the time activity curve of CK-MB was determined. The total amount of CK-MB was calculated by integrating the area beneath the CK-MB activity curve. Patients presenting with an unchanged postoperative ECG (group I) or a new bundle branch block with uncompromised h…
Contemporary results with the biosynthetic glutaraldehyde denatured ovine collagen graft (Omniflow II) in femoropopliteal position
Abstract Objective The objective of this study was to analyze the outcome of a contemporary series of femoropopliteal bypass operations with the glutaraldehyde denatured polyester mesh-reinforced ovine collagen prosthesis (OCP; Omniflow II [LeMaitre Vascular, Inc, Burlington, Mass]). The experience of two tertiary centers regarding long-term graft function, secondary reinterventions, and biodegeneration of the OCP prosthesis is presented. Methods Between January 2006 and January 2014, a series of 205 consecutive operations with the OCP in the femoropopliteal position (54 above knee and 151 below knee) were performed in 194 patients in 202 limbs for disabling claudication (72), chronic criti…
New bundle branch block after coronary artery bypass grafting— evaluation by CK-MB isoenzyme analysis and transoesophageal echocardiography
Twelve patients with a new complete bundle branch block after coronary artery bypass grafting underwent transoesophageal echocardiography (TEE). The results of TEE were compared with the pre-operative ventriculography, CK-MB isoenzyme time-release curves and clinical course. In eight patients with transient right bundle branch block or bifascicular block, low CK-MB activities and an uncomplicated postoperative course, transoesophageal echocardiography showed no new segmental wall motion abnormalities apart from a paradoxical septal movement in five. A persistent right or left bundle branch block was associated with either elevated isoenzyme activities, transoesophageal echocardiographic evi…
Einfluss von Typ-II-Endoleaks auf die Größenänderung und Hämodynamik experimenteller Aortenaneurysmen nach endovaskulärer Therapie
PURPOSE To evaluate the aneurysm volume and the intra-aneurysmatic pressure and maximal pressure pulse (dp/dtmax) in completely excluded aneurysms and cases with endoleaks. MATERIALS AND METHODS In 36 mongrel dogs, experimental autologous aneurysms were treated with stent-grafts. All aortic side branches were ligated in 18 cases (group I) but were preserved in group II (n = 18). Aneurysm volumes were calculated from CT scans before and after intervention, and from follow-up CT scans at 1 week, 6 weeks and 6 months. Finally, for hemodynamic measurements, manometer-tipped catheters were introduced into the excluded aneurysm sac (group I and II), selectively in endoleaks (group II), and intral…
Immune Response to Gelatin- and Collagen-Impregnated Aortic Dacron Grafts
Dacron grafts are very common in vascular surgery. Primarily sealed grafts have been available for ten years. These improve handling and reduce intraoperative blood loss. Despite a widespread use all over the world, it has as yet not been clarified whether coating (sealing) substances might cause an immune response, especially in situations of fever or other unexplained events in the postoperative course after graft implantation. In this study, 37 patients with a gelatin-impregnated (Unigraft) and 33 with a collagen-impregnated (Hemashield) graft for aortic or aortoiliac replacement were compared. Serum samples were investigated for collagen antibodies at operation, one week and three mont…
Systemic pulsatile pressure in type II endoleaks after stent grafting of experimental abdominal aortic aneurysms.
Purpose: To investigate pressure and maximum rate of rise of systolic pressure (peak dP/dt) in completely excluded aneurysms and endoleaks to determine the hemodynamic impact of endoleaks. Methods: In mongrel dogs (n = 36) experimental aneurysms were created by insertion of a patch (portion of rectus abdominis muscle sheath) into the infrarenal aorta. In group I (n = 18), all aortic branches of the aneurysm were ligated and all aneurysms were completely excluded by stent grafts. Group II (n = 18) consisted of aneurysms with patent aortic side branches that represented sources of endoleaks. One week (n = 12), six weeks (n = 12), and six months (n = 12) after stent grafting, hemodynamic measu…
Endovascular Aneurysm Repair
Background — The purpose of the present study was to systematically analyze the histopathologic organization processes in excluded aneurysms after endovascular stenting and to develop a noninvasive monitoring method for these processes using MRI. Methods and Results — In 36 mongrel dogs, autologous aortic aneurysms were created. Endovascular treatment was performed using covered stents. Follow-up was after 1 week, 6 weeks, and 6 months. MRI was performed with T 2 -weighted turbo-spin-echo sequences and T 1 -weighted spin-echo sequences and was repeated after contrast bolus with gadolinium. Histopathologic findings were correlated to signal intensities (SIs) of MRI images. SIs of distinct a…