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…

CD59 (homologous restriction factor 20), a plasma membrane protein that protects against complement C5b-9 attack, in human atherosclerotic lesions

Blood cells express a cell membrane protein, termed homologous restriction factor 20 (HRF20) and identical to CD59, that can inhibit complement C5b-9 insertion into their membranes. In this report, we investigated by immunohistochemistry whether CD59 was present on cells in human atherosclerotic lesions since membranous C5b-9(m) has been found in lesions. Using a monoclonal anti-CD59 antibody, a cellular CD59 staining pattern was apparent in nearly all lesion specimens. CD59 stain co-localised with macrophage (CD14), T lymphocyte (CD7), endothelial cell (anti-factor VIII related antigen) and smooth muscle cell cytoskeletal-specific antigens (anti-alpha actin and muscle myosin). Endothelial …

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…

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…

Complement C6 deficiency protects against diet-induced atherosclerosis in rabbits.

Abstract —Low-density lipoprotein (LDL) can be transformed to an atherogenic moiety by nonoxidative, enzymatic degradation. Enzymatically degraded LDL induces macrophage foam cell formation, provokes release of cytokines, and also activates complement. To determine whether complement activation may contribute to atherogenesis, 6 pairs of homozygous C6-deficient rabbits and their non–C6-deficient heterozygous siblings were fed a cholesterol-rich diet for 14 weeks. Cholesterol levels and plasma lipoprotein profiles of the animals in the C6-competent and C6-deficient groups did not significantly differ, and the high density lipoprotein and LDL cholesterol ratios at the end of the experiment w…

An�sthesie zur endovaskul�ren Therapie aortaler Aneurysmen Verfahren und perioperative Risiken

Die transvaskulare Plazierung endoluminaler Gefasprothesen mittels interventionell-radiologischer Methoden ist ein neues, minimal invasives Verfahren zur Therapie von Aortenaneurysmen. Wir analysierten retrospektiv die Praktikabilitat verschiedener Anasthesieverfahren, die pathophysiologischen Auswirkungen des Eingriffs und typische Risiken. Bei 19 Patienten mit Aneurysmen der infrarenalen (n=18) oder der thorakalen Aorta (n=1) wurden in 23 Eingriffen aortale Stentprothesen implantiert. Die Eingriffe erfolgten in Allgemeinanasthesie (AA: n=9), in Periduralanasthesie (PDA: n=8) oder Lokalanasthesie (LA: n=6) mit Analgosedierung. Trotz erhohten Uberwachungsaufwands in der Gruppe AA ergaben si…

Penetration eines Iliacaaneurysmas in die Beckenvene

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…

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…

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 …

Enzymatically Degraded, Nonoxidized LDL Induces Human Vascular Smooth Muscle Cell Activation, Foam Cell Transformation, and Proliferation

Background —Enzymatic, nonoxidative modification transforms LDL to an atherogenic molecule (E-LDL) that activates complement and macrophages and is present in early atherosclerotic lesions. Methods and Results —We report on the atherogenic effects of E-LDL on human vascular smooth muscle cells (SMC). E-LDL accumulated in these cells, and this was accompanied by selective induction of monocyte chemotactic protein-1 in the absence of effects on the expression of interleukin (IL)-8, RANTES, or monocyte inflammatory proteins-1α and -β). Furthermore, E-LDL stimulated the expression of gp130, the signal-transducing chain of the IL-6 receptor (IL-6R) family, and the secretion of IL-6. E-LDL invok…

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…

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 …

Intravaskuläre Sonographie: Erste klinische Ergebnisse

Intravascular ultrasound is a new diagnostic modality which, for the first time, provides high resolution images of the vessel wall. 91 intraluminal ultrasound studies were performed in 50 patients during the course of 55 diagnostic and therapeutic catheterizations. A F-6 ultrasound catheter (20 MHz) was used. The method is an easily and rapidly performed addition to angiography. Changes in vessel walls (arteriosclerosis, dissection, tumour infiltration) can be readily diagnosed and their extent can be accurately described. The ability to determine luminal cross sectional area is particularly helpful for planning and performing therapeutic interventions.

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…

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…

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…

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…

Klinische Erfahrungen mit dem Kensey-Katheter-System - Komplikationen und Ergebnisse

Fifteen procedures have been carried out in 14 patients using the Kensey rotation angioplasty system. Sixteen occlusions of the superficial femoral artery, with an average length of 10.2 cm (3 to 24 cm) and one artery with multiple stenoses were treated. The following results were obtained: creation of a lumen, with subsequent balloon dilatation in eight out of fifteen procedures; in two patients the vessels were occluded shortly after the procedure, due to complications (one obstructive plaque and one haematoma); five perforations, three dissections and one peripheral embolus. The total complication rate was 11 out of 15 cases, clinical improvement was obtained in six out of 15 cases.

Laser Welding - Suitable for Vascular Anastomosis?

Carotid arteries of 21 piglets were transsected and reanastomosed either by laser welding (Neodym:YAG laser) or by conventional suture anastomosis. Histological specimens of the anastomoses obtained 2 to 32 days after the operation showed less foreign body reaction and intimal hyperplasia after laser welding than after suturing. There was, however, no significant difference when comparing occurrence of thrombosis, patency rate, or growth of the anastomosis in growing animals. Neither our study nor a review of the literature of laser-assisted vascular anastomosis in microvessels and large arteries up to 5 mm diameter could establish a definite clinical application for laser welding in vascul…

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…

Evaluation of the healing of precoated vascular dacron prostheses.

Knitted and woven Dacron grafts commercially coated with bovine collagen, gelatin and human albumin were implanted end-to-side between the infrarenal aorta and the bifurcation in 35 growing pigs. Grafts were explanted after 4, 8 and 12 weeks and compared to 6 uncoated knitted prostheses preclotted with blood that served as a control. Uncoated grafts rapidly developed a firmly attached neointima lined with endothelium. Compared with coated grafts the thrombus-free area of uncoated grafts was significantly larger (P less than 0.05). The slow resorption of albumin resulted in a delayed and incomplete neointimal healing and failing graft incorporation. Although the bovine collagen was only mini…

Prospective comparison of CT angiography of the legs with intraarterial digital subtraction angiography.

The aim of this study was to determine the accuracy of CT angiography (CTA) with a single spiral acquisition for the diagnosis of arterial stenoses and occlusion in patients with peripheral vascular occlusive disease.In a prospective study, intraarterial digital subtraction angiography and i.v. CTA from the groin to the lower calves were performed on 50 patients with vascular occlusive disease. Maximum-intensity-projection images in multiple views were produced. The accuracy of CTA with and without analysis of the axial scans was determined with digital subtraction angiography as the standard.The sensitivities of CTA were 100% for the diagnosis of femoral artery occlusion, 100% for the dete…