0000000000006288
AUTHOR
Savvas Savvidis
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…
Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction.
Background— An ankle-brachial index (ABI; ratio of ankle and brachial systolic blood pressure) <0.9 indicates peripheral arterial disease (PAD) and is a strong predictor of cardiovascular events. The aim of the present study was to address the prognostic value of different methods of ABI calculation. Methods and Results— In 831 patients admitted with chest pain for diagnostic heart catheterization, blood pressure of both anterior and posterior tibial arteries was measured. ABI was calculated for each leg with the higher of the 2 ankle pressures (current definition of the American Heart Association) or with the lower of the 2 ankle pressures (modified definition) in relation to the highe…
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…
Thromboembolieprophylaxe mit niedermolekularem Heparin (Dalteparin-Na) bei Risikoschwangerschaften
Hintergrund: Venose thromboembolische Ereignisse zahlen zu den haufigsten Ursachen mutterlicher Morbiditat und Mortalitat. Wahrend der Schwangerschaft sowie postpartal ist die Hamostase auch bei gesunden Frauen verandert. Die Gerinnung ist aktiviert, die Fibrinolyse supprimiert, die Konzentration einzelner Gerinnungsfaktoren erhoht, das Inhibitorenpotential vermindert. Dazu kommt noch der behinderte venose Blutruckstrom durch mechanische Gefaskompression des graviden Uterus. Als Folge dieser komplexen physiologischen Anpassung resultiert ein funf- bis sechsfach erhohtes relatives Thromboembolierisiko im Vergleich zu Frauen gleichen Alters ohne Graviditat. Dieses Risiko erhoht sich deutlich …
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…
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…
Response to Letter Regarding Article, “Different Calculations of Ankle Brachial Index and Their Impact on Cardiovascular Risk Prediction”
We thank Jaquinandi et al for their interest in our publication. We want to stress that the patient population of the AtheroGene study is not comparable with the patient populations reported in the articles from Lee et al and Kreitner et al, which included only patients with known advanced peripheral arterial disease.1,2 The AtheroGene study includes primarily patients with coronary artery disease, no patient had rest pain or peripheral ulcers and only 52 patients (6.3%) had intermittent claudication.3 In addition, …
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…
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 …
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 …
β-Blockers in Patients With Intermittent Claudication and Arterial Hypertension
The use of β-receptor blockers in peripheral arterial disease is controversial for their impact on vasomotor tone. The β-blocker nebivolol possesses vasodilating, endothelium-dependent, NO-releasing properties that might be beneficial in peripheral arterial disease. The aim of the study was to evaluate the effects and tolerability of nebivolol in comparison with metoprolol in these patients. A total of 128 patients with intermittent claudication and essential hypertension were included and double-blind randomized to receive 5 mg of nebivolol (N=65) or 95 mg of metoprolol (N=63) once daily. End points were changes in ankle-brachial index, initial and absolute claudication distance, endothel…
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…
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…