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Biomedical subjects

A H Boontje

Publications and source records attributed to A H Boontje.

At least 19 recordsLinked to original sources
PubMed1996

Thromboendarterectomy for obstructive disease of the common iliac artery.

A retrospective case study was carried out from 1971-1990, with a median follow-up of 7 years, to assess the long-term results of thromboendarterectomy of the common iliac artery. The study included 94 consecutive patients, median age 52 years, of whom 84 suffered from atherosclerotic obstructive common iliac disease causing claudication, and 10 suffered from rest pain. Bilateral disease was present in 67 patients, and unilateral disease in 27. A total of 163 semiclosed endarterectomies (with the ringstripper) were performed. The mean ankle:brachial pressure index rose from 0.66 to 0.98. All patients with claudication became symptom-free after endarterectomy. Postoperative morbidity was low and there was no postoperative mortality. Recurrent aortoiliac symptoms were seen in 25 patients, leading to aortobifemoral bypass grafting in 12 cases. The primary cumulative patency rate at 5 and 10 years was 83% and 68% respectively. Thromboendarterectomy of the common iliac artery is a safe procedure with few complications and good long-term results. It is an effective method of treating common iliac artery stenoses or occlusions.

Adolescent↗
PubMed1996

Aneurysm formation in modified human umbilical vein grafts.

OBJECTIVES: Aneurysm formation in Human Umbilical Vein Grafts has been reported to be as high as 65% after 5 years. One of the causes might be the structure of the Biograft-wall and in 1985 a new method of processing the graft was begun. In Groningen this new improved Biograft has been used since late 1986. DESIGN: Duplex scanning was used to examine the frequency of aneurysm formation in the new improved Biograft. MATERIALS: Sixty-nine patent Biografts have been examined in a period up to 6 years after implantation. MAIN RESULTS: Aneurysms were found in only 17% of grafts although the frequency increased with time. Dilatation was common but may be due to a more elastic graft. CONCLUSION: These findings justify the continued use of the new Biograft as a substitute for arterial femoropopliteal reconstructions.

Aged↗
PubMed1995

Results of vascular reconstructions for atherosclerotic arterial occlusive disease of the lower limbs in young adults.

OBJECTIVE: To evaluate early and long-term results of vascular reconstructions for arterial atherosclerotic occlusive disease (AOD) of the lower limb in young patients under the age of 40 years. DESIGN: Retrospective study. SETTING: University hospital. MATERIALS: Twenty-nine young adults, who underwent vascular reconstruction for histologically proven AOD of the aortoiliac and/or femoropopliteal segments in a 15-year period. CHIEF OUTCOME MEASURES: Early and late mortality, failure of vascular reconstructions, additional procedures, other manifestations of atherosclerosis, recurrence of symptoms. MAIN RESULTS: Nine patients (31%) died, seven related to atherosclerotic disease. In 21 patients (72%) initial vascular reconstruction(s) failed. Twenty-two patients (76%) underwent surgery for failures and/or progression of AOD in other segments of the lower limb. Amputation was performed in five patients (17%). At the end of the follow-up period only 25% of surviving patients were asymptomatic. CONCLUSION: Young patients undergoing vascular reconstructions for AOD of the lower limbs, in particular those who initially have extensive and progressive atherosclerosis, have a poor outcome in terms of a high mortality and a high operative failure rate. A liberal attitude towards reconstructive surgery, particularly in claudication, is not warranted.

Adult↗
PubMed1994

Carotid endarterectomy without a temporary indwelling shunt: results and analysis of back pressure measurements.

A consecutive series of 342 carotid endarterectomies for cerebrovascular insufficiency without a temporary indwelling shunt is presented. The series is clinically analysed regarding the incidence of postoperative neurological deficits and mortality and statistically analysed concerning factors that may be reliable in identifying patients at risk. A transient neurological deficit occurred in five patients (1.5%) and a permanent deficit in six (1.7%). The mortality rate was 1.5% (five patients). The combined postoperative stroke and mortality rate was 2.6%. There was no statistical difference in the incidence of neurological deficits relative to operative indication (symptom-free 2.7%; transient ischaemic attack 1.4%; prior stroke 2.4%), and to the condition of the contralateral internal carotid artery (normal 1.4%; stenosis 2.9%; total occlusion 0%); nor between patients with internal carotid artery back pressure measurements > 50 mmHg (1.2%), 25-50 mmHg (2.0%) and < 25 mmHg (3.8%). In conclusion, carotid endarterectomy without a shunt is a safe procedure with a low combined perioperative stroke and mortality rate.

Adult↗
PubMed1991

Unilateral iliofemoral occlusive disease: long-term results of the semi-closed endarterectomy with the ring-stripper.

Nowadays, fewer endarterectomies are performed for treatment of occlusive arterial disease; more often a bypass procedure is done. This study investigates whether the results of the semiclosed endarterectomy for unilateral iliofemoral occlusive disease indeed indicate a wider use of bypass procedures for such short obstructions. Ninety-four patients with an obstructed external iliac and common femoral artery, but with patent ipsilateral common iliac and contralateral iliac arteries, underwent 101 operations. Seven of these patients were operated on at a later stage for occlusive disease on the contralateral side. Ninety-three endarterectomies were performed, and an iliofemoral bypass graft was inserted eight times because an endarterectomy was not feasible. Sixty-two operations were performed for disabling claudication, and 39 operations were performed for limb-threatening ischemia. Eighty-five percent of the patients who underwent an endarterectomy for disabling claudication became asymptomatic. Eighty percent of the patients who underwent an endarterectomy for limb-threatening ischemia became asymptomatic or improved to claudication. After endarterectomy no deaths, false aneurysms, or infections occurred. The patency rates at 1, 5, and 10 years were 94%, 83%, and 65%, respectively. We conclude that the semiclosed endarterectomy with the ringstripper of a unilateral obstruction of one external iliac and common femoral artery can be performed with a low morbidity and without deaths and gives good long-term results.

Adult↗
PubMed1990

Femoropopliteal arterial fibrodysplasia.

Fibrodysplasia is a rare and unusual cause of obstruction of the superficial femoral or popliteal artery. Three young patients with intermittent claudication due to occlusion of the femoropopliteal artery are described. Histological examination showed destruction of the elastic and muscle fibres of the media. In one patient secondary fibrosis of the intima was seen. The adventitia showed an increase in elastin fibres in all cases. The lesions described can be respectively classified as perimedial fibroplasia, as medial dissection and as intimal fibroplasia. This is the first description of a patient with histopathologically proven perimedial fibroplasia and medial dissection of the femoropoliteal artery and the second case of intimal fibroplasia.

Adolescent↗
PubMed1990

The effect of abdominal surgery on the serum concentration of the tumour-associated antigen CA 125.

The CA 125 assay is used to monitor the course of disease in women with adenocarcinoma of the genital tract. We measured serum CA 125 levels longitudinally in three different groups of patients who had normal serum CA 125 levels (less than or equal to 16 U/ml) before extensive intraperitoneal abdominal surgery (group 1, second-look laparotomy in 28 women with ovarian cancer; group 2, radical hysterectomy in 42 patients with cervical cancer; group 3, 13 men and one woman who had aortic surgery for atherosclerotic occlusive disease or aneurysm formation). Following surgery, rising serum CA 125 levels were observed in 69 out of the 84 patients (82%), irrespective of the primary diagnosis, type of operation or sex. The highest levels were found during the second week after the operation (range 3-336 U/ml) and decreased gradually thereafter, to become normal at 8 weeks after surgery. It was concluded that abdominal surgery interferes with the specificity of CA 125 as a tumour marker during the early postoperative period.

Abdomen↗
PubMed1985

Carotid endarterectomy: does it improve cognitive or motor functioning?

In a group of 20 patients who were to undergo endarterectomy for atherosclerotic occlusive disease of the internal carotid artery, the stenosis did not appear to have resulted in cognitive or motor deficits. Consistent with this finding, surgery could not be shown to have a beneficial effect on cognitive or motor functioning. Control data were supplied by 20 patients who underwent peripheral vascular surgery and 20 healthy subjects. The test-retest interval was 10 weeks.

Arteriosclerosis↗
PubMed1985

Aneurysm formation in human umbilical vein grafts used as arterial substitutes.

A series of 257 human umbilical vein grafts for femoropopliteal bypass in 203 patients, inserted between 1978 and 1984, is presented. The 6-year cumulative patency rate is 74% for above-knee and 44% for below-knee cases. Late complications, such as formation of aneurysms in the human umbilical vein graft, occurred in nine grafts, 21/2 to 6 years after implantation. This corresponds to 3.5% of the total number of 257 human umbilical vein grafts. Three of the grafts developed a second aneurysm at a later time, making a total of 12 aneurysms. The aneurysms were evident as a painful, pulsating mass. All patients were operated on, primarily by resection and interposition grafting. All aneurysms were saccular and false. Macroscopic and microscopic examination revealed that all aneurysms except four originated from a gap in the umbilical vein wall and the Dacron mesh. The adjacent graft wall had a completely normal architecture without biodegradation. The cause of the origin of the gap in the wall remains obscure. Four aneurysms were anastomotic and were located at the site of the suture line, placed at the factory, joining the two components of a composite human umbilical vein graft; these anastomotic aneurysms were caused by breaking of the Prolene suture.

Aged↗
PubMed1985

Improved tunneling procedures for bypass grafting.

A tunneling design and procedure for femoropopliteal, femorocrural, femorofemoral and axillofemoral bypass operations is described. The usefulness and importance is the prevention of tortuosity, kinking and torsion of the bypass and the protection of the graft from damage.

Axillary Artery↗
PubMed1979

Axillary vein entrapment.

This paper describes a patient with right axillary vein obstruction resulting from compression of the vein due to anomalous muscle tissue extending from the latissimus dorsi muscle across the neurovascular bundle to the pectoralis major muscle. This 'axillopectoral muscle' causing entrapment of the axillary vein has been described in only a few cases. These previous reports are discussed, with special reference to the symptoms and phlebographic findings. The obstruction and the symptoms caused by it are intermittent; the phlebographic features are characteristic.

Adult↗
PubMed1979

Revascularization or amputation.

The factors which determine the choice, revascularization or amputation of an ischaemic leg are very numerous, variable and sometimes also related. They are concerned with the extent and course of the gangrene, the general condition of the patient and the risk of operation, the technical operability in terms of arterial reconstruction, the skill and judgement of the vascular surgeon, the motivation and life expectancy of the patient, as well as the facilities at the limb-fitting centre. In principle, arterial reconstruction should be the primary consideration in all patients with severe ischaemia of a leg, and threatened with loss of the limb. This implies the need for evaluation by a vascular surgeon. If arterial reconstruction is impossible or undesirable and if lumbar sympathectomy is not indicated either, then if amputation is necessary it must be decided, when is it necessary, and whether a below-knee or an above-knee amputation is possible. The patient with severe arterial circulatory disorders is best served when the vascular surgeon who is responsible for the arterial reconstruction, also assumes responsibility for determining the timing and the level of an amputation, and in some hospitals even for doing the amputation. In other words, the same doctor, preferably the vascular surgeon, has to be responsible for the selection of the patients and the judgement whether the patient is a candidate for revascularization or amputation.

Amputation, Surgical↗