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Biomedical subjects

A Nevelsteen

Publications and source records attributed to A Nevelsteen.

At least 91 records · Page 5Linked to original sources
PubMed1989

Campylobacter fetus subspecies fetus infection of an abdominal aneurysm.

We report a case of aneurysm of the abdominal aorta with spontaneous rupture in a 64-year-old man with emphysema and chronic alcoholism. Campylobacter fetus subspecies fetus was repeatedly recovered from the blood and from specimens of the excised aneurysm. The patient died in spite of early diagnosis, intravenous erythromycin and surgical intervention. The bacteriology and epidemiology of campylobacteriosis in man is briefly discussed and eight other published cases of aneurysm, infected with the same organism, are tabulated. C. fetus ssp. fetus should be added to the list of bacteria having a tropism for vascular endothelium.

Aorta, Abdominal↗
PubMed1989

Percutaneous transluminal renal angioplasty versus renovascular surgery: statistical, medical and economical considerations.

Retro- and prospective comparative studies in patients with renal artery stenosis demonstrate that technical results and blood pressure improvement after renovascular surgery or percutaneous transluminal renal angioplasty (PTRA) are strictly comparable. The lesser invasive character of PTRA together with its lower complication rate and the lower cost explain why PTRA is the method of choice in the treatment of renal artery stenosis, with less restrictive selection criteria than used for surgery.

Angioplasty, Balloon↗
PubMed1989

Balloon angioplasty of venous structures.

Percutaneous transluminal angioplasty was attempted in 20 patients with stenoses of venous structures. It concerned one stenosis in a native subclavian vein, 12 stenoses in venous bypass grafts and 7 stenoses in hemodialysis-access fistulas. Primary results were excellent for the procedures in the native vein and the venous bypass grafts with success in all patients (13/13). In the arteriovenous fistulas for hemodialysis, dilatation of the venous stenoses was only possible in 5 out of 7 patients. The subclavian vein stenosis did not recur within a follow-up period of 3 years. Of the stenoses in the venous bypass grafts, two lesions reoccluded within one week and 6 lesions recurred within one year. Two of these lesions were successfully redilated so that 6 lesions remain patent with a follow-up of more than one year. Of the 5 successful dilatations in hemodialysis-access fistulas, two lesions recurred within 2 months. Only 3 veins are still accessible for hemodialysis. It is concluded that attempts at balloon dilatation of stenoses in venous bypass grafts or hemodialysis-access fistulas are meaningful in order to prolong the life of these surgical procedures. Recurrence of stenoses is however likely to occur within one or two years.

Angioplasty, Balloon↗
PubMed1988

Intravenous digital subtraction angiography and Duplex scanning in the detection of late human umbilical vein degeneration.

To define the exact incidence of late degeneration, 32 patients underwent intravenous digital subtraction angiography (IVDSA) and/or a Duplex scan more than 3 years after human umbilical vein (HUV) grafting. IVDSA (n = 26) showed a 23 per cent aneurysmal degeneration rate which increased to 40 per cent with Duplex scanning (n = 25). Although the differences obtained in those patients receiving both examinations (n = 19) were statistically not significant, Duplex scanning appeared to be more sensitive, demonstrating two additional cases of aneurysmal degeneration not detected by IVDSA. Since, moreover, Duplex scanning proved able to detect anastomotic stenosis, it appears to be the examination of choice in long-term follow-up of the HUV graft. Despite this relatively high degeneration rate, the authors consider continued use of the HUV graft in selected patients to be justified, especially when the long-term patency rates, the available alternatives, and the less favourable long-term survival after femoropopliteal reconstruction are taken into consideration.

Aneurysm↗
PubMed1988

Transabdominal or retroperitoneal approach to the aorto-iliac tract: a pulmonary function study.

An unselected consecutive series of 30 males, receiving an aorto-bifemoral Dacron graft for occlusive arterial disease, were randomised preoperatively to a transperitoneal or extraperitoneal approach. Pulmonary function tests (Forced Vital Capacity--Forced Expiratory Volume at 1 s) were performed once preoperatively and repeated four times postoperatively. As far as pulmonary function tests are concerned the results clearly demonstrated the superiority of the retroperitoneal to the transperitoneal approach. It is therefore recommended that the extraperitoneal approach should be used more frequently in reconstructive aorto-ilio-femoral surgery.

Aorta, Abdominal↗
PubMed1987

Percutaneous transluminal angioplasty of the subclavian artery: early and late results.

Percutaneous transluminal angioplasty of 23 subclavian arteries was attempted in 22 patients. Dilatation was successful in 3 of 4 right subclavian artery stenoses and 18 of 19 left subclavian artery stenoses. The primary clinical indication was posterior fossa ischemia in 11 patients, upper limb ischemia in 14 and both symptoms in 6. In 2 patients, dilatation of an asymptomatic high-degree left subclavian artery stenosis was performed before coronary artery bypass surgery using the internal mammary artery. Eighteen patients on follow-up over 6-60 months (mean 25 months) are free of symptoms with equivalent systolic blood pressures in both arms. Three patients showed relapse of the stenosis after 8, 12, and 15 months; one was successfully treated with a second dilatation. Complications consisted of an occlusion at the left axillary artery puncture site and a distal embolus to a finger artery. Percutaneous transluminal angioplasty appears safe and efficient therapy for subclavian artery stenoses with excellent short- and long-term results.

Aged↗
PubMed1987

Intraoperative angioplasty.

Of 768 angioplasties performed in our institute, 42 procedures (5%) in 39 patients were performed by a radiologist in the operating room in combination with vascular surgery; 15 ilial, 20 femoral, 5 tibial, 1 renal, and 1 brachiocephalic artery stenoses were treated. Immediate and late successes, as well as the complication rates, were comparable to those of the percutaneous approach. The main reasons for the intraoperative approach were absence of arterial pulsations, ulcerative lesions at the puncture site with risk of peripheral embolisation, and the opportunity of a surgical arteriotomy offering access to an otherwise unreachable stenotic artery. The advantages of intraoperative dilatation in combination with surgery over simple operation are the reduction of operative morbidity and mortality, shortening of the operative time, and improved results by reassuring the in- or outflow of the operated territory. The main disadvantages are the limited fluoroscopic field and the limited mobility of the fluoroscopy device.

Angioplasty, Balloon↗
PubMed1987

Obturator bypass: a sixteen year experience with 55 cases.

Fifty-five obturator bypasses were performed over a 16 year period for limb salvage. The indications for the choice of this technique included arterial infection, aneurysm formation or soft tissue skin loss at the groin (26 patients), and extensive atherosclerotic disease of the iliofemoral vessels, precluding their use for inflow or outflow (27 patients). There were five perioperative deaths and the five-year patency rate was 37%. Long-term results after above-knee reconstruction substantially exceeded those for below-knee anastomoses (three year patency rates of 71% and 45% respectively). Due to its morbidity and mortality the decision to perform an obturator bypass should be based upon sound indications such as deep infection at the groin, or extensive multilevel arterial disease. Its usefulness in extensive multilevel arterial disease is not demonstrated.

Adult↗
PubMed1987

Extensive disobliteration of the aorto-iliac and common femoral arteries using the LeVeen plaque cracker.

In 1978 LeVeen et al. described an original technique for extended aortobifemoral disobliteration using a retroperitoneal approach. This technique was introduced to Europe by Widdershoven and Willekens in 1977 and was adopted in Belgium by Suy and Nevelsteen in 1982 and in Spain by Cuesta and Bengoechea in 1984. A group of 228 patients treated by the LeVeen's method from 1982 to 1987 were followed-up for a mean of 21 months (1-54). Disabling claudication (66%) or more advanced ischaemia (34%) was the indication for treatment. An aorto-bifemoral endarterectomy was performed in 124 patients. Aorto-biiliac endarterectomy in 39, unilateral aortofemoral endarterectomy with a contralateral aorto-iliac endarterectomy in 17 and unilateral iliofemoral endarterectomy in 48 cases. There were seven postoperative deaths (3%) and an early thrombectomy had to be performed in 8 patients. There were 14 late deaths. Occlusion occurred in 11 patients giving a 3-year-patency rate of 97%. There were no late complications related to the technique. It is concluded that disobliteration using the LeVeen technique compares well with prosthetic grafting. Since this method does not require the use of foreign material the patient is protected from the complications sometimes seen after the insertion of prosthetic grafts.

Aorta, Abdominal↗
PubMed1987

Recurrent aneurysms of the upper arteries of the lower limb: an atypical manifestation of fibromuscular dysplasia--a case report.

Fibromuscular dysplasia (syn. arterial dysplasia, fibromuscular hyperplasia, medial fibroplasia) is an arteriopathy of unknown etiology, most frequently involving the renal arteries. The string-of-beads appearance of these lesions seems to be a characteristic angiographic finding. We report atypical angiographic findings at an unusual site, which proved to correspond to fibromuscular dysplasia at histological examination.

Adult↗
PubMed1987

Comparison of quantification methods of 111In-labelled platelet deposition in peripheral bypass grafts.

The action of antithrombotic drugs can be evaluated by measuring the deposition of 111In-labelled platelets on peripheral bypass grafts several days after injection. This evaluation can be performed qualitatively (visual interpretation on the daily images) or quantitatively. Four different methods which calculate the ratio of platelet uptake with a reference region are compared: two methods use a gamma camera and two a detector. A blood sample or the region under the sternal angle are used as reference. The daily ratio of the counts, recorded by a gamma camera in a region of interest covering the graft, and the blood radioactivity interpolated from a platelet survival curve appears to be the most reliable method. The information of all the ratios can be combined in a single thrombogenicity index which reflects the daily rise of a linear or exponential regression versus time.

Aged↗
PubMed1986

The human umbilical vein graft in below-knee femoropopliteal and femorotibial surgery: an eight year experience.

The authors present a series of 175 femoropopliteal (below-knee) and 65 femorotibial reconstructions with the human umbilical vein (HUV) graft performed over an eight year period. With a mean follow-up of 36.7 months (range one month to 84 months) the early patency rate of 89% decreased to 54% after five years. Long-term patency was found to be primarily related to the location of the distal anastomosis and the quality of the outflow, showing a statistically significant decrease after repeat revascularization. Early thrombosis, even in the absence of a technical failure and late aneurysmal degeneration remain the major problems associated with the use of the HUV graft. It is therefore recommended that these reconstructions be preserved for patients with advanced ischemia or a limited life-expectancy.

Adult↗
PubMed1986

[Sciatic artery or persistent axial artery. Apropos of 2 rare variants].

Arteriography in two patients showed a persistent sciatic artery, in one case complete and the other case incomplete, associated with a persistent superficial femoral artery. One case was complicated by the presence of an aneurysm. Embryology, pathology, clinical aspects and surgical repercussions are discussed, and emphasis placed on the need for preoperative angiography to detect this embryologic variant requiring another surgical attitude.

Aged↗
PubMed1984

Restoration of post-thrombotic peripheral collateral circulation in the cat by ketanserin, a selective 5-HT2-receptor antagonist.

In cats, an acute thrombotic obstruction of the aorta inducing continuous platelet activation, was produced by permanent ligation above the trifurcation, temporary ligation below the caudal mesenteric artery and production of a stasis thrombus in the segment. Before, 5 min, 24 hr and 48 hr after surgery, plethysmographic systolic blood pressure in fore- and hindlegs, and clinical scoring of the hindleg function were performed; at 72 hr, venous occlusion plethysmography for quantification of blood flow was performed and collateral vascular resistance was calculated. Thrombotic occlusion resulted in a loss of adequately functioning collateral circulation as evidence by the changes in both the objective and the clinical parameters. Pre-treatment with ketanserin (1.25 mg/kg i.p. daily) significantly improved the objective circulation parameters blood pressure ratio, blood flow and collateral vascular resistance and restored the clinically scored function of post-thrombotic collateral function. Provided platelet activation contributes to human vascular pathology, a similar mechanism may be involved in the potential effect of ketanserin in man.

Animals↗
PubMed1983

Nine years' experience with the Björk-Shiley prosthetic valve: early and late results of 932 valve replacements.

Between November, 1970, and December, 1977, 932 consecutive patients received the standard Björk-Shiley prosthesis. Operative mortality was 4.6% for aortic valve replacement (AVR; N = 364), 5.1% for mitral valve replacement (MVR; N = 313); 11.3% for multiple valve replacement (N = 194), and 13.7% for valve replacement combined with coronary artery bypass grafting (CABG; N = 51). Factors influencing hospital mortality included type of valve replacement, age at operation, whether the valve replacement was done as an emergency, and year of implantation. Complete follow-up (mean, 3.7 years) was achieved in 95% of the survivors. Actuarial survival was 82% for AVR patients at 8 years, 83% for MVR patients at 7 years, 72% for multiple valve replacement patients at 7 years, and 76% for those who had valve replacement with CABG at 3 years. No significant difference in late survival was found between patients with mitral insufficiency alone (p greater than 0.2) or aortic insufficiency alone (p greater than 0.9) and those with stenotic lesions only. Thromboembolic complications occurred at an incidence of 1.17% per patient-year, and Dicumarol-induced hemorrhages occurred at an incidence of 2.11% per patient-year. Twelve out of 13 patients survived operation for prosthetic valve thrombosis, indicating that this complication is not as catastrophic as many believe. The incidence of reoperation in anticoagulated patients was 0.63% per patient-year. All of these results are compared with data from the recent literature.

Aged↗
PubMed1983

[Surgery in the octogenarian (introduction). Results of a national survey].

Presentation of the results of a national, multicentric and retrospective study regarding the surgery of the octogenarian. The series counts 7,407 patients accepted for surgery, and which can be divided into 4,581 women (61.8%) and 2,826 men (38.2%) of an average age of 84.4 years old (extremities 80-101 years old). The global mortality of this population of elderly (whether operated on or not) amounts to 16.7%. The postoperative mortality of the 4,177 operated patients is 18.2% with different rates according to the surgical disciplines: 34.7% for surgery of the colon, 23.2% for bone surgery, 22.4% for vascular surgery, 15.3% for biliary surgery, 8.7% for urologic surgery and 5.6% for cardiac surgery.

Age Factors↗
PubMed1983

[Arterial thrombosis of the lower limb in patients over 80 years of age. Belgian multicentric experience concerning 802 patients].

This report concerns a joint study of fourteen centres about the treatment of arterial occlusion of the low extremity. Eight hundred and two patients older than 80 years have been studied during a period from 1 to 27 years. The operative mortality was 25.2%. There was no significant difference in mortality between emergency cases and those patients who were operated under elective conditions. Leg amputations are followed by a significant higher mortality than more conservative surgery such as arterial by-pass, sympathectomy or embolectomy. The most frequent cause of death was from cardiopulmonar origin (57%). The postoperative morbidity of cardiac, pulmonary, urinary or infectious origin was frequent (50%). Surgical complications in the true sence of the word are quite rare and their frequency is limited to 7%. The conclusion of this study is that conservative surgery such as reascularisation or sympathectomy is, whenever possible, to be preferred over amputation not only because of their lower mortality (13 to 19%) but also since they permit better revalidation of these elderly patients.

Aged↗