Biomedical subjects

A Nevelsteen

Publications and source records attributed to A Nevelsteen.

121 records · Page 7Linked to original sources

PubMedDate not supplied

[Abdominal aneurysms: long-term results].

437 patients who underwent surgery for abdominal aortic aneurysm have been studied. Of these, 206 patients (medium age 63 years) had elective surgery, 231 patients (medium age 73 years) had acute surgery. The five-year survival rate was 65% for the elective group and 40% for the acute group, but these percentages are influenced by the perioperative mortality. When the survival curves of the 198 survivors of elective surgery and the 153 survivors of acute surgery were compared with these of a demographically similar population, we noted lower survival probabilities than for the standard population in the elective group, whereas the patients who underwent emergency surgery have similar survival probabilities as the standard population. The influence of age is especially related to the perioperative period and arteriosclerosis is the most determining factor for long time survival.

Acute Disease↗

PubMedDate not supplied

Surgical treatment of acute, massive lung embolism. Results and follow-up.

Between 1970 and 1984 the diagnosis of acute, massive lung embolism was made 30 times in our department. In 29 patients the clinical diagnosis was correct and a Trendelenburg operation under extra-corporeal circulation was performed. In 18 cases there was an operation in the immediate preoperative course. In 1 case there was a combination of operation and the use of contraceptives. 3 cases were immobilized by a plaster of Paris cast. In 4 cases the use of oral contraceptives and in 3 patients the history of chronic recurrent lung embolism were evident. The mean immobilisation time was 15 days. In 24 cases the diagnosis was made only on the base of the clinical anamnesis, and examination, E.C.G. and chest radiography. In 4 cases angiography and in 1 patient the scintigraphy confirmed the diagnosis. Preoperatively 28 patients were in severe shock. One patient was operated electively. 14 patients needed external cardiac massage. In all cases clots were found in the left pulmonary artery, 28 in the right pulmonary artery, in 3 cases clots in the right atrium, 3 in the right ventricle and three in the inferior caval vein. Nine De Weese caval vein clips were inserted and one Mobin-Uddin filter. Postoperatively 18 patients were alive and well without sequelae. Two patients developed a cerebro-vascular accident (CVA) with one complete recovery. Ten patients died. Postoperative treatment consisted of I.V. heparin administration immediately after surgery and 6 months of oral anticoagulants. Except for chronic recurrent lung embolism the pulmonary function tests were excellent postoperatively without recurrence of the disease.

Acute Disease↗

PubMedDate not supplied

The patient's perspectives after aortofemoral grafting for occlusive disease.

The late results of aortofemoral grafting for aortoiliac occlusive disease in 371 patients are presented. Late survival (30% after 15 years) was primarily dependent on age at the time of surgery and the presence of atherosclerotic heart disease on subinguinal atherosclerotic involvement. The majority of late deaths (42%) was due to atherosclerotic disease. With a mean follow-up period of 7 years the late complication rate was 29%. Late thrombosis was responsible for 66% of the late complications and a subsequent redo-operation was necessary in 24% of the patients. Age at the time of surgery and the presence of femoropopliteal occlusive disease were the most important factors. Regarding the late mortality rate of 45%, it is recommended that follow-up in these patients should be directed not only to late graft complications but also to other manifestations of generalized atherosclerosis.

Adult↗

PubMedDate not supplied

[Infrarenal abdominal aneurysms. Course and their effect on perioperative mortality. A 23-year study].

The perioperative mortality rate in elective aneurysmectomy progressively declined to 2%; despite the fact that the percentage of patients with risk factors has increased. Important is that this perioperative mortality is not related to the age of the patients. In acute situations the perioperative mortality has increased to 30 à 50%. This can be explained by the increasing number of ruptured aneurysms and the influence of increasing age at the time of surgery. These results support the concept of elective resection of abdominal aortic aneurysms.

Aged↗

PubMedDate not supplied

Aorto(ilio)popliteal grafting by the obturator route using the human umbilical vein graft.

Over a 5 year period, the human umbilical vein (HUV) graft has been used for 16 aorto(ilio)popliteal reconstructions by the obturator foramen route. 69% of the operations has been performed for multilevel disease with the femoral arteries completely unsuitable for reconstruction. One patient died after operation and one early thrombosis could be repaired by thrombectomy and reconstruction of the distal anastomosis. With a mean follow-up period of 15 months (range 1 to 54 months) there were 2 late occlusions (2 years patency rate 73.3%). Another 2 patients returned with ischemic restpain due to progression of distal disease in the presence of a patent graft. It is concluded that the HUV graft represents a very satisfactory prosthesis for long aorto popliteal reconstruction and that a primary obturator graft is justified in the selected patient with multilevel disease and a very poor profunda femoris connection.

Aged↗

PubMedDate not supplied

[Inflammatory aneurysms].

Inflammatory aneurysms are not so frequent, etiology and pathogenesis are uncertain. Resection can be a problem because of the dense inflammatory fibrous reaction. Preoperative diagnosis may be possible with the aid of intravenous urography and CAT-scan. The treatment of choice is an aortic replacement followed by uni- or bilateral ureterolysis and omentoplasty to cover the entire vascular reconstruction and protect the ureters.

Aged↗

PubMedDate not supplied

Total pericardectomy for chronic constrictive pericarditis. Early and late results.

The early and late results of total pericardiectomy, performed over a 17 years period in 39 patients with chronic constrictive pericarditis, are presented. The overall operative mortality was 18%. With growing surgical experience and anesthesiological improvement, the operative morality of 26% during the first 12 years decreased to an acceptable 6.2% during the last 5 years. The cumulative 5 and 10 years survival rates were respectively 73% and 68%. Ninety-three percent of the surviving patients were classified in functional class I or II (NYHA classification), while preoperatively 90% of these cases belonged to class III or IV. Viewing these results it is concluded that the tendency towards early surgery should be encouraged, especially because the chronic state is accompanied by several deleterious effects.

Adolescent↗

PubMedDate not supplied

Uremic pericarditis. Treatment by limited pericardiectomy.

Between 1963 and 1979, limited pericardiectomy through left anterolateral thoracotomy was performed in 14 patients with uremic pericarditis. Two patients died after operation and one patient presented an early recurrence. Within a mean follow-up time of 3.3 years there were 7 late deaths but no recurrences or no cases of constrictive pericardidis. After reviewing the literature, it is concluded that the best early and late results in uremic pericarditis are obtained with pericardiectomy through an anterolateral thoractomy, the subxiphoid approach with creation of a pericardial window being a good alternative in critically ill patients.

Adult↗

PubMedDate not supplied

Paraprosthetic fistula after aortobifemoral prosthetic reconstruction: treatment by autogenous saphenous venous replacement. A case report.

Paraprosthetic fistula is a rare but dramatic complication of aortofemoral prosthetic reconstruction. Conventional treatment consisting of removal of the prosthesis and extra-anatomical revascularization results in a high morbidity and mortality rate. The authors present a patient with a paraprosthetic fistula, who was successfully treated by excision of the graft and "in situ" replacement by autogenous saphenous vein.

Arterial Occlusive Diseases↗

PubMedDate not supplied

Transperitoneal versus extraperitoneal approach for routine vascular reconstruction of the abdominal aorta.

In this non-randomised retrospective study we have compared 79 cases with transperitoneal approach and 90 cases with extended postero-lateral extraperitoneal approach for elective reconstruction of the infrarenal aorta. In the extraperitoneal group more patients were diabetic (7.8% vs 1.3%, p < 0.05) or had a serum creatinine of more than 1.5 mg % (10.1% vs 2.5%, p < 0.05). The study shows that in spite of a higher proportion of risk factors, a longer preparation (61' vs 44', p < 0.001), dissection (55' vs 46', p < 0.05) and total procedure time (193' vs 173', p < 0.05), the need for more blood transfusion (2.8 U vs 2.3 U, p < 0.05) and colloid perfusion (2.1 L vs 1.8 L, p < 0.05) in the extraperitoneal group, the incidence of complications is not higher compared to the transperitoneal group (29% vs 24%, NS). On the contrary, problems of intestinal transit were found exclusively in the transperitoneal group (7.6%, p < 0.01). Therefore it seems that, as far as the peri- and postoperative period is concerned the extraperitoneal approach might be the technique of choice for the simple elective infrarenal aorta reconstructions.

Aged↗

PubMedDate not supplied

The value of carotid stump pressure and EEG monitoring in predicting carotid cross-clamping intolerance.

The authors analyse their experience with carotid stump pressure (CSP) and electro-encephalogram (EEG) monitoring in relation to the incidence of peroperative stroke during internal carotid artery reconstruction. A series of 215 patients is presented, among whom six (2.8%) developed a peroperative stroke. The stroke rate in patients with a CSP below 50 mm Hg (n = 92) was 7% (2/27) without a shunt and 3% (2/62) with the use of a shunt. The respective numbers for patients with a CSP equal to or above 50 mmHg were 1.7% (2/123) and 0% (0/10). The EEG remained normal after cross clamping in 180 cases (84%): the incidence of stroke was 1.5% (2/138) without and 5% (2/42) with a shunt. A shunt was used in 33 of the 35 patients with EEG changes after cross clamping. None of them sustained a stroke in contrast to both patients where despite EEG changes no shunt was used (respective stroke rates 0% and 100%). It is concluded that regarding cerebral function, EEG monitoring provides more accurate information than CSP.

Adult↗

PubMedDate not supplied

The venous thrombectomy: obsolete or forgotten?

This report describes the surgical management of three patients with an extended ilio-femoral deep venous thrombosis. In the first patient a residual occlusion of the common iliac vein was treated conservatively and this patient developed severe chronic venous insufficiency. In the second patient a residual (sub)occlusion of the common iliac vein was treated with a stent and this patient remained asymptomatic with two years follow-up. In the third patient no residual or underlying anatomical abnormality was found with a good result at one year. Venous thrombectomy still has a place in the treatment of deep venous thrombosis and the long term results may be improved by application of endovascular techniques.

Adult↗

PubMedDate not supplied

Classic versus endoscopic perforating vein surgery: a retrospective study.

PURPOSE AND METHODS: In this retrospective non-randomized study the results of the FELDER technique (n = 29) were compared to two endoscopic techniques for ligation of incompetent perforating veins: using a mediastinoscope (n = 19) and laparoscopic instruments (n = 57). The indication was a venous ulcer in nine, five and thirteen patients respectively, lipodermatosclerosis in thirteen, five and twenty-four, and simple varicose veins in the remaining patients (NS). RESULTS: The mean number of interrupted perforating veins was 4.2, 2.4 and 3.8 (p < 0.05). The mean hospital stay was 3.5, 1.9 and 1.6 days (p < 0.0001). The mean period of convalescence was 8.7, 4.1 and 3.7 weeks (NS). The number of complications was 9 (suralis lesion 4, pain/swelling 4, wound problem 1), 6 (saphenous lesion 3, pain/swelling 3) and 15 (pain/swelling 14, deep venous thrombosis 1) (NS). Ten patients were lost to follow-up (five, two and three). Respectively 19, 12 and 45 patients were satisfied with the end-result. The condition had worsened in one, two and three patients (NS). During the short follow-up period all ulcers healed and there was no recurrence. CONCLUSIONS: The endoscopic techniques produce results comparable to the FELDER procedure, with smaller scars and a tendency towards a faster recovery.

Adult↗