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Biomedical subjects

C W Acher

Publications and source records attributed to C W Acher.

43 records · Page 3Linked to original sources
PubMed1985

Percutaneous aspiration thromboembolectomy.

Percutaneous aspiration thromboembolectomy (PAT) was used as an angioplastic tool to remove from arteries of the lower limbs thromboembolitic material originating from any source. PAT was performed with a custom-designed catheter/sheath system, alone or in combination with balloon dilatation and/or local lytic infusion therapy with streptokinase or urokinase. PAT completed the restoration of blood flow, thus improving the results of the preceding angioplastic interventions. Clinical improvement was high, with 93% success (42 of 45 procedures). Only one below-the-knee amputation occurred, and could not be prevented. No patient became worse because of PAT intervention. The Fogarty catheter technique remains the method of choice for removing emboli within the aorto-iliac region, but in the smaller vessels below the inguinal ligament-especially in the distal superficial femoral, popliteal, and tibial regions--in our experience PAT is superior. This has been substantiated also in studies of laboratory animals, using barium-impregnated emboli.

Aged↗
PubMed1985

Graft-enteric erosion in patients with retained defunctionalized aortic prostheses: a report of two cases.

Two patients who underwent "redo" aortic graft replacement in which the original thrombosed graft was oversewn but not removed subsequently developed graft-enteric erosions that involved the oversewn graft. Each patient underwent successful removal of all intraabdominal graft material, oversewing of the aortic stump and extraanatomical bypass. These cases emphasize the need to remove any defunctionalized graft material and to cover all new and retained graft with soft tissue at the time of aortic graft reoperation if graft-enteric erosion is to be avoided.

Aortic Valve↗
PubMed1983

Arterial graft infections. Delayed v immediate vascular reconstruction.

We evaluated the treatment and clinical outcome of 20 patients with major abdominal vascular graft infections and found that immediate reconstruction of arterial inflow to the lower extremities after complete removal of contaminated graft material may not always be necessary or advisable. Patients were treated by the following categories: group 1, graft removal with immediate vascular reconstruction (seven patients, two aortoiliac and five aortofemoral grafts); group 2, graft removal with delayed vascular reconstruction (13 patients, three aortoiliac, five aortofemoral, and five extra-abdominal grafts). The mortality (57%) and the incidence of major amputation (14%) were highest when immediate vascular reconstruction was attempted. Patient survival, the incidence of recurrent graft infection, and the need for major amputation were favorably altered with delayed reconstruction even when prosthetic material was used.

Abdomen↗
PubMed1983

Digital subtraction angiography and continuous-wave Doppler studies. Their use in postoperative study of patients with carotid endarterectomy.

Postoperative study of 40 patients who underwent carotid endarterectomy was performed using digital subtraction angiography (DSA) and transcutaneous continuous-wave Doppler (CWD) studies. The two techniques were comparable in defining recurrent stenosis in the reconstructed carotid arteries and progressive disease in the contralateral carotid artery. Digital subtraction angiography appeared to be more sensitive than the CWD method in detecting minor progression of carotid disease. Our data suggested that CWD and DSA have comparable ability to identify significant (greater than 50%) carotid artery stenosis in this group of patients. However, DSA provided more detailed imaging of the carotid system and may give enough information about progression of carotid disease to avoid preoperative arteriography in some patients.

Angiography↗
PubMed1982

Intra-arterial digital angiography: a new diagnostic method for determining limb salvage bypass candidates.

Twenty patients with chronic arterial disease of a lower extremity underwent standard angiography to determine whether distal bypass surgery could be performed for limb salvage (seven had pain at rest and 13 had breakdown of ischemic skin). Standard angiography provided anatomic detail of the aortoiliac and proximal femoral arteries in all cases, but even with 7 minutes of cuff-induced reactive hyperemia, angiography failed to demonstrate the status of the tibial vessels and the plantar arcade.l Digital subtraction angiography (with intra-arterially injected contrast medium) demonstrated a patent popliteal artery with at least one patent tibial vessel communicating with the distal arcade in 14 of 20 ischemic extremities (70%). Intra-arterial digital angiography (IDA) confirmed absent distal runoff or unreconstructable tibial arterial segments with absent plantar arch communications in six limbs (30%). Fourteen patients underwent distal artery bypass because of additional information provided by IDA (femoropopliteal, 7; femorotibial-peroneal, 4; sequential, 3). Three of the remaining six patients with occluded or unreconstructable distal disease had amputations, and three underwent local profundoplasty. Intraoperative angiograms confirmed the patency of occult arteries in the distally reconstructed limbs. This small series suggests that failure to visualize distal vasculature in ischemic patients by standard angiography is usually a technical problem and that bypass surgery is possible in many patients who might otherwise be considered for amputation.

Angiography↗
PubMed1982

Digital subtraction angiography and B-mode ultrasonography for abdominal and peripheral aneurysms.

Thirty-two patients suspected of having intraabdominal and/or peripheral aneurysms were evaluated by digital subtraction angiography (DSA) and B-mode ultrasonography to determine whether diagnostic accuracy and operative management could be improved by this combination of preoperative studies. Abdominal B-mode ultrasonography accurately diagnosed most primary aortic aneurysms and correctly determined their size (93%) but missed iliac artery aneurysms in 75% of cases. Failures resulted from severe ileus and the inability to scan the intrapelvic iliac vessels. Abdominal ultrasound studies were false positive for aortic pseudoaneurysms in two of four cases. DSA correctly identified all but one intra-abdominal aneurysm but did not always correctly determine their size because of intraluminal clot. DSA identified a number of associated peripheral vascular lesions, which ultrasonography could not. All primary peripheral aneurysms were correctly diagnosed by ultrasound, but nearly half of the ultrasound studies were false positive for femoral pseudoaneurysms. DSA correctly identified all peripheral aneurysms and at the same time provided anatomic information about vessels proximal and distal to these lesions needed for surgical planning. Digital subtraction angiography combined with ultrasonography is diagnostically accurate and provides adequate anatomic information for planning surgical management of these aneurysms.

Abdomen↗