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Biomedical subjects

D Raithel

Publications and source records attributed to D Raithel.

At least 37 records · Page 2Linked to original sources
PubMed1996

Recurrent carotid disease: optimum technique for redo surgery.

Carotid restenosis has been a well-recognized, though not well-understood, long-term complication of carotid endarterectomy. Various factors contribute to recurrent stenosis, but the chief cause is technical faults during the primary procedure. Redo endarterectomy or graft reconstruction are the traditional and most effective procedures for treating symptomatic or high-grade (> 80%) asymptomatic restenotic lesions. To reduce the potential for carotid restenosis, eversion endarterectomy is recommended as the technique of choice for de novo carotid disease treatment. Angioscopy is useful in detecting correctable technical errors that could predispose to restenosis.

Angioscopy↗
PubMed1995

[Vascular surgery methods for elderly patients. Elective interventions with reduced risk are possible].

As in other areas, the percentage of elderly patients consulting the vascular surgeon is also on the increase. In recent years, our diagnostic possibilities have been expanded by non-invasive procedures (e. g. colour-coded duplex sonography, NMR angiography) and by improvements in intravascular imaging procedures. Early diagnosis makes it possible to perform interventions electively, which is of particular importance for minimizing risks in the geriatric patient. In the case of supra-aortic interventions (e.g. carotid reconstruction), surgical treatment of an aneurysm, and in venous occlusions, the indication for surgery in the elderly should not be applied too restrictively. For the treatment of arterial occlusions, a fundamental choice must be made between interventional (e.g. PTA) and surgical procedures. When peripheral arterial occlusive disease presents, conservative therapy should be applied for as long as is possible, since over the long term this can save many patients the need for surgery.

Age Factors↗
PubMed1995

The event-related P300 potential approach to cognitive functions of nondemented patients with cerebral and peripheral arteriosclerosis.

OBJECTIVES: To detect subtle cognitive dysfunction in non-demented patients with either cerebral (cAD) or peripheral (pAD) arteriosclerotic disease, and to evaluate in these patients the effects on cognitive functions of carotid endarterectomy and bypass surgery, respectively. DESIGN: Case-control study. SETTING: Tertiary care referral center. PARTICIPANTS: Eighty consecutive patients with moderate to high-grade stenosis of the internal carotid artery (ICA) (mean age +/- SD, 62 +/- 8 years), 53 patients with stenoses of the peripheral arteries (60 +/- 10 years), and 80 healthy volunteers (58 +/- 15 years) enrolled in a study on healthy aging. Cerebral and peripheral arteriosclerotic disease was verified by digital subtraction angiography, and all patients were screened for confounding effects of concomitant diseases. MAIN OUTCOME MEASURES: Cognitive functions by event-related visual P300 potentials. RESULTS: Patients with cAD showed prolonged P300 latencies and reduced P300 amplitudes, whereas pAD patients had reduced P300 amplitudes only. On an individual scale, 25% of cAD patients, but only 6% of pAD patients, revealed P300 abnormalities. In the cAD, but not in the pAD patients, the P300 latencies were especially prolonged in the older patients, but other factors such as sex, cerebral symptoms, degree of ICA stenosis, and premorbid intelligence did not play any role in either group. Within 1 to 2 weeks of surgery, the P300 latencies shortened in both cAD and pAD patients with high initial values. CONCLUSIONS: As demonstrated by P300 potentials, even nondemented arteriosclerotic patients reveal signs of subtle cognitive dysfunction affecting especially the older cAD patient. In the short-term, carotid endarterectomy presumably improves cognitive functions unspecifically in nondemented patients with a higher initial degree of P300 abnormality.

Adult↗
PubMed1995

[Results of vascular surgery reconstructions after PTA].

From 1986 through 1994 263 patients underwent vascular treatment due to 266 PTA complications. Complications at the site of the puncture were found in 35 patients (13.2%), at the site of dilatation in 210 (78.9%), and due to macro-embolism in 21 (7.9%). The most frequent pathology was thrombosis in 135 patients (50.7%). 62% of all operations were performed immediately or few days after PTA. The primary (secondary) patency rate after one month in AK femoro-popliteal reconstructions was 84% (88%), in BK reconstruction 69% (74%), after aorto-iliac reconstruction 90% (96.8%), in renal artery reconstructions 96% (96%), and in surgical interventions in the innominate artery and the subclavian artery 100%. In our opinion the unfavourable early results, especially after BK femoro-popliteal reconstructions, are due to a deterioration of the run-off caused by peripheral microembolisation. Of the aorto-iliac and limb artery reconstructions 7.1% required major amputation. The second most frequent complications were wound infections in 6.5%.

Adult↗
PubMed1993

Intraoperative angioscopy after carotid endarterectomy.

The angioscopic evaluation of the carotid bifurcation has proved valuable for intraoperative quality control after carotid endarterectomy (CEA). From January 1989 to July 1990, intraoperative angioscopy was performed in 196 patients undergoing CEA. We used a 2.2, 2.8 or 3.6 mm angioscope inserted at the end of the CEA through the remaining opening in the suture line. The angioscopic findings were classified as follows: I--no pathology (68%), II--thrombi, smaller debris, suture irregularities (29%), III--intima flap, endoscopic removal (3%), IV--intima flap, surgical redo (3%). Our results support the practicability and importance of intraoperative angioscopy for surgical decision making. It is possible to rinse out thrombi or remove remaining debris using flexible forcepy, under direct visual control. There were no significant complications related to the angioscopic procedure.

Aged↗
PubMed1991

[Surgical measures in PTA--indications and results].

We review 145 patients who underwent surgical treatment due to PTA complications between 1979 and 1990. The main problem that occurred after peripheral PTA was embolisation into the lower limb area. 56 of 88 femoropopliteal or femorotibial reconstructions showed reocclusions, with a high reocclusion rate during the first 12 months. Five years after surgery, a mere 34% of these reconstructions were patent. Due to these unfavorable results of surgery after unsuccessful PTA, careful selection of patients is absolutely necessary, i.e., a PTA is justified only in stage III to IV arterial occlusive disease, corresponding to the indications stated by the vascular surgeon.

Angioplasty, Balloon↗
PubMed1990

[Modification of non-hemispheric symptoms by carotid endarterectomy].

In case of multi-locular supra-aortic lesions the correction of a hemodynamic carotid stenosis has priority over any reconstruction of another supra-aortic lesion. Thus carotid endarterectomy leads to an improvement of the global cerebral perfusion. Patients with a classical vertebro-basilar insufficiency profit most by these operations. A subclavian or vertebral reconstruction or PTA is indicated only if the patient is not symptom-free after the carotid endarterectomy.

Brain Ischemia↗
PubMed1989

[Diagnosis and therapy of cerebrovascular insufficiency].

In these days supra-aortic occlusions can be easily diagnosed with noninvasive methods like Doppler-sonography and Duplex B-Scan. Further Diagnosis must include an intravenous or intraarterial DSA and a computer-assisted tomogram. The indication of operation depends on the stage of carotid insufficiency. Priority is given to the reconstruction in stage II of the transitory ischaemic attack. In 2.5 years far more than 2,000 vascular reconstructions of the supraaortic branches have been performed in the Department of Vascular Surgery at the General Hospital in Nuremberg. Morbidity and mortality of this operation were less than 1%. Carotid reconstruction can thus be performed even in elder patients at minimum risk--if done in a special hospital.

Brain Ischemia↗
PubMed1989

[Revascularization of the isolated popliteal segment].

An alternative to crural reconstruction of obliterations of the popliteal vascular axis and an angiographically ascertained isolated popliteal segment is a bypass to the isolated popliteal segment. A patency rate of 82.7% was found 1 year after bypass; after 3 years the patency totaled 76%, and after 4 years the cumulative patency rate amounted to 59%. A comparison of these results with those of crural reconstruction (a patency rate of no more than 60% after 3 years) proved the superiority of the bypass.

Blood Vessel Prosthesis↗
PubMed1986

[Morbidity and mortality following resection of an aortic aneurysm in the aged].

From August 1984-August 1985 118 abdominal aortic aneurysms were treated surgically in the City Hospital Nuremberg. The mean age was 68.9 years, with 26.3% being over 75 y.; and there was a notable decline of elective procedures in this group, which was particularly jeopardized by cardial arrhythmias and renal insufficiency. The lethality was 0 in elective procedures, but reached 50% for symptomatic and over 50% for perforated aneurysms in the old age group. The high lethality of ruptured aortic aneurysms justify elective operation of aortic aneurysms in high age.

Aged↗
PubMed1986

Magnetic resonance imaging of aneurysms and thrombi.

This is a report of the first systematic investigation of the qualitative and quantitative diagnosis of aneurysms in the regions of the left ventricle and thoracic and abdominal aorta plus proof of intracavitary thrombi in the heart and the aorta, as well as aneurysms in the superior and inferior vena cava. For diagnosis of the heart, ECG gating is an absolute necessity, but for the analysis of abdominal aortic aneurysms it only leads to a considerable improvement of the spatial resolution. For differential diagnosis of the blood flow and intracavitary clots in the heart and the aorta, use of a second or even multiple echoes is needed. Also, digital subtraction between the first and second echoes (magnetic resonance digital subtraction) can assist in assessing flow. When dissecting aortic aneurysm is suspected and in cases when risk of perforation of ventricular and aortic aneurysms is present. MR offers particular advantages, since it is noninvasive and few scans can provide all the information that is required.

Aged↗
PubMed1986

[Hemorheologic applications in vascular surgery].

Possible vascular surgery interventions are reviewed in respect of the supraaortic segment (carotis obstruction), in aortic aneurysm, and in the lower extremities region (aorto-iliac/femoro-popliteal segment). The conservative therapeutic measures in terms of pre-, per-, and postoperative reocclusion prevention are discussed--also with a view to "surgically exhausted" cases--with special focus on platelet antiaggregants (acetylsalicylic acid [ASA]), hemorheological principles (hemodilution, pentoxifylline) and anticoagulation. In an one year comparative reocclusion prevention study of ASA and pentoxifylline (Trental 400) in patients with prosthetic bypass surgery in the femoro-popliteal segment no difference was found in respect of the patency rate between the two treatments, the hemorheological medication, however, proved significantly better tolerable. It can be concluded that such conservative treatments can clearly support the outcome of vascular surgery on the long run, with, indeed, control of risk factors and activation of patients to physical therapy (walking exercise).

Aortic Aneurysm↗