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Biomedical subjects

F J Veith

Publications and source records attributed to F J Veith.

At least 271 records · Page 15Linked to original sources
PubMed1985

Tibiotibial vein bypass grafts: a new operation for limb salvage.

Tibiotibial bypasses were performed with short (8 to 33 cm) segments of reversed autologous vein in 14 patients who did not have longer segments of usable vein. All patients faced imminent amputation unless they had an effective revascularization. Two patients died, one within 1 month of operation. One patient required below-knee amputation despite a patent bypass. Eleven patients (79%) have a patent bypass and a functional limb 6 to 50 months after operation. These good patency results even with several grafts inserted into isolated segments of tibial arteries, some with incomplete plantar arches, suggest that these short vein grafts may be superior to other vein grafts. Tibiotibial bypasses may improve limb salvage results in otherwise difficult circumstances.

Aged↗
PubMed1985

Bronchial anastomotic healing in canine lung allotransplants treated with cyclosporine.

Bronchial anastomotic healing was evaluated in 22 long-term-surviving canine lung allotransplant recipients treated with cyclosporine as the major immunosuppressive agent. Mean survival in these dogs was over 155 days, and 4 animals survived 1-3 years. Bronchial anastomotic complications were limited to 5 cases of minimal (less than 15%) bronchostenosis. The bronchial anastomoses became somewhat edematous and friable during rejection episodes, but no clinically serious sequelae--such as hemorrhage, peribronchial abscess, or bronchial dehiscence--were observed. Gross and microscopic evaluation of the recipient and donor segments of the anastomoses revealed excellent healing, with only scattered areas of inflammatory cells. The decreased frequency and severity of rejection episodes in animals treated with cyclosporine permits early revascularization of the bronchus to take place and reduces the need for other immunosuppressive agents that may interfere with bronchial healing. Cyclosporine is an effective immunosuppressive agent for canine lung allotransplantation and allows normal bronchial anastomotic healing to occur.

Animals↗
PubMed1985

A proposal for cadaver organ procurement: routine removal with right of informed refusal.

In order to alleviate the shortage of vital organs for transplant, we propose a system of routine removal of cadaver organs with an option of informed refusal by family. Unless an individual registered an objection during his or her lifetime, or unless the family objected to the procedure, clinicians would be permitted routinely to salvage vital organs for transplant. Our proposal charts a middle path between the current ineffective policy based on "encouraged voluntarism" and "presumed consent" policies that promise effectiveness at the cost of violating traditional ethical and legal principles. In this article, we analyze the failure of the current regime, articulate a policy of routine removal subject to the right of informed refusal, and defend this policy against several possible objections.

Cadaver↗
PubMed1985

Obtaining consent for organ donation.

The medical, emotional, and legal environments in which consent for organ donation is pursued greatly influence the outcome of this request. Knowledge of the circumstances and facts regarding brain death are important first steps in resolving misconceptions a potential donor's family may have that might preclude a favorable decision. The attitudes of hospital staff members toward these issues, and the grief and shock experienced at these times by next-of-kin, further complicate the circumstances in which consent for organ donation is requested. Clarification of traditional religious beliefs and reconciliation of these with the concept of organ donation may also have to be addressed at this time. Significant benefit to the bereaved family as well as to the transplantation process can accrue only in an atmosphere in which all involved understand the facts of brain death, and in which organ donation is viewed positively.

Attitude of Health Personnel↗
PubMed1985

Organ selection and preservation for transplantation. Part II: liver, pancreas, skin, and bone marrow.

Transplantation of organs and tissues provides the clinician with treatment options for many types of organ failure. However, nearly all transplant efforts are limited by a relative scarcity of donor material. Donor organ and tissue availability can be increased by developing suitable preservation methods and by improving the awareness of primary health care providers as to the needs and scope of therapeutic transplantation. Donor material capable of immediate function upon implantation will become available as increasingly effective techniques of tissue and organ preservation develop. These techniques are extremely important for lung, heart, and liver transplantation, where no artificial, long-term methods of support exist, making immediate function a necessity. In Part I of this article, the authors discussed transplantation of cornea, kidney, heart, lung, and heart-lung block; Part II covers transplantation of liver, pancreas, skin, and bone marrow.

Bone Marrow Transplantation↗
PubMed1985

Combined segment arterial disease.

CSAD provides a challenge for the vascular surgeon. Patients are older, sicker, and at greater risk than are patients with unisegmental disease. Similarly, symptoms are more severe and limb loss is more frequent. A multitude of different reconstructive techniques are available, but their injudicious or untimely use can not only fail to improve the patient but can also cause limb loss or death. Their use must be predicated by a differentiation of which arterial segments are hemodynamically involved, yet this determination may not be possible even after extensive noninvasive and invasive investigation. To optimize the approach to these patients, the following principles should be employed. First, incapacitating claudication is a valid indication for a suprainguinal inflow procedure in a good-risk patient. However, indications for surgery should usually be limited to limb salvage, especially if an infrainguinal procedure is contemplated. Medical conditions such as heart failure and diabetes should be improved before arteriography. The latter should delineate the entire infrarenal arterial system, with special attention to the iliac, deep femoral, and pedal arteries. Oblique views may be of critical importance. Noninvasive hemodynamic tests should be used to confirm the need for arterial reconstruction and help delineate areas of functional stenosis. Direct pull-through pressure measurements may be required for ultimate confirmation. If proximal disease is thus defined, as proximal inflow operation should usually be sufficient unless there is extensive gangrene of the foot, in which case synchronous distal grafts may be required. If the proximal graft alone is performed, the patient must be followed closely since approximately 10% of patients may need subsequent distal reconstructions. The role of the "runoff" segments such as the deep femoral artery, popliteal trifurcation, and pedal arteries may be critical. Every effort should be made to ensure flow through these vessels. Profundoplasty alone is seldom indicated but is often a valuable adjunct to other reconstructive procedures. Lumbar sympathectomy is seldom required. PTA is becoming a valuable adjunct to treatment of CSAD, and intraoperative dilatation also has potential attributes. If such an approach is followed, lasting limb salvage with minimal morbidity should be achieved in most patients with CSAD.

Aging↗
PubMed1985

Revascularization of ischemic bronchial anastomoses by an intercostal pedicle flap.

Ischemia of the donor bronchus, perfused solely by retrograde collaterals from the pulmonary circulation, is an important factor in the impaired healing of the bronchial anastomosis of transplanted lungs. The healing of two experimental models of bronchial anastomotic ischemia, the bronchial segmental autograft and the postpneumonectomy bronchial autograft, was assessed in dogs. The application of a polytetrafluoroethylene wrap to the bronchial segmental autograft and the application of an intercostal pedicle flap to the postpneumonectomy bronchial autograft, with and without concomitant administration of corticosteroids, were also studied to elucidate factors that affect bronchial anastomotic healing. The bronchial segmental autograft healed normally without stricture, but isolation of this autograft from the mediastinum and lung by the polytetrafluoroethylene wrap resulted in necrosis of the autograft. All dogs that had a postpneumonectomy bronchial autograft died of bronchopleural fistulas due to autograft necrosis. Application of an intercostal pedicle flap to the autograft resulted in healing in all animals. Arteriography and Microfil injection demonstrated revascularization of the postpneumonectomy bronchial autograft by the pedicled intercostal artery. Several conclusions can be drawn: With the lung in situ the bronchial segmental autograft survives, probably as a free composite graft. In contrast, the postpneumonectomy bronchial autograft is an excellent model of bronchial anastomotic ischemia. The intercostal pedicle flap is a reliable method for providing neovascularity and mechanical reinforcement to an ischemic bronchial anastomosis. Its effect on bronchial anastomotic healing was not diminished by administration of corticosteroids. The intercostal pedicle flap may be useful in preventing bronchial anastomotic complications in clinical lung transplantation.

Bronchi↗
PubMed1985

The value of needle renal allograft biopsy. III. A prospective study.

Previous studies of the value of percutaneous renal transplant biopsy have been retrospective. We prospectively studied whether biopsy affected patient management. Thirty-five patients with elevated serum creatinine level underwent 44 biopsies in situations in which the diagnosis was in doubt. At the time of biopsy, all clinical and laboratory data were reviewed, and a proposed treatment plan was outlined. Biopsy results were available within 24 hours. We evaluated whether biopsy influenced treatment. Other than hematuria (less than 24 hours), there were no complications. Nine biopsy specimens (20.5%) were inadequate for evaluation. Forty-six percent of adequate biopsy specimens (36% of total biopsy specimens) influenced patient management. Adequate biopsy specimens resulted in a change in treatment in 10 of 19 patients receiving prednisone and azathioprine and 6 of 16 receiving prednisone and cyclosporine. The remaining biopsy specimens, although not changing management confirmed the treatment plan in ambiguous clinical situations. We conclude that percutaneous biopsy is an important aid in patient management.

Acute Disease↗
PubMed1985

Multiple organ procurement from one donor.

To maximize organ utilization, we assessed the feasibility of retrieving the heart and two single lungs or the heart and a separate bilateral lung block for transplantation into multiple recipients. In eight dogs the excision of the heart-lung block or of the left lung was followed by six hours of lung preservation. Four of these lungs and all eight hearts were transplanted successfully. In addition, satisfactory retrieval of the three separate organs or of the heart and a separate bilateral lung block was done in six human cadavers. An appropriate division of the left atrial wall provided suitable cuffs for individual transplantation of the three organs or for the heart and bilateral lung block. This study demonstrates the feasibility of multiple organ donation from a single donor followed by separate organ transplantation.

Animals↗
PubMed1985

Comparison of axillounifemoral and axillobifemoral bypass operations.

Routine use of axillobifemoral (ABF) bypass has been advocated because this operation is thought to achieve better patency than the axillounifemoral (AUF) procedure. In 5 years we performed 34 AUF and 22 ABF bypass operations for limb salvage in high-risk patients using 6 mm polytetrafluoroethylene grafts. Five-year cumulative life table patency rates for AUF bypasses were 71% with reoperation (secondary patency) and 44% without reoperation (primary patency). These values were not significantly different (p greater than 0.5) from those for ABF bypasses (77% and 50%, respectively). Five-year limb salvage results (AUF 73%; ABF 89%) were also not significantly different (p greater than 0.1). Correlation of arterial outflow characteristics with graft patency revealed that 78% of the patients who never had graft occlusion had occluded superficial femoral arteries (SFA) demonstrated at the first operation, while 79% of the patients who experienced graft closure had comparable SFA occlusions. Our aggressive approach to graft thrombosis included angiographic study of the inflow arterial system. This revealed that 16% of the failed grafts were associated with hemodynamically significant stenosis of the donor subclavian artery. Our results indicate that AUF bypass is the procedure of choice for unilateral limb ischemia in high-risk patients who require an axillary source and that patency of the SFA does not affect outcome. These results also emphasize the need to obtain angiographic evaluation of the inflow system.

Aged↗
PubMed1984

Inadequacy of the noninvasive hemodynamic evaluation of percutaneous transluminal angioplasty.

The role of noninvasive hemodynamic tests in the evaluation of percutaneous transluminal angioplasty success or failure was studied. The ankle-brachial pressure index and pulse volume recording amplitude were measured before and after 37 iliac and 46 femoropopliteal angiographically successful percutaneous transluminal angioplasties. Immediate evidence of hemodynamic improvement was seen in 53 percent of angiographically successful dilatations using the ankle-brachial pressure index and in 60 percent using the pulse volume recording amplitude alone. A better correlation was seen when improvement was noted on either test but was still only 71 percent. Twelve primary iliac percutaneous transluminal angioplasties were considered to be successful immediately by angiography, yet no hemodynamic improvement was recorded. Nine primary iliac percutaneous transluminal angioplasties, however, had continued clinical success and limb viability. Twelve angiographically successful femoropopliteal percutaneous transluminal angioplasties also showed no improvement in hemodynamic values, yet three have continued clinical evidence of patency. Thus, although noninvasive hemodynamic tests are important and must be carried out, they are only one of many ways to assess the effectiveness of angioplasty.

Adult↗
PubMed1984

Evaluation of graft patency utilizing the ankle-brachial pressure index and ankle pulse volume recording amplitude.

To determine femoropopliteal graft patency, the ankle-brachial pulse index and the ankle pulse volume recording amplitude were measured. Fourteen healthy volunteer subjects were tested on two occasions over 24 hours (ankle-brachial pressure index 1.14+:-0.16, change 0.03+:-0.05; ankle pulse volume recording amplitude 25+:-7 mm, change 5+:-4 mm). In the second control group, hemodynamic function in the unoperated limb was studied before and after surgery in 40 patients undergoing infrainguinal bypass on the contralateral side (preoperative ankle-brachial pressure index 0.66+:-0.3, change 0.02+:-0.12; preoperative ankle pulse volume recording amplitude 8+:-7 mm, change 1+:-3 mm). After 119 patent femoropopliteal bypasses ankle-brachial pressure index and ankle pulse volume recording amplitude increased by 0.41+:-0.26 and 11+:8 mm, respectively.

Ankle↗
PubMed1984

Quantitative assessment of outflow resistance in lower extremity arterial reconstructions.

Graft patency is thought to correlate with resistance in the runoff bed or outflow resistance. However, accurate measurement of this parameter has been difficult. A simple and reproducible method for direct measurement of outflow resistance following completion of the distal anastomosis of a bypass graft has been developed. This method employs injection of a fixed amount of normal saline through the proximal end of the graft and measurement of the resulting integrated pressure increment by an analog computer. Division of this pressure integral by the volume injected is a measure of the outflow resistance expressed in resistance units (mm Hg/ml/min). The median outflow resistance in 31 femoropopliteal bypasses was 0.29 units with a range of 0.08-1.38 units. The median outflow resistance in 33 femorodistal bypasses was 0.7 units with a range of 0.18-2.34 units. All bypasses with an outflow resistance of 1.1 units or less remained patent for 3 months. There were 51 grafts in this group (30 femoropopliteal; 21 femorodistal) and their outflow resistance ranged from 0.08 to 1.1 units. All bypasses with an outflow resistance of 1.2 units or higher thrombosed within the first postoperative month. There were 13 grafts in this group (1 femoropopliteal; 12 femorodistal) and their outflow resistance ranged from 1.2 to 2.38 units. Eight of the 13 grafts that failed originally were subjected to thrombectomy, which was uniformly unsuccessful. Although this method does not yet allow bypass surgery to be denied to any patient, it does define a group of patients in whom thrombectomy will not be effective and should not be attempted.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Components of outflow resistance and their correlation with graft patency in lower extremity arterial reconstructions.

We have used a simple reproducible method to measure total outflow resistance (OR) and its proximal and distal components in 101 bypasses (46 femoropopliteal [FP] and 55 femorodistal [FD]). All bypasses with a distal OR greater than 1.2 mm Hg/ml/min failed within 3 months and all with distal OR less than 1.2 mm Hg/ml/min remained patent for at least 3 months. To evaluate the contribution of vasospasm to OR and its role in graft failure, 60 bypasses (29 FP, 31 FD) had OR measurements before and after local infusion of papaverine hydrochloride (60 mg). Within 3 months, nine grafts (all FD) occluded and 51 remained patent. All nine failures had distal OR greater than 1.2 mm Hg/ml/min before papaverine infusion. After infusion, the mean percentage decrease in both total and distal OR for all grafts was 30% and 31%, respectively. However, there was no significant difference between these papaverine-induced decreases in OR and 3-month graft failure or success. Moreover, in three bypasses, even though papaverine lowered the distal OR from greater than 1.2 to less than 1.2 mm Hg/ml/min, early occlusion occurred. In six grafts (1 FP, 5 FD) when total and distal OR before and after papaverine was greater than 1.2 mm Hg/ml/min, the graft was extended to a second distal artery as a sequential bypass. These six grafts have remained patent over 3 months. Thus measurement of OR and particularly distal OR is a most accurate predictor of early graft success or failure. Pharmacologic manipulation does not enhance the predictive value of the OR measurement. OR measurements also help to select those FD bypass cases in which extension to a second distal artery as a sequential bypass improves patency.

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