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Biomedical subjects

F J Veith

Publications and source records attributed to F J Veith.

At least 37 records · Page 2Linked to original sources
PubMed2001

Limited role for IVUS in the endovascular repair of aortoiliac aneurysms.

BACKGROUND: To determine the need for routine versus selective intraoperative IVUS during endovascular aortoiliac aneurysm (AIA) repair. METHODS: One-hundred and eighty-eight endovascular AIA repairs performed over a 5-year period were reviewed and included in the study. Surgeon-made aorto-uni-femoral grafts (n=78) and industry-made bifurcated or tube grafts (n=110) were used. In the initial 51 cases IVUS was routinely performed. In the latter 137 cases IVUS was used selectively. In this group graft deformities suspected on completion angiography or pullback pressure measurements were treated with balloon dilatation and stenting. IVUS was then performed only in the presence of a persistent pressure gradient or inconclusive angiographic findings. RESULTS: In the initial 51 cases IVUS revealed 20 lesions of which 8 were not initially detected angiographically and which required further treatment. In the latter 137 cases IVUS was necessary in only 1 case, and guided the treatment of an angiographically undetectable lesion. There have been no late episodes of graft compression, kinking, or thrombosis in the selective IVUS group. CONCLUSIONS: The use of pullback pressure measurements with a low threshold for angioplasty and stenting, especially in unsupported grafts, followed by the selective use of IVUS decreases the overall requirement for IVUS and its associated costs.

Angiography↗
PubMed2000

The use of gastric tonometry in the assessment of celiac artery compression syndrome.

This report describes the use of gastric tonometry to measure gastric mucosal ischemia/intestinal mucosa pH (pHi) in a patient treated for celiac artery compression syndrome. Significant gastric mucosal ischemia was demonstrated prior to celiac artery decompression as indicated by a pHi of 7.29. The ischemia was relieved by celiac artery decompression, with an increase in the pHi to 7.48. The patient experienced complete relief of his symptoms after surgical decompression and remains asymptomatic 14 months after surgery. Gastric tonometry provides an objective measurement of intestinal perfusion and ischemia in the treatment of celiac artery compression syndrome.

Adult↗
PubMed2000

Can a tissue-engineered skin graft improve healing of lower extremity foot wounds after revascularization?

A bilayered tissue-engineered skin graft composed of human neonatal foreskin fibroblasts and keratinocytes in a type I bovine collagen matrix has been developed. We sought to determine if this graft improves wound healing after lower extremity revascularization. Thirty-one previously ischemic foot wounds were randomly assigned to moist dressing changes or tissue-engineered skin graft within 60 days of revascularization. In the grafted group, 10 received meshed and 11 received unmeshed graft. Wound healing was followed by wound area measurements and photography. There were no statistically significant differences between groups in patient age, sex, diabetes or renal failure risk factors, revascularization procedure, or wound location or size. Treatment with tissue-engineered skin graft was significantly more effective than moist dressing in the percentage of wounds healed (62 vs. 0% at 8 weeks, 86 vs. 40% at 12 weeks, p < 0.01) and the median time to complete wound closure (7 vs. 15 weeks, p = 0.0021, rank-sum test). There was no difference in the wound closure rate of meshed and unmeshed graft at 4, 8, 12, or 24 weeks (p > 0.05). Three indolent localized wound infections in the tissue-engineered skin graft group were the only complication. Tissue-engineered skin grafting can be used safely in previously ischemic wounds after lower extremity revascularization. Treatment with this graft promotes healing more rapidly and in more patients than standard moist dressings. It obviates the risk, inconvenience, and expense of donor skin harvesting, anesthesia, and hospitalization associated with autologous skin grafting. This graft may represent an advance in the treatment of previously ischemic lower extremity foot wounds.

Aged↗
PubMed2000

Prosthetic patch remnants to treat infected arterial grafts.

PURPOSE: Our previous experience with the traditional management of infected prosthetic arterial grafts, which included graft excision and vein patch repair of the involved artery, was complicated by a high incidence of vein patch rupture. This study assessed the treatment of infected prosthetic grafts with subtotal graft excision and oversewing of small graft remnants. METHODS: During the last 20 years, we treated 53 wounds involving 45 infected prosthetic grafts in 42 patients by means of subtotal graft excision and oversewing of a residual 2- to 3-mm graft remnant (patch) at an intact arterial anastomosis. This technique was selectively used to maintain patency of small-diameter arteries (41 common femoral, five deep femoral, three axillary, two iliac, and two popliteal), which were critical for limb salvage or amputation healing. This strategy avoided difficult dissection of the underlying artery in scarred wounds and obviated the placement of a new patch in an infected field. Graft remnants were polytetrafluoroethylene in 51 cases and Dacron in two cases. Of the 45 grafts, 31 were occluded and 14 were patent. All infected tissue was widely debrided, wet-to-dry dressing changes were performed three times daily, and appropriate intravenous antibiotics were administered for at least 1 week. Secondary bypass grafting procedures were performed as needed to achieve limb salvage. The follow-up period in surviving patients averaged 32 months (range, 1 to 218 months). RESULTS: No complications were directly attributable to prosthetic patch remnants in 92% of cases (49 of 53 cases). Six of 42 patients (14%) died during hospitalization (three of cardiac complications and three of sepsis with multiple organ failure). Two infected pseudoaneurysms developed 8 and 34 months after surgery, and two wounds failed to heal. Sixteen secondary bypass grafting procedures were necessary to achieve limb salvage. Patch oversewing led to limb salvage without the need for secondary revascularization in 26 other cases and to the successful healing of 10 amputated limbs when secondary revascularization was not possible. CONCLUSION: Prosthetic patch remnants are a useful adjunct that simplify management of infected prosthetic grafts, are associated with a low incidence of wound complications, and help maintain patency of essential collaterals to achieve limb salvage or heal an amputation.

Adult↗
PubMed2000

Hypogastric artery coil embolization prior to endoluminal repair of aneurysms and fistulas: buttock claudication, a recognized but possibly preventable complication.

PURPOSE: Hypogastric artery embolization is considered to be necessary to prevent retrograde flow and potential endoleaks when a stent-graft crosses the origin of the hypogastric artery. The authors assess the incidence of buttock claudication, which is the primary complication encountered. The effect of coil location and the presence of antegrade flow at the completion of embolization are evaluated. MATERIALS AND METHODS: Hypogastric artery embolization and endoluminal repair of aneurysms and fistulas was performed in 34 patients (30 men; four women) aged 27-91 years (mean, 76 years). Ten patients were being treated for solitary abdominal aortic aneurysms, 13 were being treated for aortoiliac aneurysms, and six patients were being treated for isolated common iliac aneurysms, three for hypogastric artery aneurysms and two for iliac arteriovenous fistulas. Eleven patients had coils placed completely above the bifurcation of the hypogastric artery and 23 patients had coils placed at the bifurcation, or within the branches of the hypogastric artery. Preservation of antegrade flow after embolization was noted in 14 of 34 patients. RESULTS: Thirty-four patients underwent stent-graft repair after hypogastric artery embolization. There were two perioperative deaths, three proximal leaks, and one collateral leak. Of the 32 patients who survived the procedure, there was one retrograde leak, even though 13 of 32 (41%) patients had continued antegrade flow at completion of the hypogastric artery embolization. When coils were placed at or in the bifurcation of the hypogastric artery, 12 of 22 (55%) experienced claudication. When coils were placed in the proximal hypogastric artery, one of 10 (10%) claudicated. CONCLUSION: It is probably not necessary to completely occlude antegrade flow in the hypogastric artery to prevent a distal endoleak. Buttock claudication is rare when coils are placed in the proximal hypogastric artery rather than at its bifurcation or in its branches.

Adult↗
PubMed2000

Complicated emergent endovascular repair of a life-threatening bilateral internal jugular vein occlusion.

A 62-year-old woman had painful facial swelling that progressed to extensive periorbital and perioral edema with loss of vision, hearing, and consciousness. Her past surgical history was significant for right radical neck dissection including internal jugular vein (IJV) resection, laryngectomy, partial esophagectomy, tracheoesophageal fistula repair, and tracheostomy for squamous cell carcinoma of the oropharynx. In addition, the patient had received radiation therapy to the neck. A venogram revealed occlusion of the left IJV. A guidewire from the femoral vein was passed through the occluded segment; however, attempts to introduce an angioplasty balloon failed. A percutaneous basilic vein approach allowed passage of a dilator sheath over a guidewire, thereby enabling Wallstent deployment across the IJV occlusion. A second Wallstent was inserted across a stenosis in the brachiocephalic vein; however, this second stent reoccluded the IJV. Surgical removal of the second Wallstent was required through a segmental claviculectomy and venotomy. Patency was restored in the IJV and the brachiocephalic vein with the return of baseline neurologic function. This case demonstrates a complicated emergent endovascular repair of a life-threatening IJV occlusion that required surgical salvage.

Constriction, Pathologic↗
PubMed2000

Acute enlargement and subsequent rupture of an abdominal aortic aneurysm in a patient receiving chemotherapy for pancreatic carcinoma.

We report a case of ruptured abdominal aortic aneurysm (AAA) in a patient receiving chemotherapy for pancreatic cancer. We reviewed the literature on the effects of corticosteroids and chemotherapy on aaa formation and discuss possible mechanisms for drug action to promote aneurysm expansion and rupture. If cancer and AAA coincide and curative chemotherapy is possible, a potential impact of chemotherapy on AAA expansion should be considered.

Adenocarcinoma↗
PubMed2000

Alternative techniques for management of distal anastomoses of aortofemoral and iliofemoral endovascular grafts.

PURPOSE: Techniques for managing the distal anastomoses of aortofemoral and iliofemoral endovascular grafts are described. METHODS: Over a 2(1/2)-year period 46 endovascular grafts were successfully placed to treat severe iliac artery occlusive disease. Endovascular grafts were anchored proximally in the distal aorta or iliac arteries with Palmaz balloon-expandable stents. The distal anastomoses were performed with the use of open, sutured anastomotic techniques. In contrast to stented distal anastomoses, these techniques allowed us to (1) treat occlusive lesions extending from the distal aorta to below the inguinal ligament, (2) terminate endovascular grafts in the groin where stents are contraindicated, (3) vary the distal anastomotic site depending on the local pattern of disease, and (4) standardize the preinsertion length of the endovascular graft. RESULTS: Two distal perianastomotic stenoses and one graft occlusion were detected postoperatively in 11 bypass grafts that had distal anastomoses sewn endoluminally without an overlying patch angioplasty. Only one perianastomotic stenosis was found among 35 anastomoses performed with other techniques. There were no significant differences in primary and secondary patency between grafts originating in the distal aorta or iliac arteries. CONCLUSIONS: Hand-sewn distal anastomoses can simplify the insertion of endovascular grafts used for the treatment of aortoiliac occlusive disease. These anastomoses permit tailoring of the graft according to the patients' pattern of disease and eliminate the need to precisely measure the length of the graft preoperatively. In addition, because a distal stent is not required, endovascular grafts can be safely terminated in the groin instead of the external iliac artery where disease progression can lead to graft failure. Finally, endovascular distal anastomoses should be closed with a patch or the hood of a more distal bypass graft to prevent perianastomotic stenoses or occlusions in the postoperative period.

Adult↗
PubMed2000

Does the endovascular repair of aortoiliac aneurysms pose a radiation safety hazard to vascular surgeons?

OBJECTIVES: Endovascular aortoiliac aneurysm (EAIA) repair uses substantial fluoroscopic guidance that requires considerable radiation exposure. Doses were determined for a team of three vascular surgeons performing 47 consecutive EAIA repairs over a 1-year period to determine whether this exposure constitutes a radiation hazard. METHODS: Twenty-nine surgeon-made aortounifemoral devices and 18 bifurcated devices were used. Three surgeons wore dosimeters (1) on the waist, under a lead apron; (2) on the waist, outside a lead apron; (3) on the collar; and (4) on the left ring finger. Dosimeters were also placed around the operating table and room to evaluate the patient, other personnel, and ambient doses. Exposures were compared with standards of the International Commission on Radiological Protection (ICRP). RESULTS: Total fluoroscopy time was 30.9 hours (1852 minutes; mean, 39.4 minutes per case). Yearly total effective body doses for all surgeons (under lead) were below the 20 mSv/y occupational exposure limit of the ICRP. Outside lead doses for two surgeons approximated recommended limits. Lead aprons attenuated 85% to 91% of the dose. Ring doses and calculated eye doses were within the ICRP exposure limits. Patient skin doses averaged 360 mSv per case (range, 120-860 mSv). The ambient (> 3 m from the source) operating room dose was 1.06 mSv/y. CONCLUSIONS: Although the total effective body doses under lead fell within established ICRP occupational exposure limits, they are not negligible. Because radiation exposure is cumulative and endovascular procedures are becoming more common, individuals performing these procedures must carefully monitor their exposure. Our results indicate that a team of surgeons can perform 386 hours of fluoroscopy per year or 587 EAIA repairs per year and remain within occupational exposure limits. Individuals who perform these procedures should actively monitor their effective doses and educate personnel in methods for reducing exposure.

Aortic Aneurysm↗
PubMed2000

Endovascular grafts and other image-guided catheter-based adjuncts to improve the treatment of ruptured aortoiliac aneurysms.

OBJECTIVE: To report a new management approach for the treatment of ruptured aortoiliac aneurysms. METHODS: This approach includes hypotensive hemostasis, minimizing fluid resuscitation, and allowing the systolic blood pressure to fall to 50 mmHg. Under local anesthesia, a transbrachial guidewire was placed under fluoroscopic control in the supraceliac aorta. A 40-mm balloon catheter was inserted over this guidewire and inflated only if the blood pressure was less than 50 mmHg, before or after the induction of anesthesia. Fluoroscopic angiography was used to determine the suitability for endovascular graft repair. When possible, a prepared, "one-size-fits-most" endovascular aortounifemoral stented PTFE graft was used, combined with occlusion of the contralateral common iliac artery and femorofemoral bypass. If the patient's anatomy was unsuitable for endovascular graft repair, standard open repair was performed using proximal balloon control as needed. RESULTS: Twenty-five patients with ruptured aortoiliac aneurysms (18 aortic, 7 iliac) were managed using this approach. Balloon inflation for proximal control was required in nine of the 25 patients. Twenty patients were treated with endovascular grafts. Five patients required open repair. The ruptured aneurysm was excluded in all 25 patients; 23 survived. Two deaths occurred in patients who received endovascular grafts with serious comorbidities. The surviving patients who received endovascular grafts had a median hospital stay of 6 days, and the preoperative symptoms resolved in all patients. CONCLUSIONS: Hypotensive hemostasis is usually an effective means to provide time for balloon placement and often for endovascular graft insertion. With appropriate preparation and planning, many if not most patients with ruptured aneurysms can be treated by endovascular grafts. Proximal balloon control is not required often but may, when needed, be an invaluable adjunct to both endovascular graft and open repairs. The use of endovascular grafts and this approach using other image-guided catheter-based adjuncts appear to improve treatment outcomes for patients with ruptured aortoiliac aneurysms.

Aged↗
PubMed2000

Prosthetic above-knee femoropopliteal bypass grafting: five-year results of a randomized trial.

PURPOSE: This trial was designed to identify factors affecting patency rates of primary prosthetic above-knee femoropopliteal bypass grafts at 5 years. METHODS: A multi-institutional, prospective trial randomized 240 patients to compare patency rates of Gore-tex and Hemashield above-knee femoropopliteal bypass grafts at 5 years. Univariate comparisons of patency between levels of each prognostic variable were made with the Kaplan-Meier method. Variables that had a univariate P value less than.25 or those known to be important were submitted to a Cox regression analysis. RESULTS: The patient survival rate at 5 years was 59.4%. There were no differences in primary or secondary patency rates at 5 years between the two graft materials (primary, 45% vs 43% and secondary, 68% vs 68%). The risk for graft occlusion was significantly increased for patients younger than 65 years (2.1; P =.001) and for grafts with a diameter less than 7 mm (1.65; P =.0219). Variables with no apparent independent effect on patency rates were smoking status, runoff, diabetes mellitus, sex, presenting symptoms, and postoperative treatment with aspirin or Coumadin. Noninvasive test results were not predictive of subsequent graft function. CONCLUSION: Although the type of prosthetic used for above-knee femoropopliteal bypass grafts does not affect 5-year patency rates, age and graft size do influence results. These factors should be considered before a prosthetic bypass grafting procedure. Furthermore, these data should serve as a contemporary standard, with which evolving and conventional procedures can be compared.

Aged↗
PubMed2000

Overview of techniques and devices for endovascular abdominal aortic aneurysm repair.

The endovascular treatment of abdominal aortic aneurysms (AAAs) is rapidly evolving. Since the onset of clinical investigations in 1990 there has been a rapid proliferation in the number of available devices, both surgeon-made and industry-made. This chapter reviews endovascular AAA repair with regard to available devices, patient selection for each device based on anatomic criteria, and techniques for graft deployment.

Angiography↗
PubMed2000

Carotid stenting with and without protection devices: should protection be used in all patients?

Embolic events that result in neurological deficits have been the most significant concern regarding carotid bifurcation stenting. Ex vivo carotid angioplasty studies using human carotid plaques have shown that embolic particles were released from all specimens. In addition, transcranial Doppler studies have confirmed the presence of multiple emboli in the middle cerebral artery during carotid stenting. Preliminary experience with the use of brain protection devices for carotid stenting have shown encouraging results in terms of safety and efficacy. Moreover, embolic particles have been recovered from all cases in which protection devices have been used. We provide the rationale for routine use of these protection devices and also review the various protection devices on the horizon.

Carotid Stenosis↗
PubMed2000

Newer developments in endovascular graft treatment for aortic and aortoiliac aneurysms. A seven-year experience.

BACKGROUND: This article described a 7-year experience with endovascular graft for the tratment of aortoiliac aneurysms and other arterial lesions. METHODS: Four hundred and seventy-two grafts of various types have been placed in 283 patients. RESULTS: Short and mid-term results in these patients suggest that endovascular grafts may provide better treatment for central artery injuries and some iliac and aortoiliac aneurysms, particularly in high-risk patients and those with previous aortoiliac surgery. CONCLUSIONS: In other circumstance, long-term evaluation will be required to determine the effectiveness and limitations of these endovascular grafts.

Aortic Aneurysm, Abdominal↗
PubMed1999

Early experience with the Corvita endoluminal graft for treatment of arterial injuries.

The aim of this study was to evaluate our early experience with the Corvita endoluminal graft for the treatment of a variety of arterial injuries. Ten patients with arterial pseudoaneurysms (8) or arteriovenous fistulas (2) due to arterial injuries were followed prospectively after undergoing treatment with the endovascular graft. Our results showed that the Corvita low-profile endoluminal graft can be successfully used to treat arterial injuries but that it sometimes requires the placement of additional stents in patients with tortuous or tapering vessels. These grafts are extremely useful for the safe treatment of difficult and high-risk patients. Further improvements in available endovascular grafts and good long-term results will be necessary before considering these grafts the best treatment available for most patients with significant arterial injuries.

Adult↗
PubMed1999

Repair of bilateral common iliac artery aneurysms coexisting with a pelvic horseshoe kidney.

This report describes the treatment of bilateral common iliac artery aneurysms in a patient with a pelvic horseshoe kidney. Anomalous renal arteries arising from the aorta, the common iliac arteries, and the left hypogastric artery were identified precisely by selective angiography. These multiple renal artery anomalies and the presence of a large pelvic horseshoe kidney complicated the surgical treatment of the aneurysms. The repair of the aneurysms was successfully accomplished by staged retroperitoneal procedures. This technique allowed excellent visualization of the iliac aneurysms and preservation of all renal arteries with intact renal function.

Humans↗
PubMed1999

When is urokinase treatment an effective sole or adjunctive treatment for acute limb ischemia secondary to native artery occlusion?

BACKGROUND: Intra-arterial thrombolytic therapy is currently a therapeutic option for the treatment of acute limb ischemia. A recent large prospective randomized trial (TOPAS) comparing lytic therapy and operative intervention showed that both forms of treatment had similar results in terms of amputation-free survival. However, the exact role for lytic treatment is unclear. METHOD: Over a 4-year period we treated 60 cases of acute limb ischemia in 57 patients secondary to native artery occlusion with thrombolytic therapy with urokinase. All patients were evaluated at 1 week, 1 month, and then at 3-month intervals posttreatment. Follow-up evaluations included pulse examination, pulse volume recordings, and duplex examinations to confirm arterial patency. No patients were lost to follow-up with a range of 8 to 54 months (mean 26). RESULTS: Of these 60 native arterial occlusions, complete lysis was achieved in 46 cases (76%). Of these 46 cases, 18 required lysis only, 19 cases (9 iliac, 7 superficial femoral artery (SFA), and 3 popliteal) required angioplasty of lesions uncovered by clot lysis, and 9 patients had lysis and angioplasty of iliac arteries followed by infrainguinal bypasses. Eight of the 57 patients (14%) who had been asymptomatic presented with symptoms limited to new onset claudication, all of which were successfully lysed. Cumulative patency for the 43 successful cases was 90% +/- 5% at 1 year and 75% +/- 4% at 2 years. The 1-year amputation-free survival for all native artery occlusions was 85% +/- 6%. CONCLUSION: Thrombolysis with urokinase simplified the treatment of native arterial occlusion proving to be the sole therapy in 18 (29%) patients or a valuable adjunct by facilitating the angioplasty of arterial lesions and avoiding open surgery in 60% of patients treated. In addition, the correction of inflow lesions reduced the magnitude of required subsequent bypass procedures to achieve limb salvage. In conclusion, successful thrombolysis of native artery occlusion provided durable arterial patency and limb salvage, particularly in patients with new onset claudication.

Acute Disease↗