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Biomedical subjects

F J Veith

Publications and source records attributed to F J Veith.

At least 127 records · Page 7Linked to original sources
PubMed1995

Recommendations for initial antibiotic treatment of extracavitary arterial graft infections.

BACKGROUND: Initial antibiotic treatment of extracavitary arterial graft infections is usually empiric or based on Gram's stain findings. Increasing virulence of bacteria causing extracavitary arterial graft infections may render previous choices of antibiotics obsolete. The purposes of this study were to correlate Gram's stain findings of gram-positive bacteria and gram-negative bacteria with wound cultures and provide a microbiologic basis for appropriate initial antibiotic therapy. METHODS: Between July 1, 1979 and June 30, 1994, specimens obtained on the day of admission from purulent wounds involving 113 extracavitary arterial graft infections were retrospectively reviewed for Gram's stain and culture and sensitivity results. RESULTS: Gram's stain findings correlated with final cultures on only 28 of 113 cases (25%), including 20 of 48 pure gram-positive, 2 of 24 pure gram-negative, and 6 of 41 mixed bacterial cultures. Staphylococcus aureus was the most common gram-positive bacteria cultured (43 isolates) and Pseudomonas species was the most common gram-negative bacteria (25 isolates). Bacteria were sensitive to a first-generation cephalosporin in only 32% (36 of 113) of infections. A combination of vancomycin and either ticarcillin-clavulanic acid or ceftazidime, which have minimal toxicity and provide excellent coverage against staphylococci, Pseudomonas, and other gram-negative bacteria, would have covered 96% (109) and 95% (107) of cultured organisms, respectively. CONCLUSIONS: Regardless of Gram's stain findings, current recommendations for initial treatment of extracavitary arterial graft infections should include vancomycin and ceftazidime or ticarcillin-clavulanic acid until final culture and sensitivity results dictate the use of more selective antibiotics.

Anti-Bacterial Agents↗
PubMed1995

Transfemoral endovascular repair of iliac artery aneurysms.

PURPOSE: This report evaluates the application of transfemoral endovascular repair of iliac artery aneurysms. PATIENTS AND METHODS: Over a 20-month period, 11 patients with serious comorbid illnesses and a total of 14 iliac artery aneurysms were treated with endovascular grafts composed of polytetrafluoroethylene conduits combined with balloon expandable iliac artery stents (Palmaz). Nine right common, 3 left common, and 2 right internal iliac artery aneurysms were treated. The patients were men between 58 and 89 years of age (mean 72). Eight patients had isolated aneurysms and 3 had multiple iliac artery aneurysms. RESULTS: Endovascular iliac grafts were successfully placed in all 11 patients. No procedural deaths occurred. Follow-up ranged from 3 to 21 months (mean 11). No acute or late graft thromboses occurred. CONCLUSIONS: Transluminally placed endovascular stented grafts can be used to successfully exclude iliac artery aneurysms from the circulation while maintaining lower-extremity arterial perfusion. However, longer follow-up in more patients is necessary to confirm the durability of this technique.

Aged↗
PubMed1995

Differences in early versus late extracavitary arterial graft infections.

PURPOSE: The purpose of this report was to determine differences in presentation, bacteriology, management, and outcome of early (EGIs) versus late extracavitary arterial graft infections (LGIs). METHODS: Between July 1, 1979, and June 30, 1994, we treated 141 patients with infected extracavitary arterial grafts (112 prosthetic, 29 vein) with selective partial or complete graft preservation. RESULTS: A total of 99 (70%) EGIs (< 2 months) and 42 (30%) LGIs (4 to 96 months) were involved. The hospital mortality rate was 14% (20 of 141), and the amputation rate in survivors was 13% (16 of 121). No significant difference in mortality (16% [16 of 99] vs 10% (4 of 42]) or limb loss (16% [13 of 83] vs 8% [3 of 38]) was seen between EGIs and LGIs, respectively (p > 0.05). Patients with EGIs were as likely to have a disrupted anastomosis (17% [17 of 99] vs 21% [9 of 42]) or systemic sepsis (4% [4 of 99] vs 4% [2 of 42]) as patients with LGIs, respectively (p > 0.05). Patients with EGIs were more likely to have patent, intact grafts and to be treated by complete graft preservation (61% [61 of 99] vs 26% [11 of 42]) (p = 0.0001). In comparison, patients with LGIs were more likely to have occluded grafts and to require subtotal graft excision (48% [20 of 42] vs 18% [18 of 99]) (p = 0.0001). Surviving patients with EGIs treated by complete graft preservation were more likely to have successful healing of their wounds after long-term follow-up (average 3 years) than patients with LGIs (79% [41 of 52] vs 40% [4 of 10], respectively) (p = 0.03). The pathogens cultured from wounds of EGIs versus LGIs were pure gram-positive bacteria in 49 (49%) versus 19 (46%), pure gram-negatives in 18 (18%) versus 11 (26%), and both types in 33 (33%) versus 12 (28%) (p > 0.05). CONCLUSION: Complete graft preservation can be attempted more frequently and is more likely to be successful in EGIs than in LGIs. No difference in bacteriology was seen between the two groups. Graft-preserving treatment can be successful but should only be cautiously attempted in patients with late extracavitary arterial graft infections.

Amputation, Surgical↗
PubMed1995

Endovascular aortoiliac grafts in combination with standard infrainguinal arterial bypasses in the management of limb-threatening ischemia: preliminary report.

PURPOSE: Occlusive disease of the aortoiliac segment may lead to limb-threatening ischemia, if coexisting disease is present in the femoral, popliteal, or tibial arteries. The combined treatment of severe aortoiliac and infrainguinal disease with standard techniques may be hazardous or contraindicated in patients with multiple previous reconstructions, severe comorbid medical illnesses, or both. This report summarizes the technical feasibility and early results of aortoiliac endovascular stented grafts (ESGs) in combination with conventional surgical reconstructions for the treatment of multilevel arterial occlusive disease. METHODS: Seventeen patients with multilevel aortoiliofemoral limb-threatening occlusive disease had an ESG inserted to treat long-segment occlusive disease followed by a conventional surgical bypass. ESGs originated from the aortoiliac junction (seven) or the common iliac artery (10) and were inserted into the common femoral (nine), superficial femoral (four), or deep femoral (four) artery. ESG lengths ranged from 16 to 30 cm (mean, 21 cm). Conventional surgical bypasses were constructed from polytetrafluoroethylene (15) or saphenous vein (two) and extended to the popliteal (12), tibial (two), or contralateral femoral (three) arteries. RESULTS: Technical success in graft insertion was achieved in 17 (94%) of 18 attempted ESG procedures. The 1-year primary and secondary cumulative patency rates for ESGs were 94% +/- 10% and 100%, respectively, whereas the 1- and 2-year patency rates for the extravascular grafts were 92% +/- 10% and 100%, respectively. Four patients had minor postprocedure complications (23%), and no deaths occurred. One patient lost his limb at 16 months because of severe pedal sepsis. CONCLUSIONS: Transluminally placed stented grafts in combination with conventional surgical infrainguinal bypasses are a technically feasible and potentially safe option for the treatment of limb-threatening aortoiliofemoral occlusive disease and have demonstrated encouraging early patency. Long-term follow-up will be necessary before widespread application of this technique is advocated.

Adult↗
PubMed1995

Human transluminally placed endovascular stented grafts: preliminary histopathologic analysis of healing grafts in aortoiliac and femoral artery occlusive disease.

PURPOSE: The purpose of this study was to perform a preliminary histopathologic analysis of explanted human endovascular stented grafts from patients treated for occlusive disease. METHODS: Over a 16-month period, 26 endovascular stented grafts were placed in 21 patients with limb-threatening ischemia caused by aortoiliac or femoral artery occlusive disease. All grafts were inserted through open arteriotomies remote from the region of primary disease. During the follow-up period, two patients died of preexisting heart disease 2 weeks and 7 months after grafting, and a portion of their endovascular grafts were the surrounding artery was explanted. Specimens from five other endovascular grafts were obtained during surgical revision for graft stenosis after 3 and 6 weeks and for outflow artery stenosis after 3, 5, and 6 months. All specimens were formalin fixed and studied with hematoxylin and eosin and trichrome staining and immunohistochemically for factor VIII-related antigen, alpha actin smooth muscle, macrophage antigen (MAC-387) and PC-10 (a mouse monoclonal antibody which specifically recognizes proliferating cell nuclear antigen in paraffin sections). RESULTS: Three weeks after placement of the stented grafts, organizing thrombus was present on both surfaces of the expanded polytetrafluoroethylene (PTFE) grafts. At 6 weeks, evidence of a neointima with overlying endothelium was seen in the perianastomotic region, and 3 months after grafting it was seen 1 to 3 cm from the anastomosis. The specimen explanted at 5 months demonstrated factor VIII-positive cells 8 cm from the anastomosis. The histopathologic condition of the external capsule appeared to vary, depending on the presence or absence of an external wrap on the PTFE graft and on which layer in the arterial wall the graft was inserted. A foreign body reaction characterized by multinucleated giant cells was seen adjacent to wrapped grafts or around those placed in an intraadventitial plane. Grafts inserted within the media were surrounded by orderly, arranged, smooth muscle cells and few mononuclear cells. Extensive smooth muscle cell proliferation (PC-10 activity) was not seen within native artery atherosclerotic plaques peripherally displaced and external to prosthetic endovascular grafts. CONCLUSIONS: These preliminary observations on the healing of PTFE endovascular stented grafts in human beings demonstrate limited plaque hyperplasia and the presence of endothelial cells on the luminal surface remote from the graft-artery anastomosis. It is unclear whether this is a unique manifestation of healing in prosthetic grafts inserted within the walls of arteries.

Actins↗
PubMed1995

Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions.

OBJECTIVES: Complex arterial occlusive, traumatic, and aneurysmal lesions may be difficult or impossible to treat successfully by standard surgical techniques when severe medical or surgical comorbidities exist. The authors describe a single center's experience over a 2 1/2-year period with 96 endovascular graft procedures performed to treat 100 arterial lesions in 92 patients. PATIENTS AND METHODS: Thirty-three patients had 36 large aortic and/or peripheral artery aneurysms, 48 had 53 multilevel limb-threatening aortoiliac and/or femoropopliteal occlusive lesions, and 11 had traumatic arterial injuries (false aneurysms and arteriovenous fistulas). Endovascular grafts were placed through remote arteriotomies under local (16[17%]), epidural (42[43%]), or general (38[40%]) anesthesia. RESULTS: Technical and clinical successes were achieved in 91% of the patients with aneurysms, 91% with occlusive lesions, and 100% with traumatic arterial lesions. These patients and grafts have been followed from 1 to 30 months (mean, 13 months). The primary and secondary patency rates at 18 months for aortoiliac occlusions were 77% and 95%, respectively. The 18-month limb salvage rate was 98%. Immediately after aortic aneurysm exclusion, a total of 6 (33%) perigraft channels were detected; 3 of these closed within 8 weeks. Endovascular stented graft procedures were associated with a 10% major and a 14% minor complication rate. The overall 30-day mortality rate for this entire series was 6%. CONCLUSIONS: This initial experience with endovascular graft repair of complex arterial lesions justifies further use and careful evaluation of this technique for major arterial reconstruction.

Adolescent↗
PubMed1995

Endovascular repair of abdominal aortic aneurysm: value of postoperative follow-up with helical CT.

OBJECTIVE: Transfemorally placed endoluminal grafts are currently being evaluated as an alternative to open surgery for the treatment of abdominal aortic aneurysms. We determined the value of helical CT for the follow-up of patients treated with this new procedure. The purposes of this study were to determine CT features of a technically successful procedure, detect complications, and compare findings on CT scans obtained 24-48 hr after insertion of the graft with findings on angiograms obtained at the end of the endovascular procedure. SUBJECTS AND METHODS: Seven patients with large abdominal aortic aneurysms had helical CT within 48 hr after transfemoral insertion of an endoluminal graft. Findings on these CT scans were compared with findings on digital completion angiograms obtained immediately after placement of the graft. Additional follow-up CT scans were obtained for up to 15 months (mean, 8 months). The size of the aneurysmal sac; completeness of perigraft thrombosis; and position, shape, and patency of the device were recorded. RESULTS: CT scans obtained 24-48 hr after placement of the grafts showed complete thrombosis of the aneurysmal sac in three patients and incomplete thrombosis with patent perigraft channels in the four remaining patients. Angiograms showed a patent perigraft channel in only one patient. Two of four initially patent channels subsequently closed, but one of them recurred. Of four thrombosed aneurysms, two decreased in size, and two were unchanged on later follow-up. Of three aneurysms associated with perigraft channels, two became enlarged and one was stable. On the basis of CT criteria, successful endovascular repair was shown in four (57%) of seven patients. CONCLUSION: Helical CT is a sensitive means of evaluating the efficacy of endoluminal grafts. Decreased or stable size of the aneurysmal sac without perigraft channels on late follow-up CT signifies technical success. Persistence or recurrence of perigraft channels is the most likely cause of later enlargement of an aneurysm and therefore suggests procedural failure. Helical CT was more sensitive than angiography for detection of perigraft channels that occurred soon after treatment.

Aged↗
PubMed1995

Endovascular stented graft repair of a pseudoaneurysm of the subclavian artery caused by percutaneous internal jugular vein cannulation: case report.

In high-risk patients endovascular repair of a pseudoaneurysm with a stented graft is a safe and reasonable treatment option that can preclude significant morbidity and shorten hospital stay. We report a case of pseudoaneurysm of the subclavian artery after internal jugular vein cannulation that was treated successfully with an endovascularly inserted, stented graft. The case report highlights the importance of recognizing this unusual but serious complication of percutaneous internal jugular vein catheterization through careful clinical examination, prompt duplex scanning, and arteriography.

Aged↗
PubMed1994

Comparison of muscle flaps and delayed secondary intention wound healing for infected lower extremity arterial grafts.

Selective preservation of infected arterial grafts is an alternative to graft excision. The purpose of this study was to compare the outcome and cost of treating infected lower extremity arterial grafts with either muscle flaps (MFs) or delayed secondary intention (DSI) wound healing. Between 1985 and 1991 we treated 28 graft infections by graft preservation. All grafts (19 polytetrafluoroethylene, 8 autologous vein, and 1 Dacron) were patent with intact anastomoses and showed no signs of sepsis. Wounds in 18 patients were treated by repeated, aggressive operative debridement and allowed to heal by DSI. Wounds in 10 patients were treated with MFs (4 sartorius, 3 gracilis, 1 rectus abdominis, 1 semimembranous, and 1 gastrocnemius). Costs included anesthesiologists' and surgeons' fees, operating room charges, and daily semiprivate and ICU bed charges. Four (14%) patients died from cardiac complications (1 DSI and 1 MF), sepsis (1 MF), and anastomotic hemorrhage (1 DSI). Of the 24 survivors, 4 patients treated by DSI required graft excision for nonhealing wounds (2), graft thrombosis (1), and recurrent infection (1). However, 3 of these 4 patients were not candidates for MFs because the wounds were not considered acceptable for a flap. Twenty (83%) grafts in survivors were successfully preserved after long-term follow-up (mean 26 mo). No survivors required an amputation. Twenty patients who did not require graft removal were compared for treatment by MF (n = 8) or DSI (n = 12). Two MFs (both sartorius) in survivors necrosed and a new flap was required to successfully preserve the graft.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Transluminally placed endovascular stented graft repair for arterial trauma.

PURPOSE: Intravascular stents have become important tools for the management of vascular lesions; however, stents in combination with vascular grafts have only recently reached clinical application. This report describes an experience with stented grafts for the treatment of penetrating arterial trauma. METHODS: Seven transluminally placed stented grafts were used to treat one arteriovenous fistula and six pseudoaneurysms. These grafts were successfully inserted percutaneously or through open arteriotomies that were remote from the site of vascular trauma. The devices were composed of balloon-expandable stainless steel stents covered with polytetrafluoroethylene grafts. RESULTS: Patency up to 14 months was achieved (mean follow-up 6.5 months) with these stented grafts. The use of stented grafts appears to be associated with decreased blood loss, a less invasive insertion procedure, reduced requirements for anesthesia, and a limited need for an extensive dissection in the traumatized field. These advantages are particularly important in patients with central arteriovenous fistulas or false aneurysms who are critically ill from other coexisting injuries or medical comorbidities. CONCLUSIONS: The use of stented grafts already appears justified to treat traumatic arterial lesions in critically ill patients. Although the early results with the seven cases in this report are encouraging, documentation of long-term effectiveness must be obtained before these devices can be recommended for widespread or generalized use in the treatment of major arterial injuries.

Adult↗
PubMed1994

Eleven-year experience with tibiotibial bypass: an unusual but effective solution to distal tibial artery occlusive disease and limited autologous vein.

PURPOSE: The absence of sufficient length of suitable autologous vein occasionally prohibits the treatment of severe distal lower extremity arterial occlusive disease with a standard distal bypass originating from the common femoral artery. During the past 11 years, we have therefore selectively performed short distal bypasses originating from the infrapopliteal arteries in patients with limb-threatening ischemia and occlusive lesions limited to the distal tibial and peroneal arteries. This report summarizes our experience with these tibial artery based distal bypasses. METHODS: Forty-two distal lower extremity arterial bypasses originating from infrapopliteal arteries in 41 patients were performed over an 11-year period. Autologous vein was used as the bypass conduit in all cases. Extensions from a more proximal bypass were excluded. RESULTS: The primary patency rate of these tibiotibial bypasses was 77% at 1 year and 62% after 5 years. The limb salvage rate after 5 years was 74%. The perioperative mortality rate was low (2%), but the 5-year patient survival rate (64%) was similar to that with more standard lower extremity arterial reconstructive procedures. CONCLUSIONS: Tibiotibial bypass is an effective limb salvage procedure in carefully selected patients with distal tibial artery occlusive disease and limited autologous vein. It offers a durable means of distal revascularization in circumstances in which a standard operation might not be desirable or possible.

Adult↗