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Biomedical subjects

H Bruijnen

Publications and source records attributed to H Bruijnen.

25 records · Page 2Linked to original sources
PubMed1993

In situ saphenous vein grafts for femorodistal bypass: evaluation of endoscopically monitored valvulotomy on graft patency.

An overview of a total of 135 in situ femorocrural bypass operations is given. In the operations all grafts were anastomosed distally to the infrapopliteal arteries: to the proximal half of the crural vessels 52 times and to the distal half 83 times. The indication for surgery was critical limb ischaemia. In addition to routine intraoperative angiography, orthograde angioscopy of the graft was carried out to assess the completeness of valvulotomy in 96 patients (group A). In 39 patients (group B) for whom an endoscope was not available, completion angiography was conducted to ensure graft integrity. The two groups were comparable with respect to their composition. On the basis of the endoscopic findings, revisions were performed in 17 patients with incomplete valve ablation in group A, whereas in group B there were no interventions (P < 0.01, chi 2 test). Using life-table analysis, cumulative primary patency rates for groups A and B were 76% and 76% at 30 days, 62% and 44% at 1 year and 43% and 27% at 4 years, respectively. By comparison with the log rank test, a significant difference in patency among both groups could not be established (P = 0.18).

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PubMed1992

Technique and results of vascular endoscopy in arterial and venous reconstructions.

In an effort to maximize results, vascular endoscopy was used in our institution to monitor arterial and venous reconstructions. Since 1982, angioscopy was applied as a control method in 182 venous thrombectomies to treat iliofemoral thrombosis and 114 aortoiliac thromboendarterectomies. Of the cases with venous thrombectomy reviewed, 50% were incomplete by endoscopic evidence; of these, in 80% the remaining clots could be partly or completely removed. Additionally, in six patients a venous spur was found. Of 114 attempted aortoiliac thromboendarterectomies, only 91 could be completed. In the remainder, endoscopic evidence of persistent intimal flaps forced us to bypass the affected segments. With further miniaturization of the angioscopes, the method was also applied to check vessel repair on small-caliber arteries. In an initial study with 220 femorodistal bypasses we were unable to find a statistically significant difference of primary patency in grafts that were endoscopically controlled or not. In the learning phase with the in situ technique, we identified competent valve remnants in 40%, but this rate could be reduced to 12.7% with growing experience in valvulotomy. We conclude from our data that angioscopy is very helpful in assessing the morphological integrity of aortoiliac thromboendarterectomies and venous thrombectomies. The actual value in infrainguinal arterial reconstructions still remains to be proven.

Angioscopy↗
PubMed1992

[Duplex sonographic monitoring of infra-inguinal arterial reconstructions: can a threatened bypass occlusion be detected by this method?].

In our institution, 95 infrainguinal arterial reconstructions were prospectively entered into a graft surveillance programme which consisted of a postoperative i.a. DSA and routine assessment of graft flow velocity (GFV) and ankle pressure indices (ABI) during the first postoperative year. An average of 4.1 GFV measurements was obtained during a mean follow-up period of 8.2 months. Abnormal GFV led to arteriography in 29 bypasses identifying--aside from three false positive findings--two graft occlusions and 24 severe (> 70%) graft stenoses. Of the latter, in only 7 cases a significant decrease in ABI was found. Unheralded graft occlusion occurred in 6 patients. Including the corrections of the above mentioned lesions, secondary patency rates were 97% at 30 days and 89% at one year.

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PubMed1992

[Determination of vascular resistance in bypass operations with infragenual anastomosis: is prediction of early occlusion possible with this value?].

Peripheral outflow resistance (OR) was assessed intraoperatively in 75 infrainguinal bypass procedures to the below knee popliteal artery (20) or a single crural artery (55). OR measurement was done after completion of the distal anastomosis. For that purpose, the graft was perfused with Ringer solution at constant flow rates of 100 and 150 ml/min using a roller pump. During infusion, arterial pressure was recorded. In this way distal (DOR) and total (TOR) outflow resistance in E/S anastomoses was calculated before and after vasodilatation with papaverine. DOR at a flow rate of 100 ml/min was found to be most discriminant as a predictor of early graft thrombosis: 1. In the limbs with a thrombosed graft at 30 days OR was significantly higher than in the limbs with a patent graft (1828 +/- 418 vs. 1472 +/- 221 mPRU; p less than 0.01, Mann-Whitney U-Test). 2. The cut-off value of 1700 mPRU, which was determined by ROC curves, was 100% sensitive and 81% specific in the group of femoro-crural grafts to predict early graft failure. A better discrimination by the application of papaverine could not be achieved. We concluded from our results that OR might be an important factor in early graft thrombosis. But still there is more experience required to select patients for primary amputation or adjunctive procedures (av-fistula, sequential graft) on the basis of the present available data.

Arterial Occlusive Diseases↗
PubMed1989

[Cost-benefit analysis of saving the leg].

To acquire cost-benefit analysis data for limb salvage a prospective study was performed between 1. January 1988 und 30. Juni 1988, including 128 admissions for AOD Stage IV or acute complete ischemia. After dividing the patients into three groups--limb salvage (LS), limb loss (LL) and primary amputation (PA)--the average total costs per admission were calculated. In the LS group these costs amounted to DM 14,652 for all cases and DM 14,069 for the survivors, in the LS group to DM 25,364 and DM 27,583 and in the PA group to DM 22,946 and DM 28,186. Therefore in light of the total costs alone every effort should be made to salvage threatened limbs.

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