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Biomedical subjects

J F Vollmar

Publications and source records attributed to J F Vollmar.

At least 55 records · Page 3Linked to original sources
PubMed1986

[Surgical indications in abdominal aortic aneurysm in advanced age].

The operative mortality of abdominal aortic aneurysms (AAA) increases with the age of life (0.0% below 65 y., 11.8% above 75 y.). This fact is mainly caused by an increasing number of concomitant diseases. Therefore indication for surgery needs a critical assessment of the risk caused by concomitant diseases vs. risk of rupture of the aneurysm. Recent progress in operative technique and anaesthesia justifies surgery also in high risk patients with impending rupture (large aneurysms, especially with eccentric aortic dilatation). The best approach to reduce emergency interventions for ruptured AAAs (mortality rate: 50%) is an ultrasound screening program for arteriosclerotic patients at risk.

Aged↗
PubMed1985

[Ischemic colitis following reconstructive interventions of the aortoiliac vascular segment].

Ischemic colitis after aortoiliac vascular reconstructions represents a seldom but life-threatening postoperative complication (incidence: 1.6%, mortality rate: 50-70%). The authors present a retrospective evaluation of 10 cases observed in a consecutive series of 1121 reconstructive aorto-iliac procedures. The incidence of ischemic bowel complications was 1.3% in the group of abdominal aortic aneurysms but only 0.6% in the group of arterial occlusive disease. The pathogenesis including new approaches of prophylaxis, diagnostic and therapeutical measures are discussed. The risk of ischemic damage to the bowel may be best assessed from the preoperative aortogram (special vascular patterns), the intraoperative stump-pressure measurement in the inferior-mesenteric artery and the pre- and postoperative PB-Index. In contrast to earlier reports the leading clinical symptom is an unexplained prolonged gastrointestinal paralysis during the first postoperative week. Early diagnosis is most important and best realized by the routine use of colonscopy in all risk cases in the first 48 h. Such an aggressive diagnostic approach offers the possibility of early relaparotomy in a pretoxic stage and a better outcome for the patient than heretofore with a median delay of 11 days between vascular reconstruction and relaparotomy.

Aged↗
PubMed1985

[Transcutaneous measurement of oxygen partial pressure in the preoperative determination of the amputation level in the arterial occlusive disease of the lower extremity].

For major limb amputation in patients with occlusive arterial disease, the peripheral amputation level (at the knee or below the knee) is the most important factor in obtaining an optimal functional result and reducing the relatively high operative mortality of above knee amputation. In the study presented, measurement of transcutaneous oxygen tension has proved to be a helpful tool in realizing this therapeutical principle. Comparison with another group of amputees without pO2 measurement indicated that the ratio of above-knee to below-knee amputation could be changed from 2:1 to 1:2. The reduced number of above-knee amputations also resulted in a decrease in operative mortality (7.1% vs 11.4%). The optimal value of pO2 in the lower leg is in the range of 40-45 mm Hg. With this prerequisite, primary stump healing may be expected below the knee. For amputation at the knee and above the knee, the primarily used borderline value of 30-35 mm Hg has proved sufficient. The pO2 values were in good correlation with the arteriographic finding of a patent deep femoral artery, but there was no clear correlation with the ankle pressures found preoperatively by Doppler ultrasound. The sensitivity of the transcutaneous pO2 method is still limited because it mainly reflects the perfusion quality of the skin and the subcutaneous tissue, but no the quality of the blood supply in the subfascial tissue layers. Tissue histography with micro-Pt electrodes offers a new, but invasive approach to measurement of the actual pO2 level in the underlying muscle as well [3].

Amputation, Surgical↗
PubMed1985

[Aorto-enteral fistula--pathogenesis, clinical aspects and therapy].

This report is based on 14 own observations and 166 patients collected from the literature. The most frequent location both of primary and secondary aortic-enteric fistulas (AEF) is the end part of the duodenum (60-70%). In the group of secondary AEF the paraprothetic type represents the most frequent morphological finding. The best diagnostic approach should be seen in a gastroduodenoscopy. The choice of surgical repair is still controversal. Most of the surgeons insist on a radical repair (Type A: restoration of the intestinal tract, complete removal of the vascular prosthesis, blind closure of the infrarenal aortic stump, axillo-bifemoral bypass). Type A repair is loaded with a high operative mortality (52%) and a number of secondary complications (e.g. recurrent AEF; bleeding from the aortic stump). As an alternative surgical approach the authors present an in-situ-repair (Type B: closing of the intestinal defect, partial exchange of inserted vascular prosthesis, a circular omentum sleeve covering the prosthesis and anastomosis). The Type B repair offers a time saving procedure with a reduced operative mortality (29%) and a better outcome for the patients. This method is only contraindicated in the presence of a spread infection of the retroperitoneal space including the vascular prosthesis.

Aorta, Abdominal↗
PubMed1985

[Recurrent stenoses following carotid TEA].

Follow-up of 798 patients by Duplex scanning or digital venous angiography 6 months to 13 years after carotid endarterectomy revealed a recurrent stenosis rate of 3.4%. The incidence of the recurrent lesions showed a clear correlation with the operative technique: after closure of the arteriotomy directly (continuous suture) or with a vein patch (303 pat.) the recurrent stenosis rate was 4 times higher than after closure with a dacron patch (495 pat.). Our investigations indicate that recurrent stenosis and occlusions after carotid endarterectomy are largely avoidable. Sufficient length of arteriotomy (5-8 cm), dilatation of the distal internal carotid artery and lumen congruent closure of the arteriotomy with a dacron patch are the pivots of success.

Blood Vessel Prosthesis↗
PubMed1982

[Pro and contra profundaplasty (author's transl)].

The profundaplasty has recently advanced to a widely used surgical approach for revascularisation of the lower extremities, both for claudication and limb salvage. The effectiveness of this simple time saving procedure depends on a critical selection of patients and the use of an improved surgical technique. Main prerequisites are the simultaneous aorto-iliac inflow repair, using thromboendarterectomy or bypass, the patency of the so-called "receptor segment" of the popliteal artery and a sufficient run- off in the distal arterial tree. An additional lumbar sympathectomy has proved as a protective adjunct which results in an additional increase of flow in the restored deep femoral artery. In combined occlusive lesions of the aorto-iliac and femoro-popliteal segment the late results of a proximal inflow repair in combination with profundaplasty and lumbar sympathectomy are significantly superior to the total repair of both arterial segments. A profundaplasty is contraindicated if this artery is seriously diseased or in the presence of total occlusion of the popliteal artery (receptor segment) and of more than two main arteries below the knee. This is the place where long distal grafts are still justified for limb salvage. In over 80% of patients with arterial occlusive disease of the leg arteries the profundaplasty (with or without aorto-iliac inflow-repair) has proved as an effective alternative to time-consuming extensive arterial reconstructions with equivocal outcome.

Arterial Occlusive Diseases↗