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J J Skillman

Publications and source records attributed to J J Skillman.

At least 37 records · Page 2Linked to original sources
PubMed1992

Peripheral directional atherectomy: 4-year experience.

Directional atherectomy alone or with supplemental percutaneous transluminal angioplasty was used to treat peripheral vascular lesions in 77 patients (85 procedures). Lesions involved 17 iliac arteries, 45 infrainguinal arteries, and 23 laser extremity vein bypass grafts. Technical success, defined as reduction of stenosis diameter to 30% or less of the normal vessel diameter, was achieved in 78 of 85 (92%) cases. The complication rate was 21% (18 of 85 procedures). Most complications were minor and were related to puncture sites. Patients underwent noninvasive follow-up studies, including measurement of ankle-brachial index and segmental pressures, plethysmography, and clinical examination. The mean follow-up period was 13.5 months. The probability of 1-, 2-, and 3-year patency for lesions treated with atherectomy alone was 92%, 84%, and 84%, respectively. Kaplan-Meier survival analysis revealed no difference in 2- to 3-year patency rate on the basis of lesion location or presence of calcification, eccentricity, or ulceration. Diabetic patients, however, had a higher restenosis rate than did patients who were not diabetic (P less than .03).

Aged↗
PubMed1991

Magnetic resonance imaging: a reliable test for the evaluation of proximal atherosclerotic renal arterial stenosis.

Symptomatic renal artery stenosis is a significant and treatable clinical problem. A reliable and accurate noninvasive method of screening for renal artery stenosis has not yet been found. We used magnetic resonance imaging to study 37 patients who had undergone recent renal angiography. Fourteen patients had normal renal arteries by angiography. In 23 patients either unilateral or bilateral stenosis or occlusion was present. The disease process in all patients appeared to be atherosclerosis. The average age of the 37 patients was 68 years. The magnetic resonance scans and angiograms were read independently by two different radiologists, each of whom was blinded to the clinical history and the results of the other study. Renal arterial stenoses found on angiogram and magnetic resonance scans were graded as absent (0% to 24%), mild (25% to 49%), moderate (50% to 74%), or severe (75% to 99%). The magnetic resonance imaging results concurred with the angiographic findings in 70 of 77 arteries (91%). Magnetic resonance imaging predicted the presence of a greater than 50% stenosis of the renal artery with a sensitivity of 100% and a specificity of 94%. Magnetic resonance imaging may prove to be the best noninvasive screening test for proximal atherosclerotic renal arterial stenosis.

Adult↗
PubMed1991

Evaluation of the extracranial carotid arteries: correlation of magnetic resonance angiography, duplex ultrasonography, and conventional angiography.

We compared duplex scanning, "bright blood" and "black blood" magnetic resonance angiography, and conventional angiography for evaluation of the extracranial carotid arteries. All three methods were applied to 39 vessels in 20 patients. Duplex scanning was inaccurate when compared to conventional angiography in six instances. In three instances the degree of stenosis was overgraded by the scanner, and in three cases the stenosis was undergraded. Magnetic resonance angiography was inaccurate when compared to conventional angiography in three instances. In all cases magnetic resonance angiography overgraded the degree of stenosis. By use of a greater than 70% stenosis as a positive study, the sensitivity of magnetic resonance angiography was 100% and the specificity 92%. With use of the same criteria, the sensitivity of duplex scanning was 86%, and specificity was 84%. In those evaluations where the results of the magnetic resonance angiography and duplex scanning were in agreement, the correlation with conventional angiography was 100%. We conclude that magnetic resonance angiography is an alternative means to duplex scanning for noninvasive carotid imaging. A combination of bright and black blood magnetic resonance angiography is precise in delineating lesions of the extracranial carotid artery and may ultimately eliminate the need for conventional angiography in the evaluation of carotid stenosis.

Angiography, Digital Subtraction↗
PubMed1990

Abdominal aorta and renal artery stenosis: evaluation with MR angiography.

A blinded, prospective study with magnetic resonance (MR) angiography was performed to study patients who had undergone abdominal aortography. In 55 renal arteries among 25 patients, MR angiography had a sensitivity of 100% for detecting renal artery stenosis of 50% or greater and a specificity of 92%. With MR angiography, the degree of renal artery stenosis was overgraded in four of 55 renal arteries: Mild stenosis was overgraded as moderate stenosis in two arteries and as a severe stenosis in one, and a moderate stenosis was overgraded as a severe stenosis in one. The number of renal arteries was correctly determined in all cases. The renal arteries could be well evaluated only in the proximal third of the vessel, precluding detection of more distal stenoses. Atherosclerotic plaque uniformly appeared dark on gradient-echo images and was easily differentiated from bright, flowing blood in the aortic lumen. MR angiography enabled correct grading of the presence of atherosclerotic plaque and stenoses of the abdominal aorta in 22 of 25 patients (88%). The authors conclude that MR angiography has the potential to be a useful screening technique for patients with suspected renal artery stenosis and disorders of the abdominal aorta, but further clinical studies are warranted.

Angiography↗
PubMed1990

Extracranial carotid arteries: evaluation with "black blood" MR angiography.

The authors evaluated the accuracy of "black blood" magnetic resonance (MR) angiography for depicting disease involving the extracranial carotid arteries. Two- and three-dimensional flow-compensated gradient-echo sequences were employed to create "bright blood" images. A thin-section spin-echo sequence with flow presaturation allowed the creation of black blood images. Projection angiograms were made from bright and black blood images with application of a maximum- or minimum-intensity projection algorithm, respectively. These methods were used in 13 healthy volunteers and 17 patients, and a prospective blinded comparison of MR angiography and conventional angiography was performed. Normal carotid arteries were well shown with both bright and black blood methods; in patients, both methods were sensitive for detecting carotid disease. However, bright blood angiography exaggerated the severity of carotid lesions in 13 of 33 arteries, mostly in severe disease; this problem was not encountered with black blood angiography. The authors conclude that bright blood angiography is a sensitive method for screening carotid disease; when a significant abnormality is found, black blood angiography should be performed for more precise delineation of the lesion.

Adult↗
PubMed1990

Simultaneous occurrence of superficial and deep thrombophlebitis in the lower extremity.

Forty-two consecutive patients diagnosed with superficial phlebitis were seen during a 5-year period. Thirty-five of the 42 patients were outpatients. The diagnosis of superficial phlebitis was made by the presence of palpable subcutaneous cords in the course of the greater saphenous vein or its tributaries in association with tenderness, erythema, and edema. The presence of concurrent deep venous thrombosis (DVT) was assessed by impedance plethysmography in 37 patients, compression venous ultrasonography in 3 patients, and venography in 8 patients. Five of the 42 patients (12%) had DVT. Four of these five patients had a positive impedance plethysmographic or ultrasonographic test result followed by a confirmatory venogram. The fifth patient had a positive ultrasonographic test result, but no venogram was performed. Two of the five patients had clots that involved the popliteal or femoral veins. Four of 23 patients (17%) with superficial phlebitis at or above the knee had DVT. Only 1 of the 19 patients (5%) with superficial phlebitis below the knee had DVT. Three of the five patients with both superficial phlebitis and DVT had undergone surgery recently. All but 3 of the 42 patients (93%) had varicose veins. No patients had clinically apparent pulmonary emboli. DVT occurred in 17% of the patients with above-knee extension of the superficial phlebitis. In the clinical management of superficial lower-limb thrombophlebitis, noninvasive tests should be performed to guide therapy. When superficial phlebitis develops after recent surgery or the superficial phlebitis extends above the knee, diagnostic surveillance should be especially strict. When the noninvasive test results are equivocal, phlebography is indicated to rule out DVT.

Female↗
PubMed1989

Surgical significance of popliteal arterial variants. A unified angiographic classification.

Distal popliteal arterial variations may influence the success of femorodistal popliteal and tibial arterial reconstructions. Two patients whose bypass procedures were initially unsatisfactory because of a poor choice for anastomosis stimulated a review of variations in the distal popliteal artery in 1000 femoral arteriograms. The popliteal arterial anatomy could be assessed in 605 extremities and the tibial arterial anatomy in 495 extremities. Seventy-five variant cases were identified. Normal branching of the popliteal artery was present in 92.2%. Among the 7.8% incidence of variants, the majority (72%) were either high origin of the anterior tibial artery or a trifurcation pattern. Of variant patterns to the foot (5.6%), the most common was that in which the supply to the distal posterior tibial artery arose from the peroneal artery. We propose a unified classification of the popliteal and tibial arterial variations that encompasses both anatomic areas. Variant arterial supply to the foot can be suspected when the infrapopliteal vessels show a hypoplastic or aplastic anterior or posterior tibial artery and compensatory hypertrophy of the peroneal artery. Knowledge of these variants is important to angiographers and vascular surgeons.

Angiography↗
PubMed1988

Vascular complications of percutaneous femoral cardiac interventions. Incidence and operative repair.

Of 7333 patients undergoing percutaneous left-heart catheterization procedures during a seven-year seven-month period, 73 patients (1%) underwent 75 operative repairs of catheterization-related vascular complications. The overall incidence of operative repair varied according to the type of percutaneous femoral artery procedure performed: 0.6% for diagnostic heart catheterization, 0.9% for percutaneous transluminal angioplasty, 5.2% for transfemoral balloon valvuloplasty, and 11.5% for intra-aortic balloon pump placement. This suggests that (1) femoral and iliac artery occlusions can and should be repaired promptly while the patient is under local anesthesia; (2) false aneurysms in this clinical setting can be approached directly through the aneurysm cavity; (3) the diagnosis of false aneurysm or arteriovenous fistula can usually be made on clinical grounds alone, without resorting to angiography; (4) venous or arterial patch angioplasty is the preferred technique for small or severely traumatized femoral arteries; and (5) the necessity for operative repair of these lesions will continue to increase in frequency as percutaneous cardiologic diagnostic and therapeutic interventions are used more widely.

Adult↗
PubMed1988

Current complications of diagnostic and therapeutic cardiac catheterization.

Data from 2,883 cardiac catheterizations performed during an 18 month period (from July 1986 through December 1987) were analyzed to assess the current complication profile of diagnostic and therapeutic procedures. Procedures performed during the study period included 1,609 diagnostic catheterizations, 933 percutaneous transluminal coronary angioplasties and 199 percutaneous balloon valvuloplasties. Overall, the mortality rate was 0.28% but ranged from 0.12% for diagnostic catheterizations to 0.3% for coronary angioplasty and 1.5% for balloon valvuloplasty. Emergency cardiac surgery was required in 12 angioplasty patients (1.2%). Cardiac perforation occurred in seven patients (0.2%), of whom six were undergoing valvuloplasty, and five (2.5% of valvuloplasty attempts) required emergency surgery for correction. Local vascular complications requiring operative repair occurred in 1.9% of patients overall, ranging from 1.6% for diagnostic catheterization to 1.5% for angioplasty and 7.5% for valvuloplasty. Although the complication rates for diagnostic catheterization compare favorably with those of previous multicenter registries, current overall complication rates are significantly higher because of the performance of therapeutic procedures with greater intrinsic risk and the inclusion of increasingly aged and acutely ill or unstable patients.

Aged↗
PubMed1987

Incidence and management of limb ischemia with percutaneous wire-guided intraaortic balloon catheters.

In 103 patients who underwent placement of 106 percutaneous wire-guided intraaortic balloon catheters between August 1983 and January 1986, all placements were successful and the average duration of counterpulsation was 3.4 +/- 1.6 days. During counterpulsation, 45 patients developed limb ischemia that required premature balloon removal in 29 patients. The development of limb ischemia was significantly related to the presence of diabetes (risk ratio 2.0), peripheral vascular disease (risk ratio 1.9), female gender (risk ratio 1.8) and the presence of a postinsertion ankle-brachial pressure index less than 0.8 (risk ratio 7.9). There was no association between the development of limb ischemia and age, body surface area, balloon size (10.5F/12F) or adequacy of anticoagulation. Fifteen patients underwent vascular surgery for treatment of balloon-related limb ischemia, which was associated with one operative death. Nine patients had persistent limb ischemia (seven asymptomatic, two symptomatic) at the time of hospital discharge. Improvements in wire-guided balloon technology have increased the probability of successful balloon placement over that of surgical placement and have reduced the incidence of major aortic injury, but there is no evidence that these improvements have reduced the incidence of limb ischemia or its sequelae. This should be borne in mind before proceeding with balloon insertion in patients with one or more risk factors for developing limb ischemia.

Aged↗
PubMed1986

Compartmental pressure monitoring after arterial reconstruction lacks clinical relevance.

Anterior compartmental intramuscular pressure was studied by the continuous-infusion technique during and after arterial reconstruction of the abdominal or lower extremity vessels in 23 patients. Although there were significant differences between the mean pressures in those patients who had proximal or distal arterial reconstruction, the mean pressure did not increase in the sequential preocclusion, occlusion, and postoperative periods during a mean follow-up of 26 hours in proximal reconstructions and 19 hours in distal reconstructions. One patient had pressures consistent with a borderline compartmental syndrome but died of a ruptured left ventricle before complete correlation of the clinical course and pressures could be made. We conclude from this study that although routine measurement of compartmental pressures during arterial reconstruction of the lower extremities yields interesting findings, it makes no important contribution to the clinical management of the patient.

Blood Pressure↗
PubMed1985

Energy intake can determine albumin synthesis in man after surgery.

Albumin synthesis rate, nitrogen balance, plasma hormone levels, and selected substrates were measured after operation in 12 patients who underwent colonic operations who were randomized to receive an intravenous fluid regimen that contained either 3.5% amino acids with 20% fat and 2.5% glucose or 3.5% amino acids with 20% fat alone. The albumin synthesis rate was higher in patients who received the first of these intravenous mixtures (357 +/- 34 mg/kg/day versus 216 +/- 22 mg/kg/day; p less than 0.01), but they also had a significantly higher intake of calories (10.2 +/- 1.1 calorie/kg/day versus 6.4 +/- 0.6 calorie/kg/day; p = 0.01). The mean albumin synthesis rate in the group who received amino acids with glucose and fat is the highest we have measured in our series of studies. Although a previous trial in a similar group of patients suggested that glucose acts on albumin synthesis by diverting uptake of amino acids into skeletal muscle, it is possible that the impressive increase in the albumin synthesis rate in patients of the present series who received supplementary glucose is related to the extra energy infused. In contrast, nitrogen balance was similar in both groups, and thus was not predictive of protein synthesis. In addition, myofibrillar protein degradation appears to be equivalent in the two groups, as indicated by 3-methylhistidine output. Plasma albumin synthesis thus may be sensitive, especially to energy intake.

Adenocarcinoma↗
PubMed1984

15 (R)-15-methyl prostaglandin E2 does not prevent gastrointestinal bleeding in seriously ill patients.

A prospective, randomized trial was designed to compare the relative efficacy of 15 (R)-15-methyl prostaglandin E2 with antacid (usually Mylanta II) in 46 patients admitted to a respiratory-surgical intensive care unit. Bleeding was assessed by a modification of the Hemoccult slide test. Three of 22 patients in the antacid group bled, and 12 of 24 patients in the prostaglandin group bled, for a highly significant difference (p = 0.008). Patients in whom prophylaxis failed tended to have a greater number of risk factors. Other prostaglandin analogues that do not require conversion from an inactive to an active form, may be more useful than the agent we studied. Based on currently available data, the hourly titration of the gastric juice to a pH of greater than 3.5 remains the preferred method of prophylaxis for acute bleeding from the stomach in seriously ill patients.

Aged↗
PubMed1982

Cardiac performance testing by volume loading and lower-extremity compression.

Cardiac performance was tested with a combination of volume loading and lower-extremity compression by an anti-g suit in 11 patients scheduled for aortic operations. The mean response of cardiac output (CO) to volume loading and anti-g suit compression was flat, despite a significant rise in pulmonary capillary wedge pressure (PCWP). Right to left intrapulmonary shunt was unchanged by the testing procedure. The low mean wedge pressure reemphasizes the need for preoperative insertion of a Swan-Ganz catheter and for measurement of PCWP and Co to provide optimal fluid treatment to each patient who undergoes an aortic reconstructive operation.

Aged↗