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J L Terpstra

Publications and source records attributed to J L Terpstra.

At least 37 records · Page 2Linked to original sources
PubMed1989

Long-term results of renal artery reconstruction with autogenous artery in patients with renovascular hypertension.

Renal artery reconstruction for the treatment of renovascular hypertension is preferably performed with an autologous graft when a graft is required. Although satisfactory results with vein grafts have been reported, stenosis and dilatation are not infrequent complications which have been observed only occasionally in arterial grafts. We have analysed our long-term results obtained with autogenous arterial grafts for renal artery reconstruction to determine the functional and anatomical results with regard to these complications. The data from 57 survivors operated on from 1959 through 1983 were analysed. All patients were hypertensive and the average systolic and diastolic blood pressure was 173/109 mmHg (mean number of 2.2 drugs). The renal artery stenosis was caused by arteriosclerosis and fibrodysplasia in 24 and 33 patients, respectively. In situ repair was performed in 30 patients (arterial bypass: 17 patients; splenorenal bypass: 13 patients). Extracorporeal repair of fibrodysplastic branch lesions was performed in 27 patients using branched hypogastric artery grafts (mean number of 2.4 branch anastomoses per kidney). Results were evaluated in the short (mean 8.3 months) and long term (mean 7.5 years) and the blood pressure response classified as either beneficial (cured/improved) or failed. Anatomical results were evaluated by angiography in the short-term in 87% of the patients and the long-term in 70%. A beneficial blood pressure response was obtained in 77% and 86% of patients in the short and long-term, respectively. The average blood pressure level after an interval of several years (long term) was 144/87 mmHg (mean number of 0.9 antihypertensive drugs). After in situ reconstruction, 2 and 1 anatomical failures were observed in the short and long-term, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Arterial Occlusive Diseases↗
PubMed1989

False aneurysms after prosthetic reconstructions for aortoiliac obstructive disease.

Several aspects of false aneurysm development after prosthetic resconstruction for aortoiliac obstructive disease were studied. For this purpose the long-term results (up to 20 years of follow-up) of 518 patients with implanted arterial prostheses in the aortoiliofemoral tract were retrospectively evaluated. Completeness of follow-up data was 83.2% 15 years after operation. A total of 101 false aneurysms (21 aortic, 53 iliac, and 27 femoral) were detected in 69 patients and verified by operation. The incidence per patient was 69 of 518 patients (13.3%). The incidences per anastomosis were: aortic, 21 of 438 anastomoses (4.8%); iliac, 53 of 835 anastomoses (6.3%); and femoral, 27 of 198 anastomoses (13.6%). Almost one half (47.5%) of all the false aneurysms were asymptomatic and were detected by angiography or ultrasonography. Chances for late survivors to develop a false aneurysm during follow-up were calculated by the life-table method. The chance to be free of a false aneurysm at any site was 77.2% 15 years after operation. These chances were 92.3%, 84.5%, and 76.2% for aortic, iliac, and femoral anastomoses, respectively. Analyses of subgroups showed that the development of a false aneurysm was significantly correlated with the presence of hypertension, multilevel disease, the type of suture material, and the type of anastomosis. These results indicate unexpectedly high chances for the development of false aneurysms in long-term survivors after aortoiliac or aortofemoral prosthetic reconstructions. We advocate the use of a life-long follow-up schedule with periodic angiography and ultrasonography for these patients.

Anastomosis, Surgical↗
PubMed1989

Renovascular hypertension.

Renovascular hypertension is caused by renovascular disease and it can be potentially cured by ablative or reconstructive operation or PTA. The incidence of renovascular hypertension is 1 to 2 per cent among nonselected hypertensive patients. Renovascular disease in hypertensive patients is progressive in 20 to 40 per cent. The diagnosis of renovascular hypertension can only be made retrospectively after successful intervention. The accuracy of all tests for the determination of the functional significance of a stenosis before intervention remains limited. It has been demonstrated that medical therapy, reconstructive surgical treatment and PTA each can effectively lower high blood pressure. Although medical therapy has been considerably improved because of the development of new drugs, it should be recognized that medical management does not prevent the natural progression of renovascular disease. Therefore, renovascular hypertension is best treated by correction of the underlying renal arterial stenosis. Improvements in surgical management include improved selection of patients for surgical treatment, increased beneficial blood pressure response rates in 70 to 95 per cent of the patients and decreased surgical mortality rates of less than 5 per cent. The anatomic failure rates have been reduced because of the increase in surgical expertise, the use of autologous materials for bypass, the avoidance of combined procedures in the event of concomitant aortoiliac disease, the use of extra-anatomic reconstructions when appropriate and the introduction of extra-corporeal reconstruction and autotransplantation. PTA has evolved as a relatively safe and effective method in the treatment of renovascular hypertension. However, complications do occur and orificial arteriosclerotic lesions and renal arterial branch lesions should not be considered for angioplasty. At present, the question of whether renovascular surgical treatment or PTA should be the treatment of choice cannot be answered completely. Treatment of renovascular hypertension should be accommodated to each patient.

Humans↗
PubMed1988

Influence of preoperative risk factors and the surgical procedure on surgical mortality in renovascular hypertension.

The present study was undertaken to assess surgical risk in 112 severely hypertensive patients with renovascular disease secondary to atherosclerosis. The influence of preoperative risk factors and the surgical procedure on surgical mortality was also investigated. Extrarenal atherosclerosis was present in 51 percent of the patients, and hypertensive target organ damage was present in 66 percent. Renal artery reconstruction was performed unilaterally in 92 patients and bilaterally in 20 patients. Simultaneous aortoiliac operations were performed in 25 patients. There were nine operative deaths (8 percent). The presence of extrarenal atherosclerosis was particularly associated with mortality (14 percent compared with 1.8 percent when it was absent; p = 0.02). The surgical procedure also represented a significant risk; the mortality rate was 1.4 percent if surgery was restricted to unilateral reconstruction, but otherwise it increased to 20 percent (p = 0.001). This increase in mortality rate was clearly associated with aortoiliac surgery (20 percent compared with 4.6 percent when aortoiliac surgery was not performed; p = 0.025) and could be explained by the increased blood loss during operation. We conclude that the surgical treatment of renovascular disease secondary to atherosclerosis can be safely performed, provided that extrarenal atherosclerosis is absent and that simultaneous aortoiliac surgery can be avoided.

Adult↗
PubMed1988

Reconstructive surgery for renovascular hypertension. II. Influence of patient selection and anatomical result on the blood pressure response after operation.

The results of renovascular surgery for renovascular hypertension are influenced markedly by patient selection. Our method of patient selection was based primarily on clinical characteristics rather than functional tests. To determine its effect on the results obtained by surgery, we studied all 115 patients in whom angiography showed that surgery had eliminated the renal artery stenosis. Six to 12 months after the operation, hypertension was cured or improved in 83 per cent of the patients and 17 per cent were classified as treatment failures. The results obtained for patients with stenosis caused by arteriosclerosis were similar to those found for patients with fibrodysplasia. Clinical characteristics (sex, blood pressure, duration of hypertension, creatinine level and extrarenal arteriosclerosis or target organ damage before surgery) were analysed separately. The characteristics of patients with a beneficial blood pressure response were not significantly different from those of patients who failed to respond, except for the blood pressure level itself. On the basis of our findings and the results of functional tests reported in the literature, we conclude that the decision to operate should be based on all of the clinical data available. Functional tests can be used to support the diagnosis of renovascular hypertension in selected patients. The presence of extrarenal arteriosclerosis before surgery is not associated with a poorer chance of a beneficial blood pressure response.

Adult↗
PubMed1988

The influence of the surgical technique upon the short term and long term anatomic results in reconstructive operation for renovascular hypertension.

The anatomic results of reconstructive operation for renovascular disease was analyzed in 161 patients with hypertension who were treated between 1959 and 1983. Arteriosclerotic lesions in 103 patients were repaired by endarterectomy (58 per cent), autologous bypasses (27 per cent) and miscellaneous procedures (15 per cent). Fibrodysplastic lesions in 58 patients were treated by in situ procedures (54 per cent) and by extracorporeal repair and autotransplantation (46 per cent). The results were evaluated by means of angiography at both a short term and long term interval after the operation. Angiograms were taken of 79 per cent of the reconstructions at the short term interval and 65 per cent at the long term interval. For the short term interval, the failure rate of angiographically verified reconstructions was 5.7 per cent for arteriosclerotic and 5.8 per cent for fibrodysplastic lesions. The secondary nephrectomy rate was 3.4 and 4.5 per cent, respectively. Surgical expertise appeared to be an important factor, since all failures but one occurred during the first period of the study. Furthermore, the introduction of extracorporeal reconstruction reduced the failure rate for reconstructive operation for fibrodysplasia; residual lesions in the main renal artery did not occur and those of reconstructed hilar branches were only occasionally observed (6.9 per cent). For the long term interval, failure rates were 17 per cent for arteriosclerotic and 14 per cent for fibrodysplastic lesions. In this respect, the results obtained with endarterectomy and arterial bypasses were superior to those obtained with venous bypasses. We conclude that surgical technique is the most important factor for successful reconstruction and that the use of autologous materials, except autologous veins, is preferred.

Arteries↗
PubMed1987

Highly symptomatic adult polycystic disease of the liver. A report of fifteen cases.

Fifteen patients were evaluated because of highly symptomatic adult polycystic liver disease. All of them had abdominal pain, two patients had obstructive jaundice, one had ascites and a large right-sided pleural effusion, and one had oesophageal varices. In 4 patients percutaneous aspiration of the largest cysts was performed, but this form of treatment only provided temporary relief. In 9 patients a fenestration operation was carried out. One of these patients died per-operatively due to irreversible shock. The abdominal complaints disappeared post-operatively in 7 of the other 8 patients, although a decrease of the liver span was uncommon. In the two patients with obstructive jaundice the serum bilirubin level normalized after the operation, and in the patient with oesophageal varices this abnormality disappeared post-operatively. Biochemical analysis of cyst fluid was performed in 7 of the cases. The mean ratios of the levels of most of the non-protein-bound inorganic ions and other small molecules in cyst fluid and serum were about 1, whereas those of all proteins and protein-bound constituents were generally far below 1.

Cysts↗
PubMed1987

Pancreas transplantation in The Netherlands: report of the first case.

This case report describes the first clinical pancreas transplant performed in The Netherlands. A duct-obliterated segmental graft from a cadaver donor was transplanted to a male recipient who was insulin-dependent after total pancreatectomy eight years earlier. The recipient was off insulin for four postoperative months; during this period a rejection crisis was successfully treated. The graft was removed eight months after transplantation. Histologic examination indicated both fibrosis and rejection to have presumably contributed to graft failure. The patient is well but again insulin-dependent.

Chronic Disease↗