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K Grabitz

Publications and source records attributed to K Grabitz.

At least 19 recordsLinked to original sources
PubMed2004

[Mycotic visceral artery aneurysm: clinical picture, diagnosis, differential therapy, and discussion of the literature].

Bacterially infected arterial aneurysms were named mycotic aneurysms by William Osler in 1885 due to their morphology. This rare vascular disease is mainly localized in the femoral artery but also occurs in the aorta and visceral arteries. After the first surgically treated mycotic visceral aneurysm in 1949, we found 36 casuistics in the literature. We report on two patients treated in our department with mycotic visceral aneurysms and discuss the literature concerning topography, differential diagnosis, and surgical management.

Adult↗
PubMed2004

[Interdisciplinary operative procedure-pelvis and abdomen].

Surgery for tumors in the abdomen, retroperitoneum, and pelvis requires technical skills and expertise sometimes beyond the capability of a single surgeon. This holds especially true if curative tumor resection involves replacement of arteries and veins, which needs careful planning to avoid long periods of ischemia, and the selection and provision of vascular substitutes according to anatomical position, postsurgical therapy, and adjuncts to avoid thrombosis and infection of vascular grafts. Since the works of Fortner, the value of close collaboration between general and vascular surgeons has been demonstrated, but many of the former even today continue to attempt the operation alone, although the result is not always a masterpiece. The authors refer to their experience in major tumor surgery in either the single management of vascular complications or collaboration. The potential value of close collaboration is presented by negative examples, and a plea is made for a less "eminence"-based management of these sometimes difficult cases, which is based on vast positive experience with vascular diseases of the aorta and the visceral and iliac arteries and veins, including safety measures and adjuncts.

Abdominal Neoplasms↗
PubMed2003

Graft patency and clinical outcome of femorodistal arterial reconstruction in diabetic and non-diabetic patients: results of a multicentre comparative analysis.

OBJECTIVE: in diabetic patients with critical limb ischaemia (CLI) an inferior success rate following infrainguinal bypass surgery is quite often suggested. The aim of this retrospective analysis was, therefore, to evaluate the graft patency and, particularly, the clinical outcome at 1 year in diabetic compared with non-diabetic patients. MATERIAL AND METHODS: two hundred and eleven patients (diabetics 94; non-diabetics 117) with femorodistal reconstruction for CLI were studied. Groups were comparable with regard to the Fontaine classification, the distribution of vascular risk factors, graft material, distal anastomosis site, and the angiographic runoff grading. RESULTS: diabetes did not adversely affect graft function. For diabetics and non-diabetics primary cumulative patency rate at 1 year was found to be 66 and 56%, respectively (p=0.10) and a virtually identical limb salvage rate of 85 and 83% was achieved (p=0.76). With regard to healing of ischaemic foot ulcers a trend against diabetics was noted with a healing rate of 81% compared to 96% in non-diabetics at 1 year (p=0.067); gangrenous foot lesions could be equally remedied in 94% and in 87% among patients with and without diabetes (p=0.44). The survival rate of diabetics, however, was significantly lower with 78% at 1 year compared with 95% in non-diabetic patients (p=0.0004). CONCLUSIONS: our preliminary results support the view that infrainguinal bypass grafting can be safely done even in diabetics. Despite increased mortality in this group, liberal indication for reconstructive vascular surgery seems to be justified by favourable patency rates and clinical outcome in selected patients.

Aged↗
PubMed2002

[Surgical reconstruction of high grade carotid stenosis: a safe procedure?].

Carotid surgery is still controversial. Some large randomized trials have demonstrated the benefit of surgery in correlation to conservative treatment alone, but these positive results depend on how specific the diagnosis is and a low complication rate. This study presents the results of 2162 patients (male n = 1596 (74%), female n = 566 (26%), mean age 65 +/- 9 years), who underwent carotid surgery between 1990 and 1999. Forth-three percent of these patients had no ipsilateral neurological symptoms with high-grade carotid artery stenosis (Stage I). Thirty-eight percent appeared with prior ipsilateral TIA or PRIND--symptomatology (Stage II) and 19% suffered from stroke with persisting deficits (Stage IV). The operative technique of choice was thromboendarterectomy of the carotid bifurcation with vein-patch closure in 1967 patients (91%). In 1324 patients segmental resection of the internal carotid artery was performed. Carotid endarterectomies and other reconstructions for coronary artery disease including abdominal aortic aneurysm were combined during the same operation in 11% of the patients. The rate of postoperative ipsilateral neurological events was 4.1%. On the ontralateral side neurological symptoms appeared among 0.8%, and 0.4% of the patients had bilateral symptoms. Twenty patients (0.9%) died as a result of postoperative stroke. In relation to preoperative staging of the cerebrovascular occlusive disease in stage I, postoperative neurological symptoms appeared in 2.8% (mortality 0.6%), stage II in 5.7% (mortality 1.0%) and stage IV in 7.8% (mortality 1.2%) of the patients. These results confirm the importance of carotid reconstruction as a measure in the prevention of cerebral infarction in patients with asymptomatic or symptomatic high-grade carotid artery stenosis. The complication rate was lower than the data reported in the literature and the results were clearly better than under conservative treatment alone. In our opinion, the indication for carotid artery reconstruction should be made by a team of vascular surgeons, neurologists and neuroradiologists taking all patient-specific factors into consideration. Only by optimal patient selection and minimal complication rates will a significant benefit for the patient be achieved.

Aged↗
PubMed2001

[Simultaneous surgical intervention for occlusion of the internal carotid artery and coronary disease--reasonable or high-risk combination?].

BACKGROUND AND OBJECTIVE: Carotid artery stenosis as risk factor for postoperative stroke after cardiac surgery is confirmed in recent publications. Nevertheless indications for combined procedures in carotid occlusive disease and coronary artery disease are discussed controversely in the literature. Based on our own experiences since 1992 the risk factors are reviewed. PATIENTS AND METHODS: The data of 104 patients (80 male, 24 female, age 67 +/- 7 years), with 106 combined operations performed between 1992 and 1999, were evaluated retrospectively. 36% of the patients had symptomatic and 64% had asymptomatic carotid artery stenosis. RESULTS: Seven patients (6.6%) developed postoperative neurological deficits. One patient (1.0%) died as result of a stroke. In three patients a stroke occurred in the ipsilateral hemisphere, whereas two of three patients with cerebral infarction in the contralateral hemisphere had no significant carotid artery stenosis on this side. One patient had multiple bilateral embolism. Cardiac complications occurred in seven patients (6.6%). The inhospital mortality for non-stroke related complications was 3.8%, the total mortality 4.8%. CONCLUSION: From our experiences the combined approach for carotid artery occlusive disease and coronary artery disease can be recommended in selected patients. The rate of complications seems to be lower than in staged procedures. The spontaneous course of the disease can be improved and the patient is spared a second operation.

Aged↗
PubMed2001

Reconstructive surgery for carotid artery occlusive disease in the elderly--a high risk operation?

Patients over 80 yr of age may require carotid surgery for symptomatic or critical asymptomatic carotid artery occlusive disease.A total of 2262 operations were performed between 1990 and 1999; 76 (3.4%) were carotid reconstructions in 70 patients over 80 yr of age. Twenty patients (26%) presented with asymptomatic critical stenosis. Transient ischemic symptoms were the reason for presentation in 35 patients (46%). Progressive stroke was documented in two patients (3%) and a stroke with persisting neurological deficit was demonstrated in 19 cases (25%). Coronary artery disease was present in 47 patients (38%) and arterial hypertension in 55 (72%). Fifty-nine patients (84%) were classified as ASA group 3. Seventy-one thromboendarterectomies of the carotid bifurcation with vein-patch closure were performed. Five patients had other types of reconstruction. Simultaneous operations (aorto-coronary vein-bypass, aortic interposition graft etc.) were performed in nine patients. Postoperative complications occurred in three patients. One had a transient neurological deficit and another a lethal stroke; the third patient died from myocardial infarction. The in-hospital mortality was 2.9%, which was not significantly higher than the results of the other 2186 reconstructions (1.5%). Surgery for carotid artery occlusive disease can be safely performed in selected patients of more than 80 yr of age.

Aged↗
PubMed2001

Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic repair in 33 cases.

OBJECTIVE: A mycotic aneurysm of the aorta and adjacent arteries is a dreadful condition, threatening life, organs, and limbs. With regard to the aortic segment involved, repair by either in situ replacement or extra-anatomic reconstruction can be quite challenging. Even when surgery has been successful, the prognosis is described as very poor because of the weakened health status of the patient who has developed this type of aneurysm. The aim of our study was to find out whether any progress could be achieved in a single center over a long time period (18 years) through use of surgical techniques and antiseptic adjuncts. MATERIAL AND METHODS: From January 1983 to December 1999, a total of 2520 patients with aneurysms of the thoracic and abdominal aorta and iliac arteries underwent surgery for aortic or iliac replacement at our institution. During that period, 33 (1.31%) of these patients (mean age, 64.3 years) were treated for mycotic aneurysms of the lower descending and thoracoabdominal (n = 13), suprarenal (n = 4), and infrarenal (n = 10) aorta and iliac arteries (n = 6). Twenty (61%) of these 33 patients had histories of various septic diseases; in the other 13 (39%), the etiology remained uncertain. Preoperative signs of infection, such as leukocytosis and elevated C-reactive protein, were found in 79% of the patients, and fever was apparent in 48%; 76% of the patients complained of pain. At the time of surgery, eight (24%) mycotic aneurysms were already ruptured, and 20 (61%) had penetrated into the periaortic tissues, forming a contained rupture. Five (15%) aneurysms were completely intact. The predominant microorganisms found in the aneurysm sac were Staphylococcus aureus and Salmonella species. Careful debridement of all infected tissue was essential. In the infrarenal aortic and iliac vascular bed, in situ reconstruction was performed only in cases of anticipated "low-grade" infection. Alternative revascularization with extra-anatomic procedures (axillobifemoral or femorofemoral crossover bypass graft) was carried out in eight of 16 cases. All four suprarenal and all 13 mycotic aneurysms of the thoracoabdominal aortic segment were repaired in situ. Antibiotics were administered perioperatively, and all patients were subsequently treated with long-term antibiotics. RESULTS: In-hospital mortality was 36% (n = 12). Because of the smallness and heterogeneity of the sample, we could not demonstrate significant evidence for any influence of aneurysm location or type of reconstruction on patients' outcome. However, survival was clearly influenced by the status of rupture. During long-term follow-up (mean, 30 months; range, 1-139 months), 10 patients (48%) died-one (4.8%) probably as a consequence of the mycotic aneurysm, the others for unrelated reasons. Eleven patients (52%) are alive and well today, with no signs of persistent or recurrent infection. CONCLUSIONS: A mycotic aneurysm of the aortic iliac region remains a life-threatening condition, especially if the aneurysm has already ruptured by the time of surgery. Although the content of the aneurysm sac is considered septic, as was proved by positive cultures in 85% of our patients, in situ reconstruction is feasible and, surprisingly, was not more closely related to higher morbidity and mortality in our series than ligation and extra-anatomic reconstruction, although most of the aneurysms repaired in situ were located at the suprarenal and thoracoabdominal aorta. We assume that our operative mortality rate of 36%, which relates to a rupture rate of 85%, could be substantially lowered if the diagnosis of mycotic aneurysm were established before rupture.

Aged↗
PubMed2000

[Results of conventional surgical therapy of abdominal aortic aneurysms since the beginning of the "endovascular era"].

INTRODUCTION: In 1990 the new method of endovascular graft treatment of abdominal aortic aneurysms (AAA) emerged. For this reason we analyzed the results of open surgery for AAA in our department to consider the question of standard therapy. METHODS: In a retrospective study the medical data of 941 consecutive patients treated by open surgery in a single center from 1990 to 1997 (mean age 67 years, 14.5 % female, 3.2 % suprarenal AAA) were analyzed. Operations were performed electively in 778 asymptomatic patients, urgently in 104 symptomatic patients, and as emergency operations (immediately after admission) in 59 symptomatic patients (45 patients presenting with rupture). RESULTS: Mortality was 1.54 % (elective operations), 8.65 % (urgent operations), and 35.6 % (emergency operations, rupture). Morbidity was 15.9 % (elective operations), 28.8 % (urgent operations), and 66.7 % (emergency operations, rupture). Mortality was not increased in patients undergoing additional procedures of the renal, iliac, femoral, or crural arteries. CONCLUSION: Because of its low mortality and morbidity today open surgical repair remains the standard therapy for AAA.

Adolescent↗
PubMed2000

[Acute aortic dissection. Diagnosis and therapy of ischemic complications].

AIM OF THE STUDY: About 30% of the patients with acute aortic dissection suffer from organ or limb ischemia. We analyzed the influence of ischemic localization and method of operative treatment (aortic fenestration or extraanatomic bypass revascularization) on morbidity and mortality. PATIENTS AND METHODS: From 1 May 1987 to 31 December 1998 21 patients with 24 vascular complications such as renal or intestinal ischemia, lower extremity ischemia and paraplegia following acute aortic dissection were treated at our institution. Recruitment was retrospective in 16 and prospective in 5 patients. In 5 patients (24%) the complication was associated with Stanford A, in 16 (76%) with Stanford B dissection. Ten patients (48%) complained of malperfusion of only one region, whereas 11 patients (52%) suffered from ischemia of two or three different regions. Aortic fenestration and resection of the dissected membrane was performed in nine cases (37%). Fifteen patients (63%) were treated with extraanatomic bypass techniques. RESULTS: One third of the patients died, four of them due to aortic penetration or perforation and two due to visceral ischemia. During follow-up of 32 (1-110) months two patients developed aortic complications. One died of aortic perforation, while the other developed a thoracoabdominal aneurysm and had to be treated by a tube graft replacement. CONCLUSIONS: Outcome depended more on the spontaneous course of aortic dissection and on prompt diagnosis and therapy of the complications than on the different operative techniques.

Adult↗
PubMed2000

[Delirium after vascular surgery interventions. Intermediate-term results of a prospective study].

INTRODUCTION: Postoperative delirium is a common psychic disturbance occurring acutely after various surgical procedures and typically presenting with a fluctuating course. These patients' recovery takes longer. In this study we analyze the incidence of postoperative delirium in patients undergoing vascular surgery and try to identify risk factors for its development. METHODS: Patients undergoing elective arterial operations were included. Their medical history, the specific vascular diagnosis and operation performed, the medication and laboratory data were monitored. Additionally the patients were preoperatively interviewed by a psychiatrist. Intraoperatively the drugs, infusions, possible transfusions, blood gases and pressures were monitored, as were the times of surgery and anesthesia. Postoperatively patients were seen daily by the psychiatrist and the surgeon for at least 7 days. Postoperative delirium was diagnosed according to DSM IV criteria, and mild, moderate and severe delirium were distinguished. RESULTS: Fifty-four patients entered the study. Twenty-one (38.9%) developed postoperative delirium (11 mild, 2 moderate, 8 severe). Patients with aortic operations developed delirium more frequently than those with non-aortic procedures(55.5 vs 22.2%, n = 27 each). Some preexisting diseases (hearing disturbance) increased the probability of postoperative delirium, while age was not identified as a risk factor. General psychopathological and depressive disturbances increased the likelihood of postoperative delirium. Patients who had a severe intraoperative course developed postoperative delirium more frequently. This was not seen in the absolute time of surgery or anesthesia nor in the intraoperative development of blood pressure or intraarterial gases, which did not differ between patients with and without postoperative delirium. More reliable parameters were an increased intraoperative need for crystalloid volume, intra- or postoperatively decreased hemoglobin values (Hb < 10 g/dl) and the development of acidosis that had to be treated. Patients with delirium had serious complications more often (8/21 = 38.1% vs 6/33 = 18.2%) and needed Intensive Care treatment longer (2.7 vs 2.1 days, only aortic surgery 3.2 vs 2.4 days). CONCLUSIONS: Postoperative delirium after vascular surgery is frequent. Patients undergoing aortic surgery, with specific concomitant medical disease, psychopathological disturbances and a severe intraoperative course, are at risk of developing postoperative delirium.

Aged↗
PubMed2000

Healing characteristics of small-calibre vascular prostheses coated with plasmin-treated fibrin--an experimental study.

BACKGROUND: The autogenous vein represents the graft material of choice in crural and pedal bypass surgery. Because of the numerous problems concerning the graft harvesting and the quality of autogenous vein material an equally good allogenous graft is urgently needed. Up to the present times no such graft material has been able to achieve the success of vein grafts. METHODS: We investigated the knitted polyester prosthesis Terumo PF-V (Terumo Comp., Japan), diameter 5 mm with outer reinforce, which is characterized by a new coating of plasmin-treated fibrin. Grafts were implanted as bypass into the ligated carotid (n = 10) and femoral arteries (n = 10) of 10 dogs (beagles). As a control 5 mm-ePTFE-prostheses (Impra Carboflo) were implanted simultaneously on the contralateral side. RESULTS: After 6 months, seven of 20 PF-V-grafts and 8 of 20 PTFE-grafts were patent. All prostheses presented with good macroscopic healing characteristics. In the patent grafts, angiography showed no substantial stenoses. The histological examination of the material was performed using light microscopy, transmission polarising microscopy, scanning electron microscopy, and transmission electron microscopy. Both types of prostheses showed the typical pattern of graft healing by migration of mesenchymal cells through the prosthesis, formation of capillaries, and growing of a neointima with endothelium-like cells. All failed bypass grafts presented with an occluding proliferation from the arterial wall into the anastomotic region. CONCLUSIONS: Using clinically or histologically evaluation, neither graft demonstrated superiority over the other. The results indicate that the coating plays only a minor role for graft healing if any. For proper graft function, the arterial wall proliferation at the anastomotic region, which is not dependent on the type of prosthesis, appears to be most important. The overall results concerning both types of prostheses were disappointing.

Animals↗
PubMed2000

Reconstruction for renal artery aneurysm and its effect on hypertension.

OBJECTIVES: many renal artery aneurysms (RAA) are diagnosed incidentally in the course of investigations for hypertension and their management is controversial. AIM: to review the results of renal artery reconstruction for RAA. METHODS: between January 1978 and December 1998 111 RAR were performed in 81 kidneys in 71 patients. RESULTS: fifty-nine patients were hypertensive, three had a creatinine >2.0 mg/dl and one was on dialysis. The principal underlying pathology was fibromuscular dysplasia (39) and atherosclerosis (17). The mean RAA diameter was 2.2 (range 1-15) cm overall and 3.5 (range 2-10) cm in four patients who presented with rupture. Fifty-one patients had renal artery stenosis. Autogenous material was used in 105 RAR. There was no 30-day mortality and the morbidity rate was 16%. The 5-year cumulative patency rate was 69%. Hypertension was cured in 25% and improved in 39%. CONCLUSIONS: RAR tested for RAA treats hypertension and reduces the risk of rupture and distal embolisation.

Adolescent↗
PubMed1998

[Vena cava umbrella filter: complications and treatment].

BACKGROUND AND OBJECTIVE: Increasing numbers of vena canal filters are being implanted to prevent pulmonary embolism, which are mainly the consequence of deep vein and pelvic vein thrombosis. Can a filter be removed again in case of complications arising from it? What is the risk of such operative explantation? What is the subsequent risk of pulmonary embolism? PATIENTS AND METHODS: In nine patients (5 males, 4 females; mean age 45 (30-39 years) who had vena caval filters implanted because of thromboembolism despite anticoagulation, complications due to the filter required its operative removal and thrombectomy of the large veins 3 days to 48 months after implantation in the inferior vena cava (IVC). One inguinal arteriovenous fistula (due to perforation of rods of a displaced filter) were closed. The patients' case note were retrospectively analysed and eight of the nine patients' were reexamined according to a standardized procedure a mean of 20 months after removal of the filter. RESULTS: Explantation of the filter had been successful in all patients. But there were two nonfatal postoperative complications: a pulmonary embolus and a paradoxical cerebral embolus. In one patient a segmental stenosis of the IVC with retroperitoneal collateral circulation was found at operation. All but one of 16 pelvic veins that had thrombectomies performed at the time of filter explanation were patent, as were the IVCs in seven of the eight re-examined patients. None of the patients had evidence of postoperative pulmonary embolism. CONCLUSIONS: Vena caval filters can be explanted with a low operative risk. After removal and venous thrombectomy, implantation of another caval filter is unnecessary. As anticoagulation properly monitored is almost always an effective measure in the prevention of pulmonary thromboembolism, filter implantation should be performed only on the strictest indication, as an ultimate step.

Adult↗
PubMed1998

Open surgery or endovascular treatment of the abdominal aortic aneurysm--quality assurance is urgently needed.

PURPOSE: The endovascular treatment of the abdominal aortic aneurysm (AAA) seemed to promise great advantages over the open surgery. The current results do not show an improvement compared to the conventional therapy. New kinds of complications have appeared. Their significance especially in the longterm course cannot be assessed today because sufficient clinical data are missing. METHODS: Between 1991 and 1997, 784 patients were electively operated on for infrarenal AAA. The clinical data of these patients were analysed retrospectively and compared to the current results of endovascular surgery in the literature. RESULTS: In the 784 patients treated by conventional surgery the mortality was 2.4%, the morbidity was 20.3%. The mortality of endovascular treatment ranged between 0 and 8.9%, the morbidity was 20 to 74%. Endoleaks existed in up to 32% of patients, and up to 21% of interventions were initially not successful. The mortality of conversion to open surgery was reportedly amounting 43%. CONCLUSION: To confirm new standards in the therapy of AAA an overall quality assurance of endovascular and open surgery is necessary. Additionally randomised studies have to be demanded. Only that way the indications of both methods can be based upon scientific facts.

Adolescent↗
PubMed1997

[Incidence and therapy of peripheral arterial vascular complications after heart catheter examinations].

We analyzed the incidence and management of major vascular complications at the arterial puncture site following diagnostic or interventional cardiac catheterization. 27387 cardiac catheterization procedures were performed for diagnostic (n = 19581) or interventional (n = 7806) purposes at our institution during a 7-year study period. A total number of 114 major vascular complications (0.42%) were identified. In 36 (0.13%) patients an arterial occlusion at the puncture site was detected, 34 patients (0.12%) had severe hematoma (blood transfusion or surgical repair necessary), 32 patients (0.12%) developed false aneurysms, 9 patients (0.03%) with av-fistulas and 3 patients (0.01%) had other complications. The following factors were predictive for a significant increase in the incidence of major vascular complications: Female gender, interventional catheterization using larger introducer sheaths and necessitating effective perioperative doses of heparine, and peripheral vascular disease. Operative repair was necessary in 62 patients (54%), 34 patients (30%) were treated conservatively. In 18 patients (17%) acute vascular occlusion could be managed by percutaneous transluminal balloon dilatation and intravascular thrombolysis of the obstruction, in 3 patients additional stent-implantation was necessary in the presence of a large occlusive dissection. Overall the rate of clinically significant major vascular complications is low. In the future a greater number of vascular complications at the entry site for cardiac catheterization will be treated with nonoperative methods (e.g. manual compression of pseudoaneurysms or catheter-based techniques for recanalization of acutely occluded vessels.

Adult↗