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Biomedical subjects

P Holstein

Publications and source records attributed to P Holstein.

80 records · Page 5Linked to original sources
PubMedDate not supplied

Comparison of efficacy in crossing femoropopliteal artery occlusions with movable core and hydrophilic guidewires.

PURPOSE: Compare the recanalization rate of femoropopliteal occlusions between movable core wire guide (MG) and hydrophilic guidewire (HG). METHODS: Conventional PTA technique was used, followed by enclosed thrombolysis. The MG was used for all patients in the first 2 years, the HG in the following 2 years. Baseline characteristics were similar for the two groups of patients. RESULTS: Recanalization of 124 femoropopliteal occlusions was attempted. Technical success was achieved with the MG in 45 of 59 procedures; 42 procedures were clinically successful. Using the HG, technical success was achieved in 35 of 65 procedures; clinical success was achieved in 35 of 65 procedures; clinical success was achieved in 29 cases (p < 0.0048). At 1-year follow-up, 32 extremities improved after treatment with MG and 22 extremities after treatment with HG (p < 0.035). CONCLUSION: The results suggest that the MG should be the first choice in recanalization of femoropopliteal occlusions.

Adult↗
PubMedDate not supplied

Late hemodynamic failure following percutaneous transluminal angioplasty for long and multifocal femoropopliteal stenoses.

The outcome of percutaneous transluminal angioplasty (PTA) was evaluated for treatment of 87 limbs with femoropopliteal stenoses, including 55 short stenoses (2.4 +/- 1.6 cm, mean +/- SD), seven single long stenoses (10.4 +/- 2.0 cm), and 25 multifocal stenoses (2.1 +/- 1.6 cm), where two to four separate segments were dilated. Following 98% initial technical success, 3-year patency was 68% for single short stenoses, as opposed to 20% for long and multifocal stenoses (p = 0.05, logrank test). Antiplatelet therapy with acetylsalicyclic acid was not found to influence occurrence of restenosis. The study documents the poor PTA results for long and multifocal stenoses and suggests precautions to be taken during PTA in order to minimize the area of artery wall damage.

Angioplasty, Balloon↗
PubMedDate not supplied

Segmentally enclosed thrombolysis in percutaneous transluminal angioplasty for femoropopliteal occlusions: a report from a pilot study.

Segmentally enclosed thrombolysis (SET) was performed immediately following 34 percutaneous transluminal angioplasties (PTAs) for femoropopliteal occlusions. The dilated segment was sealed off with a double balloon catheter, and recombinant tissue plasminogen activator (rt-PA) 1 mg/ml and heparin 200 IU/ml were injected between the balloons. The catheter was removed after 30 min and heparin treatment was continued for 24 h. Alpha-2-antiplasmin was initially reduced by 13% and normalized 2 h after SET, indicating that only small amounts of free plasmin were liberated during thrombolysis. No clinically relevant changes in plasma fibrinogen occurred. Two puncture site hemorrhages did not coincide with the coagulopathy induced by SET. One-year patency was 80%. Early rethrombosis occurred in 9% versus 41% in our previous series on standard PTA for femoropopliteal occlusions (p less than 0.001). Therefore, SET is considered beneficial in reducing the incidence of early rethrombosis.

Aged↗
PubMedDate not supplied

Accuracy of auscultatory blood pressure measurements in hypertensive and obese subjects.

In 59 treated or untreated hypertensive subjects and 52 obese subjects (normotensive or hypertensive), intraarterial blood pressure (BP) was compared to simultaneous auscultatory measurements. In the hypertensive group, arm circumference was less than 35 cm compared to over 35 cm in the obese subjects. The occluding cuffs were 12 x 35 cm and 15 x 43 cm respectively. Mean difference between auscultatory and intraarterial systolic BP (SBP) was among the hypertensive -- 8.8 mm Hg (SDDIFF 9.0 mm Hg, range + 13/ - 28) and among the obese - 3.1 mm Hg (SDDIFF 13.8 mm Hg, range + 19/ - 49). Mean difference auscultatory-intraarterial diastolic BP (DBP) Phase V was among the hypertensive patients + 10.8 mm Hg (SDDIFF 6.8 mm Hg, range + 29/ - 8), and among the obese + 5.5 mm Hg (SDDIFF 7.3 mm Hg, range + 20/ - 10). Thus, a 15 x 43 cm cuff used in obese subjects with an arm circumference exceeding 35 cm gave quite as reliable measurements as a 12 x 35 cm cuff used in hypertensive subjects with "normal" dimension of the upper arm (less than 35 cm). It is emphasized that there is a wide scatter in the interindividual differences, and it is argued that a comparison between auscultatory and intraarterial BP should be performed in patients with poorly controlled hypertension.

Adult↗
PubMedDate not supplied

Ligation of the renal vein during resection of abdominal aortic aneurysm.

In resection of abdominal aortic aneurysm, ligation and division of the left renal vein may be necessary in order to expose the perirenal aorta. This manoeuvre is possible, with conservation of the left kidney function, because of the extensive venous collateral circulation of the left kidney. It is of crucial importance however, that ligation of the vein is performed close to the inferior vena cava. A case is presented where ligation of the left renal vein was performed in relation to an operation for a ruptured abdominal aortic aneurysm. After the operation there was initially dysfunction of the left kidney, and later on sepsis-induced uraemia. The renal function stabilized at a moderately reduced level. No permanent kidney damage related to the venous ligation could be demonstrated. In the literature serious renal damage has been reported in 10 cases out of 89 reported ligations of the left renal vein. Ligation of the left renal vein is thus a reasonably safe and acceptable procedure for surgical exposure in difficult aortic procedures.

Aorta, Abdominal↗