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Biomedical subjects

P Polterauer

Publications and source records attributed to P Polterauer.

At least 55 records · Page 3Linked to original sources
PubMed1997

Endovascular AAA treatment: expensive prestige or economic alternative?

OBJECTIVES: To compare the costs of endovascular aneurysm treatment versus open surgery during the perioperative period. METHODS: Retrospective analysis of a consecutive series of 44 patients undergoing infrarenal abdominal aneurysm repair from February 1995 to March 1996 at a university teaching hospital. RESULTS: No endovascular procedure was converted to open repair. Operative time was shorter for endovascular treatment (207.6 min vs. 229.1 min, n.s.), as well as postoperative intensive care unit stay (ICU, 22.7 h vs. 55.0 h, p = 0.017) and the postoperative recovery period (5.6 days vs. 13.3 days, p < 0.001). Open surgery generated significantly more costs (25,374.07 ECU vs. 22,268.78 ECU, p < 0.001), despite evaluation and a more expensive endovascular procedure (10,699.48 ECU vs. 4032.01 ECU, p < 0.001). During the study, costs for open surgery exceeded the cost for endovascular treatment by 13.95%. CONCLUSIONS: Endovascular aneurysm treatment is cost effective and less expensive than open surgery. The main reason for cost saving is faster patient recovery after surgery, associated with a shorter LOS in the patients treated with endovascular procedure.

Aged↗
PubMed1997

Treatment of abdominal aortic aneurysms with transfemoral placement of stent-grafts: complications and secondary radiologic intervention.

PURPOSE: To determine the rate of complications of transluminally placed endovascular stent-grafts in patients with abdominal aortic aneurysms and to assess efficacy of secondary radiologic intervention. MATERIALS AND METHODS: In 28 patients, covered nitinol stents were implanted. Frequency and outcome of complications were evaluated after stent-graft placement (mean follow-up, 8.2 months). RESULTS: In 27 patients, 11 tube and 16 bifurcated grafts were implanted successfully. In one (4%) patient, distal migration of a bifurcated graft necessitated conversion to standard open repair. Technical success rates (successful deployment of the device and complete exclusion of the aneurysm at intraoperative angiography) for bifurcated and tube grafts were 24% (four of 17 patients) and 91% (10 of 11 patients). After surgery, leaks were seen in six bifurcated and five tube grafts. After secondary intervention, the final exclusion rate for bifurcated and tube grafts was 88% (15 of 17 patients) and 100% (11 of 11 patients), respectively; the overall success rate was 93% (26 of 28 patients) for exclusion of aortic abdominal aneurysms. Stent-graft thrombosis necessitated local thrombolysis in one patient. Overlapping of accessory renal arteries occurred in two patients. CONCLUSION: Complications after stent-graft placement in abdominal aortic aneurysms are frequent. Secondary radiologic intervention is successful in most cases.

Aged↗
PubMed1997

Evaluation of abdominal aortic aneurysm for stent-graft placement: comparison of gadolinium-enhanced MR angiography versus helical CT angiography and digital subtraction angiography.

PURPOSE: To determine whether magnetic resonance (MR) angiography can be used alone to evaluate abdominal aortic aneurysms (AAAs) for endovascular placement of stent grafts. MATERIALS AND METHODS: Sixty-one patients with AAAs underwent gadolinium-enhanced MR angiography of the abdominal aorta and pelvic arteries. Measurements of the size and extent of the AAAs were compared with helical computed tomographic (CT) and digital subtraction angiographic measurements; 95% confidence intervals for the differences in the means were determined. RESULTS: Because of the larger field of view, MR angiography was superior to CT angiography in assessing visceral iliac artery disease. Both modalities were equal in evaluating the proximal extent of the AAA (mean difference, -0.16 mm; 95% CI, -0.31, 0.64) and in measuring all aortic dimensions (e.g., mean difference in the proximal neck diameter, -0.74 mm; 95% CI, -0.98, -0.49). MR angiography was inferior to CT angiography in depicting accessory renal arteries (seven of 12) and in grading renal artery stenoses (sensitivity, 100% [95% CI, 0.90, 1.00]; specificity, 84% [95% CI, 0.74, 0.91]). CONCLUSION: Gadolinium-enhanced MR angiography is a fast, reliable means of providing all the information relevant to the preoperative assessment of endovascular aortic stent-graft placement.

Adult↗
PubMed1997

[Abdominal aortic aneurysm: surgery, indications, technique, outcome].

The fate of a patient with an abdominal aortic aneurysm] (AAA) is influenced by the risk of rupture and embolism. When the indication for operation is considered, individual associated risk factors have to be taken into account. With regard to the literature, the following recommendations concerning indication for surgery can be given: emergency surgery for symptomatic or ruptured aneurysm; elective surgery: aneurysms 5 cm diameter or growing AAA 5 mm/year, patient with acceptable individual risk for operation; asymptomatic aneurysms less than 5 cm in diameter, without growth in patients aged over 75 years and/or considerable perioperative risk should not be operated on: sonography should be done 3-monthly as a continuing control. Finally the results in our institution are presented for elective surgery: 30-day mortality 3.5%, AAA with rupture, no shock: 20%, ruptured AAA with shock 47%, respectively.

Aortic Dissection↗
PubMed1997

[Acute mesenteric ischemia].

UNLABELLED: Acute mesenteric ischemia is a life-threatening vascular emergency. A retrospective analysis of our patients was performed to describe the development of the various procedures of diagnostic assessment and treatment between 1970 and 1996, to show the influence on survival and to define recent standards. PATIENTS: Between 1970 and 1996, 145 patients, 75 male and 70 female, suffering from acute mesenteric ischemia, have been treated at the Department of Surgery-University Hospital Vienna. RESULTS: In most cases AMI was caused by arterial embolism (64.1%, n = 93) followed by arterial thrombosis (27.6%, n= 40). Venous thrombosis (3.5%, n = 5) and non-occlusive AMI (4.8%, n = 7) were rare events. Serum lactate level has been determined routinely in all patients having been admitted with acute abdomen since 1984 and turned out to be positive in 81.2% (mean value 9.81 (3.21-22.3) mmol/l). Abdominal x-ray gave only in some individual cases special hints to the advanced intestinal gangrene. Abdominal sonography led to the correct diagnostic assessment in 52 patients (= 35.8%). Angiography was in 92% conclusive for the diagnosis. Abdominal CT led to establish the correct diagnosis in > 80%. Our series with revascularisation (thrombectomy/embolectomy or bypass) has resulted in 73.8% patient survival with intestine having been maintained in the most favourable cases. CONCLUSIONS: Early diagnostic assessment and treatment are decisive for survival. Abdominal-CT, angiography and serum-lactate constitute quick and reliable means to provide diagnosis and to judge the stage of AMI in addition to meticulous examination of patients' history, symptoms and physical conditions.

Acute Disease↗
PubMed1996

Vascular reconstruction for limb salvage in sarcoma of the lower extremity.

OBJECTIVES: To examine the patency and limb-salvage characteristics of vascular reconstruction in patients with sarcomas of the lower extremity who had been treated with limb-preserving resection and to examine patient survival during a long follow-up period. DESIGN: Retrospective cohort study. SETTING: University hospital, tertiary referral center. PATIENTS: From 1984 to 1992, 14 patients underwent limb-preserving resection of sarcomas in the proximal lower extremity, with 20 vascular reconstructions performed. OUTCOME MEASURES: Color Doppler scans documented patency of the vascular reconstructions. Clinical evaluation included functional results in terms of limb movement and quality of life. Local tumor control and systemic recurrence were examined by repeated radiologic examination. Overall survival as well as time and cause of death were assessed. RESULTS: A total of 13 patients had patent vascular grafts, while the venous graft became occluded in 1 patient. Limb function was rated as excellent or good in 9 patients, as fair in 3, as poor in 1, and could not be clinically estimated in 1. Postoperative thrombosis of the venous graft was detected in 3 patients and was effectively managed by thrombectomy in 2. Three patients underwent reoperation because of hematoma or complications caused by local infection. The tumor endoprosthesis had to be replaced in 3 patients. During follow-up periods that ranged from 15 to 132 months (mean, 55 months), 4 patients died. In all of these patients the cause of death was systemic recurrence in the lung. Two additional patients developed pulmonary metastases, but at the time of this report, they were still alive as long as 132 months after operative resection or chemotherapy. No local recurrence was found. CONCLUSION: Limb-preserving resection of sarcoma of the lower extremity can be performed with satisfactory function of the limb maintained, even if it becomes necessary to resect the femoral vessels. Autologous venous graft for vascular reconstruction is the treatment of choice. In spite of the high incidence of metastases, considerable long-term survival is possible.

Adolescent↗
PubMed1996

Demonstration of cystic adventitial disease by intravascular ultrasound imaging.

In a 34-year-old woman with intermittent calf claudication, cystic adventitial disease of the popliteal artery was demonstrated by intravascular ultrasound imaging. Multiple intramural cystic masses were seen to be compressing the arterial lumen. The diagnoses of cystic adventitial disease was confirmed by surgery. Intravascular ultrasound imaging reliably identifies cystic adventitial disease; its application can be recommended as an alternative to established diagnostic procedures (computed tomography, magnetic resonance imaging) in patients undergoing angiography.

Adult↗
PubMed1996

[Post-traumatic aneurysma spurium of the subclavian artery].

In peacetime, injuries to the subclavian artery are now very rare. Even more rare are posttraumatic aneurysms and indirect damage to the brachial plexus as a result of injury. The clinical findings, diagnosis and treatment of such a case are described and discussed. Consideration of all the clinical symptoms as a whole is of the outmost importance in the diagnostic process. The development of neurological symptoms in the course of injury with a topographic relationship to the corresponding anatomical structures gave rise to the preliminary diagnosis in this particular case. CT and DSA confirmed the diagnosis. Although surgical treatment is urgently indicated in such cases, resection of the aneurysm as an elective surgical procedure was preferred.

Aneurysm, False↗
PubMed1996

Limb salvage in periacetabular sarcomas: review of 21 consecutive cases.

The oncologic and functional outcome was reviewed in 21 consecutive patients who underwent limb salvaging surgery for periacetabular sarcoma using a new surgical approach and different types of reconstruction between 1972 and 1990. Histologic diagnosis in 86% showed osteosarcomas, chondrosarcomas, and Ewing's tumors. Age ranged from 10.0 to 61.5 years (mean age, 32.9 years). The resection margin was wide in 15 patients but marginal in 2 patients and intralesional in 4 patients. All of the latter patients died of their disease. In all cases where 3-dimensional imaging was used, wide resection margins could be achieved, whereas this was possible only in 50% of the cases with conventional imaging techniques. Seven patients died of their disease 3 to 15 months after surgery, 2 died of chemotherapy induced sepsis, and 2 patients died perioperatively. At followup, 8 patients had no evidence of disease (mean, 57.6 months; range, 12-190 months), and 2 patients were alive with disease. Fourteen patients could be observed for at least 12 months (mean, 41.1 months) and were functionally evaluated according to Enneking's criteria. If extensive resection was necessary, the best results were found if the defect had been reconstructed with a custom made prosthesis. The results were only satisfactory after implantation of saddle prostheses and poor with allografts or when no reconstruction of the bone defect was done.

Acetabulum↗
PubMed1995

Compliance mismatch and formation of distal anastomotic intimal hyperplasia in externally stiffened and lumen-adapted venous grafts.

OBJECTIVE: Compliance and formation of distal anastomotic intimal hyperplasia (DAIH) were investigated in externally stiffened venous grafts of varying calibers. METHODS: 36 femoropopliteal reconstructions were performed in 18 sheep. The autologous venous grafts were inserted into tubes made of Dacron mesh to achieve compliance-mismatch and lumen adaptation. Compliance was measured by echotracked ultrasonography and profiles of DAIH were generated from histologic sections harvested after 8.3 months. MAIN RESULTS: The external mesh tube significantly lowered the local compliance of graft and host artery. DAIH appeared extensively in those groups where mesh tube constricted venous grafts met untreated host arteries (p = 0.002). No differences in compliance and DAIH formation were observed when grafts with large and adapted diameters were compared. CONCLUSIONS: For prevention of DAIH the distal venous graft diameter is not important, while the local compliance of an autologous vein is a predictive factor for DAIH formation and thus long-term patency.

Anastomosis, Surgical↗
PubMed1995

Recovery of intraoperatively shed blood in aortoiliac surgery: comparison of cell washing with simple filtration.

To regain blood shed intraoperatively, two different systems are clinically established: washing and centrifuging red blood cells to produce autologous erythrocyte concentrates and devices for immediate reinfusion of whole blood after mere filtration. In a prospective-randomised study to compare both methods regarding their efficiency, adverse effects, and economy, 20 patients of our department undergoing elective aortoiliac surgery received intraoperative autotransfusion by means of either cell-washing (CS) or salvage of whole blood (WB). Patients were preoperatively randomized into one of the two groups and were evaluated with respect to standard metabolic and haematological laboratory parameters preoperatively, during surgery, after transfer into the recovery room, 24 h after surgery, after transfer into the recovery room, 24 h after surgery, and at discharge. Both patient groups were well comparable in demographics, preoperative laboratory data, and indication for operation. Handling was easier, the set-up time was shorter with the whole blood filtration device (10.2 +/- 2.3 versus 21 +/- 1.9 min, p = 0.0023), and no additional personnel was needed to run the system. The whole blood device also allowed a greater percentage of aspirated blood to be returned intraoperatively compared to cell washing (73.5% +/- 7.2 versus 51.1% +/- 6.5, p = 0.03). Thrombocytopenia occurred in 7 (CS) and 3 (WB) patients intraoperatively with a significant difference in platelet count between the two groups (118 +/- 17 [CS] versus 170 +/- 12 [WB]*10(9)/L, p = 0.025). Expected changes in the perioperative course of the clotting parameters such as highly increased PTT levels and moderately prolonged prothrombin times occurred in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

The value of obturator canal bypass. A review.

OBJECTIVE: To review the value of obturator canal bypass with respect to long-term results. DESIGN: Case series and literature review. SETTING: University of Vienna Medical School in Austria. PATIENTS/METHODS: Personal experience with 34 consecutive patients and 125 cases published since 1982 with respect to patient data, patency, and survival are compared and jointly analyzed retrospectively. INTERVENTIONS: Patients received obturator canal bypass for lesions of the pelvic or common femoral vessels precluding orthotopic reconstruction. MAIN OUTCOME MEASURES: The rates of patient survival, limb salvage, and graft patency were analyzed. RESULTS: The postoperative mortality rate in the present series was 14.7%. The limb salvage rate after 5 years was 76.5%. One- and 5-year secondary patency rates were 75.3% and 54.9%, respectively. All grafts in patients without atherosclerosis were patent at a median of 34 months. For 57 cases documented in the literature, 1- and 5-year patency rates were 70.8% and 59.7%, respectively. Combined analysis of 90 obturator canal bypasses revealed rates of 72.7% and 56.9% of patent grafts at 1- and 5-years, respectively. CONCLUSIONS: The use of obturator canal bypass is recommended in deep groin infections and especially in patients with lesions of the pelvic vessels due to other occlusive vascular disease.

Aged↗
PubMed1994

Intraoperative control following femorodistal revascularization: angioscopy is superior to angiography.

Intraoperative angioscopic control was performed in an early series of 27 patients undergoing peripheral vascular surgery. The majority were complex or re-do operations; reversed saphenous vein and PTFE-grafts were used as bypass material exclusively. Angioscopic findings were compared to conventional angiography with respect to the detection of technical problems leading to further surgical procedures. Angioscopy was feasable in 92.5%, it failed twice due to irrigation problems, which was before we used a dedicated angioscopy roller-pump. In 6 patients relevant findings requiring further surgical manipulations were only detected angioscopically, in 2 patients such findings were detected by angioscopy as well as by angiography. Such findings included technical problems (graft rotation [n = 1], anastomotic narrowing [n = 2]), balloon catheter injuries after thromboembolectomy (n = 2) and residual thrombi after local thrombectomy (n = 3); 5 of these patients had undergone previous vascular procedures in the same operation field. After local correction (n = 5) or placement of a new bypass (n = 3) there was no early graft failure. This early angioscopic experience confirmed previous reports that satisfactory visualization and specific recognition of angiographically unsuspected problems after peripheral reconstructions can be obtained by intraoperative angioscopic control. This was seen very distinctively in more complex and re-do operations, which we see as the cases most needing routine angioscopic control.

Aged↗
PubMed1994

[Vascular surgery and smoking--a retrospective multivariant analysis].

In a retrospective study of 2,988 patients operated because of chronic occlusive arterial disease preoperative smoking habits were related to the patency rates of arterial reconstructions of carotid arteries, infrarenal aorta, iliac vessels, of the lower extremity, and to overall survival rates: 1) 75.2% of the patients were smokers, 24.8% were nonsmokers (NS). 2) Smokers needed the first vascular procedure about 7 years earlier than NS (62.4 +/- 10.3 vs. 69.9 +/- 9.9 years of age; p = 0.001). 3) A significant difference between the 2 groups could be found regarding the location of occlusion (p = 0.000): 20.7% of all occlusions of infrarenal aorta and iliac vessels occurred in smokers (8.8% NS), whereas NS showed a higher percentage of carotid artery stenosis (20.5 vs. 11.9% in smokers). 4) Postoperative morbidity and mortality did not differ between the 2 groups. There was no difference regarding primary patency rates and preoperative smoking habits. 5) The late patency rates of reconstruction of the legs were 72.4 and 52.9% for smokers 1 and 5 years after operation, which was significantly higher than in NS (65.5 and 46%). 6) The overall number of reoperations was higher in smokers than in NS (p = 0.001). 7) Smokers received significantly less often a further anticoagulant treatment than NS (40 vs. 47%; p < or = 0.05). 8) Preoperative smoking habits influenced the overall survival rate in a statistically significant manner with disadvantage for smokers (74.5 vs. 79.9 years; p = 0.000).

Adult↗
PubMed1994

[Emergency management of ruptured/dissecting aortic aneurysm--diagnosis and therapeutic strategies].

Between December 1991 and January 1994 fifteen patients with a ruptured abdominal aortic aneurysm and seven patients with a dissecting aortic aneurysm were treated in our emergency department. Dissection/rupture of an aortic aneurysm is still a dramatic event with poor outcome, whereby survival depends largely on early diagnosis. In most cases the diagnosis can be made with reasonable assurance by history taking and physical examination. The most frequent differential diagnoses are pulmonary embolism and myocardial infarction (thoracic aneurysms) and renal or biliary colic and lumbago (abdominal aneurysms). The largest delay in commencing therapy is caused by patients' hesitation to call the Emergency Medical Service. Chest X-ray, echocardiography and abdominal sonography are of high diagnostic value, computed tomography confirms the diagnosis in most cases. Our Emergency Department provides the facilities for rapid diagnosis and interdisciplinary preoperative management of dissecting/ruptured aortic aneurysms.

Adult↗
PubMed1994

[Diabetes mellitus and vascular surgery: a retrospective, multivariate analysis].

The influence of diabetes mellitus on the outcome of arterial reconstructions was evaluated. 25.7% of 2,735 patients (average age: 63.7 years), who underwent arterial reconstruction for arterial occlusive disease, suffered from a diabetes mellitus in need of treatment. The sex ratio within the diabetic patients was 2:1 (male:female). Regardless other influencing factors insulin-depending diabetic patients (average age: 64.6 years) were operated in average 1 year earlier than non-diabetics (average age: 65.5 years). No significant differences were found for perioperative complications. Overall, diabetic patients live significantly shorter than non-diabetics (average age: 72.8 vs. 75.8 years). Concerning the survival after the operation a stronger influence can be seen (8.3 vs. 4.4 years). The lower extremity was found to be the main localization for this negative observation on survival of patients (femoro-popliteal: 8.3 vs. 3.5 years; femoro-crural: 7.7 vs. 3.8 years). No statistical significant differences between diabetics and non-diabetics were found concerning patency rates of a reconstruction of the carotid, the aortic or the iliac arteries. There was a slight tendency pointing to a worse patency in diabetics undergoing reconstruction of the femoro-popliteal level (diabetics: 77%/1, 63%/3, 38%/5 years; non-diabetics: 80%/1, 67%/3, 58%/5 years), but this tendency did not reach statistical significance. A similar result was seen in patients with femoro-crural reconstructions (diabetics: 67%/1, 51%/3, 43%/5 years; non-diabetics: 68%/1, 56%/3, 49%/5 years). We were forced to perform a major amputation significantly more often in diabetics than in non-diabetics (13% vs. 7% after 1 year).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Surgical therapy of acute thrombosis of leg-pelvic veins].

A series of 213 consecutive patients suffering from acute iliofemoral vein thrombosis who underwent venous thrombectomy is analyzed. Surgery was performed from an inguinal approach with a Fogarty-balloon-catheter from the proximal vessel and by bimanual exprimation from the femoral and popliteal veins. Post-operative oral anticoagulation treatment was attempted whenever possible. Long term results obtained in 130 patients after a median follow-up of 78 months (44% free of symptoms, 33% PTS [postthrombolic syndrome] I, 15% PTS II, 8% PTS III) showed a significant correlation to the duration of preoperative anamnesis: < or = 5 days: 64% free of symptoms, > 5 days: 34% free of symptoms, the rate of PTS III was equally distributed in the group with long (< or = 5 days) and short (> 5 days) anamnesis (8 and 9% respectively). Postoperative Dicumarol-therapy decreased the rate of severe PTS: 28% without, respectively 10% with therapy. If the medication was cancelled aggravation of the clinical symptoms in 1 third of the patients was observed. Venous thrombectomy is an important treatment option in patients with contraindications to thrombolytic therapy. With patients younger than 65 years and short anamnesis functional results are acceptable, high risk patients (severe cardiac disease and previous pulmonary embolism) should be treated with medical therapy only.

Female↗