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Biomedical subjects

S Karacagil

Publications and source records attributed to S Karacagil.

71 records · Page 4Linked to original sources
PubMed1991

Bypass grafting to the popliteal artery in limbs with occluded crural arteries.

Intraoperative completion angiograms of 47 femoropopliteal bypasses in limbs with occluded crural arteries were reviewed to identify the angiographic determinants of early outcome. Of 28 limbs in which the foot vessels were available for analysis, only 2 (7%) had an intact pedal circulation, and 18 limbs demonstrated no crural arteries suitable for distal reconstruction. The overall cumulative patency rate was 51% with a 76% limb salvage rate at 12 months. All seven grafts performed onto a popliteal artery segment of less than 8 cm occluded in the early period. The status of crural and foot arteries and the number of collaterals did not correlate well with early patency. Limbs with no patent crural artery that were analyzed in the poor angiographic runoff group, according to our previously reported classification, demonstrated relatively higher patency rates than the other subgroups with poor runoff. In cases where angiography demonstrates a poor runoff for distal revascularization, popliteal bypass with occluded crural arteries might achieve acceptable patency rates.

Adult↗
PubMed1991

A simple infusion method for measurement of intraoperative peripheral vascular runoff resistance.

A simple infusion system to assess the status of distal runoff was investigated on both hindlimbs of five mongrel dogs. Infusion catheters were placed in the superficial femoral arteries and the origin of the lower leg arteries was exposed for anatomic manipulation of the distal runoff. Saline solution was infused through the superficial femoral arteries at 64, 129, and 193 cm levels to calculate volume flow and index of resistance to flow. The in vitro part of the study was undertaken to analyze the effect of different-size catheters on flow rates in a rigid undistensible model. In the hindlimb study the flow differed significantly between two- and one-vessel runoff status at 50 and 100 mm Hg infusion pressures. In the in vitro study, in contrast to the hindlimb study, index of resistance to flow values for different-size catheters remained almost unchanged as the infusion pressure increased, demonstrating the distensibility of the runoff bed in dogs. A preliminary clinical study in 13 patients undergoing infrainguinal bypass surgery demonstrated a good correlation between angiographic runoff evaluation and intraoperative flow values. Valuable information can be obtained about the status of the distal runoff by this simple infusion method, which might be used to improve the prediction of outcome of infrainguinal bypass surgery.

Analysis of Variance↗
PubMed1990

A new method of angiographic runoff evaluation in femorodistal reconstructions. Significant correlation with early graft patency.

In 62 patients undergoing femorodistal bypass surgery, the foot vessel runoff was analyzed with a new grading system based on intraoperative postreconstruction serial angiography. The patients were divided into two groups according to the level of the distal anastomosis (proximal or low). Good runoff was defined as integrity of the anterior and/or posterior foot arch in proximal femorodistal grafts and integrity of both arches in low bypasses. In the proximal group, runoff was classified as poor when the arches were deficient or occluded, and in the low group, when only one arch was intact. The patency rate after 6 months was 81% in the good runoff group, whereas all grafts in patients with poor runoff were occluded. The new method allowed better prediction of the early outcome than does the primary and secondary pedal arch integrity concept.

Aged↗
PubMed1990

Angiographic criteria for prediction of early graft failure of secondary infrainguinal bypass surgery.

Complete intraoperative postreconstruction angiograms were obtained during 93 reoperations after failed femoropopliteal and femorodistal bypass grafts to evaluate the predictive value of a new method of angiographic runoff assessment. Good runoff was defined as patency of two or three lower leg arteries to the foot, or one patent vessel continuous with an intact anterior or posterior foot arch in femoropopliteal and proximal femorodistal bypasses, and integrity of both arches in low femorodistal bypasses. All other outflow patterns were considered poor. The cumulative 1-year patency rate was 61% with a 79% limb salvage rate after reoperations performed in limbs with good runoff. In reoperations with poor runoff, the patency rate was only 5% with a 22% limb salvage rate. In reoperations with good runoff, and 85% patency rate of vein grafts compared to 43% of prosthetic grafts clearly demonstrated the importance of graft material on early outcome. The improved prediction of early outcome with this new method of angiographic runoff evaluation might allow more rational management of patients with failed infrainguinal grafts.

Adult↗
PubMed1989

Arterial lesions of the foot vessels in diabetic and non-diabetic patients undergoing lower limb revascularisation.

This study was undertaken to compare the atherosclerotic involvement of the foot arteries in diabetic and non-diabetic patients with leg ischaemia. Ninety-four non-diabetic and 57 diabetic patients were investigated with intraoperative postreconstruction serial angiography during femoro-popliteal and femoro-distal bypass surgery. The foot vessels were evaluated with regard to the anterior and posterior foot arches which were classified as intact, deficient or occluded. Integrity of the pedal circulation was defined as patency of both the anterior and posterior foot arches. Severe involvement of the foot arches was rarely seen in limbs with 3- or 2-lower leg vessel run-off to the foot. The posterior foot arch was more often spared than the anterior foot arch, especially in the non-diabetic group (P less than 0.001). The integrity of the pedal circulation was similar in diabetic and non-diabetic patients (intact in about 20%). Patients with claudication showed a significantly lower occlusion rate of leg and foot arteries than patients with rest pain or gangrene. The results of this study showed that the foot vessels were similarly affected in diabetics and non-diabetics undergoing lower limb revascularization. The same aggressive diagnostic and therapeutic approach should be applied for limb salvage in both groups.

Aged↗
PubMed1989

Postoperative predictive value of a new method of intraoperative angiographic assessment of runoff in femoropopliteal bypass grafting.

In 96 consecutive patients undergoing primary femoropopliteal bypass grafting, the runoff was evaluated with a new grading system, based on findings at intraoperative postreconstruction serial angiography. This concept, which takes foot vessel involvement into account in patients with only one patent crural artery, is a modification of the traditional method of runoff assessment. Good runoff was defined as patency of two or three lower leg arteries to the foot or one patent, vessel continuous with intact anterior or posterior foot arch. In limbs with no patent vessel or one patent vessel with deficient or occluded foot arches, the runoff was classified as poor. The cumulative primary patency rates at 12 months in groups with good and poor runoff were 81% and 37%, respectively. The predictive value of the new method was superior to that of other comparable methods (traditional method, Society for Vascular Surgery and International Society for Cardiovascular Surgery criteria, and modified Society for Vascular Surgery and International Society for Cardiovascular Surgery criteria). This improved prediction can be ascribed to the optimal angiographic technique for visualizing distal vessels, selective evaluation of foot vessel runoff with a new concept, and the criteria used to define good and poor runoff.

Adult↗
PubMed1989

Angiographic runoff patterns in patients undergoing lower limb revascularization.

Intraoperative postreconstruction serial angiography was performed in 194 patients undergoing lower-limb revascularization (206 limbs), in order to analyze the atherosclerotic involvement of the lower leg and foot arteries. Occlusion of two or three leg vessels was found in 71% of the diabetic patients, and in 52% of the non-diabetics. The peroneal artery was less frequently affected than the other leg arteries. Severe involvement of the foot arteries was commonly observed in patients with only one or no patent leg vessel. The posterior foot arch was less commonly affected than the anterior. Complete visualization of the lower leg and foot arteries is suggested to be important for adequate evaluation of the distal vascular runoff. Pedal runoff may have prognostic significance in femoropopliteal as well as femorodistal bypass surgery.

Adult↗
PubMed1988

Pulmonary microembolization in experimental aortic surgery.

Pulmonary dysfunction frequently follows major surgery and has many features identical to "shock lung'. A porcine model of aortic surgery is described in which 111In-labelled platelet kinetics were related to subsequent pulmonary function. In 14 pigs, standardized aortic surgery resulted in reproducible shock and a 50 per cent mortality at 3 days. Cardiac output fell from 2.3 +/- 0.2 to 1.0 +/- 0.1 litres min-1 following removal of the aortic clamp and mean platelet and leucocyte counts fell from 437 +/- 48 to 252 +/- 39 x 10(9) litres-1 and 21.7 +/- 1.5 to 12.9 +/- 1.2 x 10(9) litres-1 respectively (P less than 0.01). Aggregate levels in inferior vena caval blood were maximal at this time and radiolabelled platelets accumulated in the lung with a rise in pulmonary vascular resistance. Alveolar-arterial oxygen difference subsequently increased from initial values of 13.7 +/- 2.0 to 23.4 +/- 3.5 mmHg (P less than 0.01) following resuscitation and to 32.5 +/- 3.4 mmHg at 3 days following surgery (P less than 0.01). This clear sequence suggests that pulmonary platelet microembolization occurs during surgical shock and may be responsible for subsequent pulmonary dysfunction.

Animals↗
PubMedDate not supplied

The use of below-knee percutaneous transluminal angioplasty in arterial occlusive disease causing chronic critical limb ischemia.

PURPOSE: To determine the efficacy, safety and long-term results of crural artery percutaneous transluminal angioplasty (PTA) in limbs with chronic critical limb ischemia (CLI). METHODS: Patients undergoing crural artery PTA due to CLI were followed at regular clinic visits with ankle brachial pressure index (ABPI) measurements. PTA of the crural arteries was attempted either alone (n = 39) or in combination with PTA of the superficial and/or popliteal artery (n = 55) in 86 limbs (82 patients and 94 procedures) presenting with CLI. The ages of patients ranged from 37 to 94 years (mean 72 years). The indications for PTA were rest pain in 10 and ulcer/gangrene in 84 limbs. RESULTS: A technically successful PTA with at least one crural level was achieved in 88% of cases (n = 83). Cumulative primary clinical success rates at 6, 12, 24, and 36 months were 55%, 51%, 36%, and 36%, respectively. Cumulative secondary clinical success and limb salvage rates at 36 months were 44% and 72%, respectively. CONCLUSION: PTA of the crural arteries might be considered the primary choice of treatment in patients with CLI and distal lesions with localized stenosis or segmental short occlusions.

Adult↗
PubMedDate not supplied

The role of duplex scanning in the selection of patients with critical lower-limb ischemia for infrainguinal percutaneous transluminal angioplasty.

PURPOSE: To investigate the role of duplex scanning in the selection of patients with critical lower-limb ischemia (CLI) for infrainguinal percutaneous transluminal angioplasty (PTA). METHODS: One hundred and sixty-two limbs with CLI (150 patients) that underwent duplex scanning within 3 months prior to conventional diagnostic angiography (n = 88) or infrainguinal PTA (n = 74) were retrospectively studied. The findings obtained from duplex scanning and angiography were analyzed in a masked fashion by two different investigators. RESULTS: The accuracy, sensitivity, specificity, and negative and positive predictive values of duplex scanning in the selection of patients for infrainguinal PTA were 86%, 84%, 89%, 86%, and 87% respectively. Forty-two procedures (57%) were performed at multiple arterial segments. The accuracy of duplex scanning in the selection of femoropopliteal and crural lesions for PTA was over 85%. However, the sensitivity of duplex scanning in the selection of popliteal and crural lesions for PTA was 49% and 38% respectively, compared with 80% for superior femoral artery lesions. In 39% of patients who were correctly selected for PTA, duplex scanning misdiagnosed one of the multiple lesions treated by PTA. CONCLUSION: Duplex scanning can safely be used for the selection of patients for infrainguinal PTA. The sensitivity of duplex scanning in the selection of lesions for PTA was less satisfactory in the popliteal and crural arteries compared with the femoropopliteal arteries.

Acute Disease↗
PubMedDate not supplied

The influence of distal runoff on patency of infrainguinal vein bypass grafts.

This retrospective study was conducted to analyze a new concept of evaluation of the effect of distal runoff on patency in infrainguinal bypass surgery for arterial insufficiency. Distal runoff was evaluated on postreconstruction angiograms in 191 limbs undergoing femoropopliteal and femorodistal reconstruction. Runoff was characterized as good, fair, or poor. Determination of graft patency was made by clinical examination, ankle-brachial index measurement, or duplex scanning at 1 month and thereafter at 6-month intervals. Cumulative patency rates were calculated according to the actuarial life table method. Patency rates in limbs with good runoff were better than in limbs with fair and poor runoff; at 6 months, patency rates were 88.2%, 70.9%, and 21.8%, respectively (p < 0.01). Similar patency rates were found for good runoff in femoropopliteal and femorodistal reconstructions (84.7% in femoropopliteal and 75% in femorodistal reconstructions) at 6 months. The authors conclude that this method of angiographic evaluation accurately predicts patency in infrainguinal bypass reconstructions.

Adult↗
PubMedDate not supplied

Selection of patients with lower limb arterial occlusive disease for endovascular treatment of the iliac arteries with duplex scanning.

The aim of this study was to evaluate the role of duplex scanning in selection of patients with lower limb arterial occlusive disease for endovascular treatment of the iliac arteries. From January 1995 through May 2000, 183 patients having chronic lower limb arterial insufficiency who underwent duplex scanning of the lower extremity arteries with available aortoiliac scans within 3 months before conventional aortoiliac diagnostic angiography and/or endovascular intervention of the iliac arteries were studied retrospectively. The findings obtained from duplex scanning and angiography were analyzed in a blinded manner by 2 investigators. Limbs having category 1, 2, and 3 lesions according to duplex scan findings were interpreted as being suitable for endovascular intervention. The comparison between duplex scan findings and angiography was analyzed by the third investigator. During 93 percutaneous transluminal angioplasty (PTA) procedures, 133 arterial segments, common or external iliac, were dilated with stent placement in 70. Bilateral interventions were performed in 25 cases, and of 68 unilateral interventions, 57 were at only 1 arterial segment. The accuracy, sensitivity, specificity, and negative and positive predictive values of duplex scanning to appropriately categorize the iliac artery lesions into suitable or unsuitable for endovascular intervention were 90%, 95%, 83%, 90%, and 92%, respectively when the inconclusive duplex scans were excluded (11%). In 6 patients with lesions suitable for PTA according to duplex scanning and angiography, PTA was not performed owing to clinical reasons. The accuracy of duplex scanning in predicting the performance of endovascular intervention was 88%. It is concluded that iliac artery endovascular procedures in limbs with chronic occlusive disease can be reliably planned according to duplex scan findings.

Adult↗
PubMedDate not supplied

Surgical treatment of pararenal abdominal aortic aneurysms.

Thirty patients with juxtarenal infrarenal and 16 patients with suprarenal abdominal aortic aneurysms underwent elective (58%) or urgent (42%) repair. Twenty-three patients were hypertensive and 20 had impaired renal function preoperatively. Nineteen patients required combined aortic and renal artery reconstruction, in which reimplantation was the most common technique used. The perioperative mortality rate was 7.4% in the elective group and 36.8% in the urgent group. Rupture of the aneurysm and a preoperative high serum creatinine level were risk factors correlating to early mortality. Among survivors, 61% showed a rise in serum creatinine in the early postoperative period. In all but one the transient renal insufficiency was resolved within one month. Of the hypertensive patients 64% were cured or under control with medication following combined reconstruction. These results demonstrate that surgical repair of pararenal abdominal aortic aneurysms can be performed with an acceptable mortality and morbidity.

Aged↗