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T Pfammatter

Publications and source records attributed to T Pfammatter.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Experiences with using a potentially temporary vena cava filter in multiple trauma patients].

INTRODUCTION: In Europe, there is little experience in the application of temporary cava filters in patients with multiple injuries. Especially patients with pelvic injuries, fractures of the spine, and the lower extremities are at high risk for thromboembolic events like thrombosis or pulmonary emboli. Moreover, in patients with severe head injuries, anticoagulation is contraindicated. METHOD: We present in this paper our experience with 24 consecutive patients with multiple injuries who were treated with a temporary cava filter. The insertion site was either the femoral (n = 20) or the jugular (n = 4) vein. The 24 patients revealed a mean ISS of 35.1 +/- 2.01 points. Nineteen patients had pelvic injuries and 17 patients suffered from severe head injury. In 17 patients the insertion of the filter was prophylactic, in 4 patients a thrombosis was present and in 3 patients a non-fatal pulmonary emboli was diagnosed before the application of a cava filter. RESULTS: No complication occurred due to insertion of the filter. In one patient a thrombosis of the cava was observed as the only overall complication (1 of 24 = 4.2%). CONCLUSION: The insertion of a cava filter in patients with multiple injuries with contraindication for anticoagulation is a safe and effective procedure to prevent fatal pulmonary emboli.

Adult↗
PubMed2001

[Compression syndrome of the arteria circumflexa humeri posterior in a volleyball player].

The compression syndrome of the posterior circumflex humeral artery is an infrequent vascular compression syndrome and differential diagnosis of the thoracic outlet- and the hypothenar-hammer-syndrome. The diagnosis includes a complete interview and a transfemoral armarteriography. Our report is about an affected volleyball player, the possible pathomechanism that can lead to this syndrome and the current literature.

Adult↗
PubMed2001

Spiral-CT angiography to assess feasibility of endovascular aneurysm repair in patients with ruptured aortoiliac aneurysm.

BACKGROUND: To evaluate spiral computed tomography (SCT) angiography for assessment of feasibility of endovascular aneurysm repair (EVAR) in patients with ruptured aortoiliac aneurysm (AAA). PATIENTS AND METHODS: 24 patients (mean age 74 years; range, 69 to 82 years) with suspicion of ruptured AAA and stable hemodynamics were preoperatively examined by using a SCT scanner in the emergency room. SCT angiography was performed from the suprarenal aorta to the femoral bifurcation after a fixed injection delay time of 30 seconds. After that a venous phase SCT scan, beginning at the last image position and ending at the upper thoracic aperture, was performed. RESULTS: The mean acquisition time of the SCT scan was 80 seconds (range 70 to 100 seconds), the mean overall procedure time, including image reconstruction, 5 minutes (range, 4 to 6 minutes). 2D images were directly evaluated during CT data acquisition, and 3D image reconstructions within 10 minutes (range, 8 to 11 minutes) after the SCT scan. AAA rupture was assessed in 14/24 patients (58%): in 10/14 patients (71%) rupture was contained to the retroperitoneum, and in 4/14 patients (29%) intraperitoneal rupture was observed. Successful EVAR was performed in 6/14 patients (43%) with ruptured AAA, and in 8/10 patients (80%) without ruptured AAA. Open surgery was exclusively performed in 6/24 patients (25%) with inappropriate anatomy for EVAR and in 4/24 patients (17%) with intraperitoneal rupture. CONCLUSIONS: Spiral computed tomography angiography is a reliable technique to assess feasibility of endovascular aneurysm repair in patients with ruptured aortic aneurysm. However, it can only be recommended for patients with stable hemodynamics, despite of the short acquisition time.

Aged↗
PubMed2001

Successful endovascular repair of a leaking abdominal aortic aneurysm under local anesthesia.

UNLABELLED: Local anesthesia is a safe and less invasive anesthetic management for the endovascular approach to elective aortic aneurysm. We have successfully extended the indication of local anesthesia to a high-risk patient with leaking aneurysm and stable hemodynamics. PATIENT AND METHODS: A 86 year old patient with renal insufficiency due to longstanding hypertension, coronary artery and chronic obstructive lung disease was transferred to our hospital with a leaking abdominal aortic aneurysm. Stable hemodynamics allowed to perform a fast CT scan, that confirmed the feasibility of endovascular repair. A bifurcated endograft (24 mm x 12 mm x 153 mm) was implanted under local anesthesia. RESULTS: The procedure was completed within 85 minutes without problems. The complete sealing of the aneurysm was confirmed by CT scan on the third postoperative day. Twenty months later, the patient is doing well and radiological control confirmed complete exclusion of the aneurysm. DISCUSSION: The endoluminal treatment is a minimally invasive technique. It's feasibility can be rapidly assessed by CT scan. The transfemoral implantation can be performed under local anesthesia provided that hemodynamics are stable. This anesthetic management seems to be particularly advantageous for leaking abdominal aortic aneurysm since it doesn't change the hemodynamic situation in contrast to general anesthesia. Hemodynamic instability, abdominal distension or tenderness may indicate intraperitoneal rupture and conversion to open graft repair should be performed without delay.

Aged↗
PubMed2001

Assessment of selective arterial calcium stimulation and hepatic venous sampling to localize insulin-secreting tumours.

OBJECTIVE: Non-invasive localization modalities such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) often fail to localize insulinomas smaller than 2 cm in diameter. Recent studies have shown that the selective arterial stimulation and hepatic venous sampling (ASVS) technique using intra-arterial calcium as the insulin secretagogue facilitates the regionalization of such occult insulinomas. This study assesses the sensitivity of ASVS in localizing insulin-secreting tumours. SUBJECTS AND METHODS: Eleven consecutive patients (8 women), aged 29-82 years, were studied over the past 4 years at our hospital. Hyperinsulinaemic hypoglycaemia due to an insulin-secreting tumour was proven in all patients. Calcium gluconate (0.025 mEq/kg body weight) was injected directly into the arteries supplying the pancreas and the liver. Insulin levels were measured in samples taken from the right hepatic vein before and 30, 60 and 120 s after each injection. The ASVS technique was performed in all 11 patients; the results were compared with the surgical findings in 10 patients and the autopsy findings in 1 case. The ASVS results were also compared with the findings of other, previously performed imaging modalities. RESULTS: ASVS correctly localized 4 insulin-secreting tumours to the head, 3 to the body, 1 to the tail, 2 to the tail or body of the pancreas and 1 to the liver. Thus, the sensitivity was 100% (11/11) whereas other localization techniques were less sensitive: 7/11 tumours were detected by angiography, 4/8 by endosonography, 3/8 by CT and 1/6 by MRI. Insulinomas (confirmed by histological examination), sized 4-25 mm, were found in 10 patients. All were cured by selective surgery and remained free of hypoglycaemia over the next 1-4 years of follow-up. An insulin-secreting neuroendocrine tumour in the liver was documented in 1 case at autopsy. CONCLUSIONS: Arterial stimulation and hepatic venous sampling is a very sensitive technique for preoperative localization of insulin-producing tumours. It can help to plan minimally invasive surgery and to select an appropriate strategy for patients suffering from malignant tumours in others.

Adult↗
PubMed2001

To compare general, epidural and local anaesthesia for endovascular aneurysm repair (EVAR).

OBJECTIVES: to compare general, epidural and local anaesthesia for endovascular aneurysm repair (EVAR). METHODS: retrospective analysis of 91 consecutive patients (age 43 to 89 years) who underwent EVAR under local (LA, 63 patients), epidural (EDA, 8 patients) and general (GA, 20 patients) anaesthesia. RESULTS: EVAR was successfully achieved in all patients without mortality or neurological, cardiac and respiratory complications. Vasopressive support as well as median fluid balance were significantly lessened in the LA group compared to GA group (p<0.0002). Stay in the Intensive Care Unit was necessary in 17 (27%), four (50%) and 14 (70%) patients, respectively, and median hospital stay was 3, 4.5, and 5.5 days, with a statistically significant difference between LA and GA group (p<0.0005). CONCLUSION: LA is a safe anaesthetic method for the endovascular repair of infrarenal abdominal aneurysm, offering several advantages: simplicity, stable haemodynamics, and reduced consumption of ICU and hospital beds.

Adult↗
PubMed2001

Carcinoid syndrome, acromegaly, and hypoglycemia due to an insulin-secreting neuroendocrine tumor of the liver.

We report a patient with a hepatic neuroendocrine tumor showing an extraordinary change of the tumor's humoral manifestations from a clinically documented extrapituitary acromegaly and a typical carcinoid syndrome toward a hyperinsulinemic hypoglycemia syndrome. At the primary manifestation of the tumor, an increased serum level of insulin-like growth factor I due to overproduction of GHRH and an increased urinary excretion of 5-hydroxyindoleacetic acid were found. The clinical manifestation of the GHRH excess was an arthralgia, which resolved completely after operative tumor debulking and normalization of insulin-like growth factor I and GHRH serum levels. The secretion of serotonin from the tumor resulted in a typical carcinoid syndrome including right-sided valvular heart disease. On the later course of the disease, the humoral manifestations of the tumor were supplemented by the secretion of insulin, leading to recurrent severe hyperinsulinemic hypoglycemia. The hepatic origin of hyperinsulinism was demonstrated by selective arterial calcium stimulation. Moreover, tumor cells revealed insulin and C-peptide immunoreactivity in the immunohistochemical analysis. The patient died 8 yr after the initial diagnosis of the tumor, and a carefully performed autopsy procedure confirmed the absence of any extrahepatic tumor manifestation.

Acromegaly↗
PubMed2000

Acute mesenteric ischemia caused by spontaneous isolated dissection of the superior mesenteric artery: treatment by percutaneous stent placement.

Spontaneous and isolated dissection of the superior mesenteric artery is a rare and often fatal event which has been successfully treated by surgery in several reported cases. We present a patient with acute mesenteric ischemia due to superior mesenteric artery dissection who was successfully treated by percutaneous endovascular placement of a Wallstent.

Acute Disease↗
PubMed2000

Pelvic and lower extremity arterial imaging: diagnostic performance of three-dimensional contrast-enhanced MR angiography.

OBJECTIVE: The diagnostic performance of a three-dimensional MR angiography-based strategy was assessed with regard to its ability to characterize the arterial vasculature from the aortic bifurcation to the lower extremity runoff vessels. A single-injection, two-station protocol in combination with a lower-extremity vascular coil was used. SUBJECTS AND METHODS: Both conventional digital subtraction angiography and three-dimensional contrast-enhanced MR angiography with a dedicated peripheral vascular coil were performed in 61 patients with suspected peripheral vascular disease. In a prospective analysis, one reviewer evaluated the digital subtraction angiographic images and a second reviewer evaluated the MR angiographic images; both were unaware of the results of the other imaging technique. Each vascular segment (29 segments per patient) was evaluated for the presence of occlusive vessel disease. The following grading system was applied: 0, normal; 1, vessel irregularity with a luminal reduction of less than 10%; 2, mild stenosis (lumen reduction, 10-49%); 3, severe stenosis (lumen reduction, 50-99%); and 4, occlusion (lumen reduction, 100%). In 11 patients surgical graft patency was assessed. RESULTS: MR angiography provided an image quality comparable with that of digital subtraction angiography. Overall sensitivity and specificity for MR angiography were 92% and 96.6%, respectively, for the detection of hemodynamically significant disease and 92.3% and 99.4%, respectively, for the detection of occlusions. CONCLUSION: Two-station contrast-enhanced three-dimensional MR angiography with a dedicated lower-extremity vascular coil proved effective enough to consider it as a noninvasive alternative to digital subtraction angiography in the assessment of the pelvic and lower extremity arterial vasculature.

Adult↗
PubMed1999

[Endovascular treatment of the abdominal aortic aneurysm: assessment, implantation technique, after-care and results].

BACKGROUND: Endovascular treatment of abdominal aortic aneurysm (AAA) is a new minimally invasive alternative to surgical repair. Patient selection, perioperative management, the procedure itself and postoperative follow-up are new aspects. PATIENTS: From June 1997 to June 1998, 37/70 patients (53%) with AAA were treated by the endovascular method. There were 35 males and two females, mean age 74 +/- 7 years, with a mean ASA class of 3.5 +/- 0.5. Graft repair was performed in 33 patients, due to inappropriate aortic anatomy for the endovascular technique in 24 and leaking aneurysm in 9. METHODS: Feasibility is based upon computed tomography and angiography. The procedure was performed in the operating room, under general, regional and local anaesthesia in 14, 3 and 20 patients, respectively. 36 bifurcated and one tube endoprosthesis were implanted. An open access on one femoral or iliac artery and, in case of bifurcated prosthesis, usually a percutaneous access (10 Fr) on the other side were performed. Positioning and delivery were monitored under fluoroscopy. RESULTS: All the AAA could be sealed by the endovascular technique. In one patient, an iliac limb was removed surgically because of proximal misplacement, but the procedure was completed by the endovascular technique. Mean operation time was 140 +/- 67 minutes. ICU stay was 1.4 +/- 1.6 days and patients were discharged after 6.5 +/- 3.5 days. Postoperative radiological follow-up showed totally sealed aneurysms in 34/37 patients (91%). In 3 patients a residual perfusion originating from a lumbar artery was observed. In 7/14 patients with AAA diameter > 6 cm and without residual leakage on the control CT scan, aneurysm pulsation remained after endovascular treatment. There was no early or late death after endovascular repair. During the follow-up period of 4 +/- 3 months patients are doing well. One patient needed balloon dilatation of an iliac limb. CONCLUSIONS: Endovascular treatment of AAA is a minimally invasive technique with short recovery time. This technique seems to be particularly advantageous in elderly or severely ill patients. Long-term controls are mandatory to identify potential complications, particularly when residual perfusion or aneurysm pulsation persists.

Aged↗
PubMed1999

Three-dimensional MR angiography of a nitinol-based abdominal aortic stent graft: assessment of heating and imaging characteristics.

OBJECTIVE: To assess heating- and 3D MRA imaging characteristics of a commonly used aortic stent graft in a 1.5T MR-environment. MATERIALS AND METHODS: A bifurcated stent graft (Vanguard; Boston Scientific, Oakland, N. J.) was evaluated in vitro regarding localized heating effects as well as imaging appearance using fast 3D GRE sequences. To quantitate stent related artifacts, stent wall thickness and luminal diameters were measured. Subsequently eight patients were imaged three months following placement of an aortic stentgraft with 3D MRA. Images were assessed for the presence of stent leaks, luminal patency, and stent configuration. RESULTS: There were no temperature changes associated with the stent during scanning. Wall thickness measurements overestimated true stent thickness, resulting in minimal underestimation of luminal diameters on 3D MRA images. In vivo imaging confirmed these results. Stent patency was confirmed in all 8 patients. CONCLUSION: Contrast-enhanced 3D MRA appears well suited for the evaluation of the abdominal and pelvic vasculature following aortic implantation of a Vanguard stent.

Aged↗
PubMed1999

Spontaneous reversibility of early reobstruction following percutaneous transluminal angioplasty.

Early reocclusion and late restenosis are well-known problems after percutaneous transluminal angioplasty (PTA). We report here on a phenomenon not described so far in two patients with peripheral arterial occlusive disease who had PTA of the common iliac and the superficial femoral artery, respectively. Both had a good hemodynamic and clinical initial result. However, within two days after PTA symptomatic reobstruction occurred documented by noninvasive measurements. Noteworthy, this reobstruction was spontaneously reversible within days. The possible pathomechanism is discussed.

Angiography↗
PubMed1999

Abdominal pulsatile tumor after endovascular abdominal aortic aneurysm repair.

A 70 years old patient was successfully treated for infrarenal aortic aneurysm by an endovascular bifurcated prosthesis. Three months later, because of dysuria, he underwent urological examination revealing an abdominal pulsatile tumor. Thereafter, the patient was sent to our emergency ward with suspected symptomatical endoleak. Radiological screening by computer tomography and magnetic resonance angiography showed good post-operative results without endoleak. Patient was treated with antispasmodic medication and is doing well today. Because endovascular repair of aortic aneurysm, in contrast to an open approach, does not eliminate the aneurysm itself, post-operative abdominal palpation can be ambiguous. Magnetic resonance angiography--without the need of nephrotoxic contrast medium--compares favourably to CT and provides excellent pictures with less artefacts for post-operative screening of endoleak. If reperfusion can be excluded, pulsation is due to the transmission of the blood-pressure wave to the thrombosed aneurysm.

Aged↗
PubMed1999

Transfemoral endografting of thoracic aortic aneurysm under local anesthesia: a simple, safe and fast track procedure.

BACKGROUND: Endovascular aneurysm grafting of the descending thoracic aorta is a minimally invasive catheter technique, which is performed under general anesthesia. We describe a technique allowing to perform transfemoral endovascular repair of thoracic aortic repair under local anesthesia. PATIENTS AND METHODS: In 9 consecutive patients local anesthesia was performed in order to gain an opened femoral artery access for the delivery system, and a percutaneous access to the left brachial artery. A pigtail catheter was then placed through the left brachial artery for the location of the origin of the left subclavian artery and/or the aneurysm and self-expanding endoprosthesis was released under fluoroscopic guidance. For the deployment of the endograft a short period of controlled hypotension with nitroglycerin bolus application was produced. RESULTS: All the aneurysms could be successfully sealed with the intended endovascular technique. There was no vascular access complication or pulmonary or ischemic (cardiac, cerebral or peripheral) complication. In the follow-up period of 6 +/- 3 months one patient needed a redo endovascular procedure because of the development of a severe and symptomatic distal endoleak 6 weeks postoperative. This procedure was again performed under local anesthesia. CONCLUSIONS: From a technical point of view, transfemoral endovascular repair of thoracic aneurysm can be performed under local anesthesia. This is a very simple and fast track procedure which combines a minimally invasive catheter technique and a less invasive anesthetic management.

Adult↗
PubMed1999

[Emergency surgery for abdominal aortic aneurysm--could an endovascular methods be considered?].

AIMS: The endovascular repair of abdominal aortic aneurysms (AAA) is a minimally invasive method which can be performed without laparotomy, thoracotomy or cross-clamping. Little is known about the endovascular feasibility in patients with contained ruptures. METHODS: Retrospective study on 31 patients (mean age 70 +/- 6 years, 27 men (87.1%) and 4 (12.9%) women), who were treated for a ruptured aortic aneurysm between January 1996 and July 1998. RESULTS: 17/31 (55%) patients were hemodynamically stable. 14 patients were in severe shock and two died preoperatively. The operative mortality (two just after entering the abdomen) was 17% (5/29 patients) due to irreversible shock. A graft repair was performed in 27 patients. Preoperative CT scan was available in 12/31 (39%) patients. An infrarenal neck was present in all patients (length: 19 +/- 9 mm, internal diameter: 23 +/- 5 mm). The internal diameter of the external iliac artery was 10 +/- 2 mm. Six patients has an additional aneurysm of the common iliac artery, none of them bilaterally. In one patient infrarenal kinking of more than 90 degrees was detected. CONCLUSIONS: In regard to the morphology, endovascular treatment would have been feasible in the majority of the patients where CT was already performed. Moreover, hemodynamic situation would have allowed to assess feasibility with a CT and perform endovascular treatment in most of patients with symptomatic or ruptured AAA. In conclusion, hemodynamically stable patients with symptomatic or leaking AAA should be investigated for endovascular repair.

Age Factors↗