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Biomedical subjects

V Mickley

Publications and source records attributed to V Mickley.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Percutaneous dynamic atherectomy with the aid of 12-F and 14-F transluminal atherectomy catheters (TEC): initial results].

OBJECTIVE: The presented study reports on the first experience with the large diameter 12 F and 14 F TEC system for percutaneous dynamic atherectomy of peripheral vascular obstructions. METHODS AND PATIENTS: The 12 F and 14 F TEC-extraction catheter was used to recanalize peripheral vascular obstructions in 4 patients. The extracted material was continuously aspirated during the procedure. Three patients with intermittent claudication suffered from chronic arterial occlusion (two cases) or from stenosis of an implanted stent (one case) in the region of the superficial femoral artery. In another patient with long-term dialysis history an insufficient collier shunt was treated by atherectomy. RESULTS: Complete vascular recanalisation was achieved in all cases. Supplementary intervention was not necessary. There were no complications. CONCLUSION: Atherectomy with the large diameter 12 F and 14 F TEC allows a safe and complete recanalisation of complex peripheral vascular occlusions. Further studies must show whether the enlarged vascular intrusion is justified by more favourable results.

Angiography, Digital Subtraction↗
PubMed1996

Endovascular stenting in patients with Iliac compression syndrome. Experience in three cases.

The authors report their experience in the percutaneous treatment of the iliac compression syndrome in three women (20-53 years old) with acute iliofemoral deep venous thrombosis; in one case, there was an additional thrombus in the inferior caval vein. They were treated by percutaneous implantation of Palmaz stents in the left common iliac vein 1 day after surgical thrombectomy and construction of an arterial venous fistula. All patients showed marked improvement, as determined from venograms obtained immediately after stent implantation. The arteriovenous fistulae were closed 3 months later. At 6 months follow-up, the median clinical and color-coded duplex ultrasound indicates that all stents are patent and all patients are free of symptoms.

Adult↗
PubMed1996

Reversal of blood flow direction for the salvage of forearm straight and looped ePTFE-shunts.

Long venous anastomotic stenosis of a forearm haemodialysis graft necessitates extension of the venous limb. If the extension graft crosses the antecubital region, it will be subject to kinking, and re-occlusion may be the consequence. We report our experiences with a procedure proposed by Schulak combining reversal of blood flow of forearm looped grafts and extension of the venous limbs along the ulnar aspect of the elbow. Detailed information is given on how to modify the original method in order to treat patients with straight grafts, or with looped grafts and a "misplaced" venous extension. Ten patients were successfully treated with Schulak's procedure or its modification. No intra- or post-operative complications occurred. During follow-up (from 3 to 12 months), all grafts have remained patent.

Anastomosis, Surgical↗
PubMed1996

Pulmonary arteriovenous malformations: aspects of surgical therapy.

Pulmonary arteriovenous malformations (PAVM) may occur primarily or in association with hereditary hemorrhagic telangiectasia (HHT, Rendu-Osler-Weber syndrome). Solitary or multiple fistulas may lead to clinical symptoms such as dyspnoe on exertion, central cyanosis, polycythemia, cerebral embolism, or brain abscess formation. Major neurological events may be first symptoms of PAVM. Between 1991 and 1995, 6 patients (age 25-69 years) underwent surgical treatment (2 segmental, 1 atypical, 3 anatomical resections) due to PAVM. The highest right-to left shunt fraction was 60% in a patient with a large posttraumatic fistula following war injury 50 years ago. Average shunt fraction was significantly reduced from 24 to 3% (p < 0.01), with no recurrance during follow-up. Aims of surgical resection in patients with PAVM are to reduce shunt fraction and to prevent neurological events following repeated cerebral embolism. Atypical or segmental resection is the operative method of choice; however, this is only recommended, if all contributing arteries are identified and selectively ligated. In case of central location of large fistulas, lobectomy may be necessary. Percutaneous selective embolization is an alternative treatment for patients with high operative risk or multiple fistulas. Its role for routine therapy remains to be determined by clinical studies.

Adult↗
PubMed1996

[Management of iatrogenic hemorrhage after mechanical vascular recanalization].

Nine patients with hemorrhage due to revascularization procedures underwent successful embolization (5), surgery (2), covered stent implantation (1), or long-lasting ballon dilatation (1). Bleeding was the result of Fogarty thrombectomy (3), ring stripper revascularization (1), balloon dilatation (3), or perforation of the artery with the guide wire (1). In all cases, bleeding was stopped successfully without sequelae for the patients. In spite of the preceeding hemorrhage, local fibrinolysis with 1,000,000 units of urokinase was performed on the same day in 3 patients without any complications being observed.

Adult↗
PubMed1996

[Cervical sympathetic paraganglioma].

A 24-year-old man presented with a long-standing history of Horner's complex and a slowly growing cervical mass. Duplex-sonography, angiography, and computed tomography revealed a hypervascularized tumor with well defined borders displacing the left carotid bifurcation medially. Operative and histological findings confirmed the preoperative diagnosis of cervical sympathetic paraganglioma.

Adult↗
PubMed1995

[Aneurysm of the descending thoracic aorta in tertiary syphilis].

A 53-year-old female presented with septicaemia caused by left ureteric obstruction due to ureterolithiasis. Further diagnostic work-up for left mediastinal widening revealed an asymptomatic aneurysm of the descending aorta. Serologic tests for syphilis were highly positive (TPHA 1:10240, 19s-IgM-FTA-Abs 1:20, Cardiolipin KBR 1:72 IU/ml). After a three weeks course of Penicillin G, 19s-IgM-FTA-Abs was negative. A successful tube resection of the aneurysm was performed. The diagnosis of luetic aneurysm of the descending aorta was confirmed histologically. Although rare today, tertiary syphilis should be considered in the differential diagnosis of thoracic aneurysm in middle-aged patients lacking classical risk factors for atherosclerosis. The immune pathogenesis of cardiovascular syphilis still remains subject of controversy.

Aorta, Thoracic↗
PubMed1995

Cyclosporine A stimulates endothelin release.

Administration of cyclosporine A is often associated with the development of renal dysfunction and hypertension. Because recent data provide evidence that endothelin (ET) might be involved in mediating cyclosporine-associated cardiovascular and renal side effects, the present study aimed to investigate the influence of cyclosporine A on ET release from cultured smooth-muscle cells and whether ET plasma concentrations are elevated in cyclosporine-treated patients. Addition of cyclosporine A to the medium of cultured human smooth-muscle cells, isolated from atherosclerotic iliac arteries, induced a dose-dependent increase in ET release. ET plasma levels were significantly elevated in cyclosporine-treated patients after bone marrow transplantation, compared to control groups. These data suggest that enhanced ET release might be involved in mediating the cyclosporine-associated side effects.

Cells, Cultured↗
PubMed1993

[Abdominal aortitis in polymyalgia rheumatica. Disease course as documented with computerized tomography and proton spin tomography].

In a 59-year-old woman, after four years of ambiguous and unidentified course of her disease (feeling of weakness, inappetence, weight loss, pain in the shoulder girdle, sub-febrile temperatures, increased BSR), polymyalgia rheumatica was eventually diagnosed. The findings at the abdominal aorta were particularly marked: sonography revealed a 10 mm wide echo-poor fringe around the aorta which in the computed tomogram became slightly more echogenic after injection of contrast medium. In the magnetic resonance tomogram (MR) the aortic wall was homogeneously thickened and well-defined against the retroperitoneal tissue. Subsequent to the diagnosis a therapy with glucocorticoids was initiated and strictly continued for by now 18 months. This resulted in long-term clinical remission. CT and MR proved highly suitable for long-term monitoring (> 5 years).

Aorta, Abdominal↗
PubMed1993

[Damage to a stent caused by a Shaldon catheter].

Recently, stent implantation has been used with increasing frequency in the treatment of central venous stenoses in patients undergoing chronic haemodialysis. Stent localisation may interfere with central venous catheterisation. CASE REPORT. In a 57-year-old female haemodialysis patient, a filiform stenosis of the right subclavian vein was treated by percutaneous transvenous angioplasty and stent implantation. Five weeks later, she presented with a thrombosed dialysis shunt. A Shaldon catheter was implanted via the right internal jugular vein. Post-procedure radiographs showed extensive stent damage without stent dislocation or thrombosis. CONCLUSION. Stent localisation has to be considered in the event of later central venous catheterisation. Venous puncture should be carried out under fluoroscopic control if catheter placement on the side of the stent is inevitable.

Catheters, Indwelling↗
PubMed1993

[Long-term results of percutaneous transluminal angioplasty and stent implantation in venous stenoses following transfemoral thrombectomy].

Thirty consecutive patients were operated on for iliofemoral venous thromboses. In each case, a transfemoral thrombectomy was performed and an arterio-venous fistula was created. Three to six months later, a cross-over arterio-venography revealed 10 severely stenosed venous segments in 8 patients (common iliac vein 4, external iliac vein 3, common femoral vein 3). All stenoses were treated by percutaneous transvenous angioplasty (PTA). Six times a flexible, self-expanding Wallstent was placed within the stenosis after dilation (PTA+S). Complications did not occur. Median follow up was 17 months (3-23 months). PTA+S proved superior (4/6 excellent results) when compared to PTA alone (1/4 excellent result), because of frequent restenosis after the latter. Minor results following PTA+S were caused by intimal hyperplasia within the stent, when the av-fistula was kept patent for more than a year after stent placement.

Adolescent↗