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W Hepp

Publications and source records attributed to W Hepp.

At least 19 recordsLinked to original sources
PubMed2006

Outcome of infrainguinal revascularization for critical limb ischemia in diabetics with end stage renal disease.

BACKGROUND: End stage renal disease [ESRD] and diabetes have a negative effect on outcome of arterial reconstructions, because they are associated with a vulnerability to infection, an infrageniculate arterial occlusive disease and an increased perioperative risk. The combination of both in critically ischemic patients is traditionally considered a great threat to their limb or life. The risk/benefit ratio of revascularization in this clinical setting is marginal and therefore the decision making is controversial. This study was undertaken to determine the results of arterial reconstruction in patients with end-stage renal disease and diabetes mellitus. PATIENTS AND METHODS: The outcome of 97 patients undergoing 121 arterial reconstructions due to lower limb threatening ischemia were reviewed. Primary and secondary patency rates as well as survival and limb salvage were estimated. RESULTS: Thirty-day operative mortality rate was 10.3%. At one month, one year and 2 year follow-up, the survival rate was 89.7%, 77.6% and 44.2% respectively. Limb salvage at 6 months was 85.6%, at 12 months 75.3% and at 2 years 56.3%. The primary and secondary patency was 92.4% and 93.2% at 6 months and 71.7% and 72.7% at 12 months, respectively. CONCLUSIONS: Diabeticpatients with ESRD attained an acceptable graft patency and limb salvage but they sustained higher perioperative mortality and morbidity and reduced survival.

Adult↗
PubMed2006

Inguinal anastomotic aneurysm due to salmonellosis treated with orthotopic reconstruction.

Femoral anastomosis following either an aortofemoral or femoropopliteal bypass, is a common site for anastomotic aneurysms occurring with an incidence of 2% to 5%. Among the factors contributing to the pathogenesis of such aneurysms, graft infection should be considered as a major one. We report the case of a 74 years old woman with history of an aorto-femoral right and -iliac left bypass with a Dacron Y-prosthetic graft due to abdominal aneurysm. The patient presented with a painful, inflammatory, and pulsating mass in her right inguinal region. She was treated surgically with wide radical resection of infected tissues including the anastomotic aneurysm, and in situ bypass reconstruction using a Silver-Dacron graft. Cultures of inflamed wound tissue, graft, and stools were positive for Salmonella typhimurium. In the postoperative period the patient was submitted to subtotal colectomy due to colon cancer and later to an iliofemoral crossover-bypass from right to left due to acute ischaemia of the left limb. Her postoperative follow up has been insignificant. Infected femoral anastomotic aneurysms due to salmonellosis are a rarity. Although their treatment of choice consist in an extra-anatomic bypass, under specific conditions in situ reconstruction may be adopted as a feasible and effective surgical technique to treat these infected aneurysms.

Aged↗
PubMed2006

[Angioplasty of the distal anastomosis und runoff arteries of occluded infrainguinal bypasses].

BACKGROUND: We investigated the clinical results of transluminal angioplasty performed through infrainguinal bypass grafts for stenotic or occlusive lesions at the distal anastomosis and/or in the runoff arteries in high risk patients and the influence of different parameters on limb salvage, primary and secondary patency rate. PATIENTS AND METHODS: Between January 2001 and March 2005 we performed 49 transluminal angioplasties on stenotic or occlusive lesions at the distal anastomosis and/or in the runoff arteries in 49 (16 female, 23 male, mean age 71.1 years) patients with occluded infrainguinal bypass. 20 angioplasties occurred in the runoff arteries, 5 at the distal anastomosis and 24 at both locations at a median of 11.3 months (range 2-85 months) after infrainguinal bypass grafting). 20 procedures were on popliteal artery above the knee, 21 below the knee and 8 on crural arteries. RESULTS: Kaplan-Meier analysis showed a cumulative limb salvage of 87.6 and 76.4 % after 6 months and two years, respectively. Patients with gangrenous lesions had a 5 times higher risk of amputation (Cox-regression model). Primary and secondary patency rates were at 6 months 85.1 and 91.1 % respectively and were at one year 73.3 and 78.8 % respectively. Patients with end stage renal disease were in 4 times hazard to primary occlusion and patients with gangrenous lesions 5 times to secondary occlusion (Cox-regression model). CONCLUSION: Even if the long-term results of angioplasty on stenotic or occluded lesions at the distal anastomosis and/or in the runoff arteries are inferior to the results of surgical revisions reported in literature, angioplasty in high risk patients with absence af a vein may be the first line alternative intervention for limb salvage.

Aged↗
PubMed2006

[Vascular surgery].

Explore the source record for details and available documents.

Arteriovenous Anastomosis↗
PubMed2006

Femoral anastomotic aneurysms in the modern era: a reappraisal of a continuing challenge.

AIM: Despite improvement in the operative technique and graft and suture material, femoral anastomotic aneurysms (FAAs) represent a continuing problem for patients undergoing lower extremity revascularization. The present retrospective study investigates the clinical presentation, the infection as a cause of FAAs, the interval between the original operation and the development of FAAs. It also evaluates the mortality and amputation rate of patients with FAAs. METHODS: We reviewed the records of 124 patients (thrombendarterectomy in 9, femoro-femoral bypass in 3 and axillofemoral bypass in 1). RESULTS: There were 13 infected and 14 recurrent FAAs. The overall mean time elapsing between the initial operation and the development of FAAs was 56.9 months (range 1-219). This interval was 62 months for the noninfected FAAs, while it was only 8 months for the infected FAAs. The mean time interval in which a recurrence of FAAs occurred was 39 months. The most common type of repair was an interposition prosthetic graft from the proximal prosthesis to the profunda femoral artery (100 cases). In the postoperative period local complications occurred in 21 (15.4%) cases and systemic in 7 (5.1%). The postoperative mortality was 3.7%. The overall survival at 1 year was 91.3% (standard error: +/-2.5%) and at 2 years 85.4% (standard error: +/-3.3%). Kaplan-Meier analysis showed a cumulative limb salvage of 94.2%, 93.3 % and 89.2% after 6 months, 1 and 2 years, respectively. A significant relationship was demonstrated between amputation and the following parameters: infected FAAs (Log rank test: 26.1, P-value <0.001), diabetes (Log-rank test: 12.9, P-value <0.01), peripheral arterial occlusive disease (Log-rank test: 3.1, P-value =0.08), and prior limb amputation (Log-rank test: 9.9, P-value <0.01). The mean time to amputation for the infected FAAs was 49.6 months (95% CI: 24.3-74.8), while for the noninfected it was 98.8 months (95% CI: 93.4-104.2). CONCLUSIONS: Complicated FAAs are still responsible for significant morbidity and mortality. Elective treatment produce the maximum benefit.

Aged↗
PubMed2005

Transluminal angioplasty of isolated crural arterial lesions in diabetics with critical limb ischemia.

BACKGROUND: We investigated the long-term clinical results of transluminal angioplasty of isolated infrapopliteal arteries in diabetic patients with severe ischaemic foot lesions and the influence of different parameters on primary success, the long-term outcome and the survival rate. PATIENTS AND METHODS: Between January 2001 and May 2004 we performed 50 transluminal angioplasties in 52 (10 female, 42 male, mean age 69.3 years) diabetics with isolated lesions of crural arteries (tibio-peroneal trunk 41, anterior tibial 13, posterior tibial 5, peroneal artery 14) and limb threatening ischaemia (rest pain 12, tissue loss 40). In two patients the dilatation could not be performed due to vessel perforation and impossibility to catheter localization. The morphological classification of infrapopliteal lesions was determined according to guidelines provided by TransAtlantic Inter-Society Consensus (TASC) (17 type A, 16 type B, 13 type C, 4 type D). RESULTS: Initial technical success after angioplasty of crural arteries could be obtained in 96%. Kaplan-Meier analysis showed a cumulative limb salvage of 92%, 85% and 68,9% after 6 months, one and two years, respectively. Patients falling in TASC group C had significantly higher risk of amputation. Overall survival at I year was calculated at 85% and at 2 years at 65%. CONCLUSION: Our results suggest that depending on the extent of lesions transluminal angioplasty of infrapopliteal artery stenoses and occlusions is considered as an effective and save therapy modality to avoid limb loss in diabetics with critical ischemia.

Aged↗
PubMed2005

Management of massive presacral bleeding during low pelvic surgery -- an alternative technique.

Although massive presacral bleeding during rectal mobilization is uncommon, it can rapidly destabilize a patient. So, effective hemostasis is critical in severe presacral hemorrhage due to the fatal course of this complication. Among the reported methods are packing, thumbtacks, inflatable devices, muscle tamponade, muscle fragment welding and application of endoscopic staplers. Local hemostatic agents in conjunction with other methods such as diathermy, cyanoacrylate tissue adhesives and application of bone wax are among other alternatives which may help to treat this serious complication. The aim of this study is to describe the anatomic and physiologic basis of our mode of treatment, which is new in the literature approach, treating two patients with presacral bleeding during low anterior resection for rectal cancer. The technique is the early clamping of the infrarenal aorta and suture ligation of the bleeding points from the presacral plexus.

Aorta, Abdominal↗
PubMed2005

Retroperitoneal perforation of a duodenal diverticulum with colonic necrosis -- report of a case.

Primary duodenal diverticula are usually asymptomatic. About 115 perforations have been reported, but none with right colon necrosis. We report a 45-year-old woman, with a five days history of high fever along with epigastric and periumbilical pain. Physical examination revealed right upper and lower quadrant tenderness with peritoneal signs. White blood cell count was 11 500/mm (3) while biochemical and hepatic biology tests were normal. Abdominal radiographs showed no pathologic findings. Ultrasound disclosed fluid in the lower pelvis. Computerized tomography revealed fluid collection in the right hepatorenal space. Intraoperative findings included purulent fluid in the lower pelvis, segmental necrotic changes of the right colon, and a perforated diverticulum on the antimesenteric border of the third part of the duodenum. Surgery consisted of right hemicolectomy and ileo-transverse anastomosis, diverticulectomy, and decompressive lateral duodenostomy at the second duodenal portion. The patient had an uneventful postoperative course. A contrast study from the duodenostomy tube on the 6 (th) postoperative day showed no leakage or obstruction. Duodenostomy tube was removed on the 14 (th) postoperative day. Histology confirmed the diagnosis of a primary duodenal diverticulum.

Abdomen, Acute↗
PubMed2003

Graft patency and clinical outcome of femorodistal arterial reconstruction in diabetic and non-diabetic patients: results of a multicentre comparative analysis.

OBJECTIVE: in diabetic patients with critical limb ischaemia (CLI) an inferior success rate following infrainguinal bypass surgery is quite often suggested. The aim of this retrospective analysis was, therefore, to evaluate the graft patency and, particularly, the clinical outcome at 1 year in diabetic compared with non-diabetic patients. MATERIAL AND METHODS: two hundred and eleven patients (diabetics 94; non-diabetics 117) with femorodistal reconstruction for CLI were studied. Groups were comparable with regard to the Fontaine classification, the distribution of vascular risk factors, graft material, distal anastomosis site, and the angiographic runoff grading. RESULTS: diabetes did not adversely affect graft function. For diabetics and non-diabetics primary cumulative patency rate at 1 year was found to be 66 and 56%, respectively (p=0.10) and a virtually identical limb salvage rate of 85 and 83% was achieved (p=0.76). With regard to healing of ischaemic foot ulcers a trend against diabetics was noted with a healing rate of 81% compared to 96% in non-diabetics at 1 year (p=0.067); gangrenous foot lesions could be equally remedied in 94% and in 87% among patients with and without diabetes (p=0.44). The survival rate of diabetics, however, was significantly lower with 78% at 1 year compared with 95% in non-diabetic patients (p=0.0004). CONCLUSIONS: our preliminary results support the view that infrainguinal bypass grafting can be safely done even in diabetics. Despite increased mortality in this group, liberal indication for reconstructive vascular surgery seems to be justified by favourable patency rates and clinical outcome in selected patients.

Aged↗
PubMed1996

[Perioperative evaluation of internal carotid artery stenoses: value of multislab MR angiography].

PURPOSE: Evaluation of the diagnostic potential of high resolution multislab 3D-TOF-magnetic resonance angiography (MRA) in the pre- and postoperative assessment of carotid artery stenosis in comparison to conventional angiography. METHODS: 120 Patients were evaluated with MRA and DSA prior to carotid endarterectomy (CEA). Additionally 26 patients underwent MRA after CEA. All MRA examinations were carried out on a 1.5 T MR-unit (Siemens Magnetom SP63) using a Helmholtz surface coil. For the visualization of the vascular structures in the head and neck region, flow compensated GE-sequences were employed. Both original MRA data set and MIP angiograms were included in the evaluation. The determination of the extent of stenoses was performed according to the recommendation of NASCET. RESULTS: In 195 (92.9%) of 210 cases included in the review MRA revealed the same results as DSA (grade I+II: 114, grade III: 24, grade IV: 44, grade V: 13). None of the cases showed a deviation higher than one grade. The sensitivity and specificity of hemodynamic relevant stenoses (> 60%) was 0.964 respectively 0.952. 23 out of 26 patients with postoperative follow-up examination revealed regular reperfusion of the former affected internal carotid artery. The remaining 3 patients showed a restenosis of the operated vessel (n = 2) and a reocclusion of the ICA after surgery (n = 1). MRA proofed to be an accurate and reliable method for the perioperative evaluation of vascular structures in the head and neck region. Despite of some drawbacks MRA reached a high accuracy in the diagnostic imaging before and after CEA. MRA is accurate and useful in screening carotid artery diseases. The indication of MRA employment therefore not only covers the screening of vascular structures but also includes pre- and postoperative evaluation of vascular stenoses.

Adult↗
PubMed1996

[Extracranial carotid aneurysms].

Extracranial carotid artery aneurysms occur very seldom. Here will be reported on 15 aneurysms (11 arteriosclerotic, 3 false and 1 dissecting aneurysm). Therapy of choice during the second half of this period was aneurysm exstirpation and PTFE interposition, twice with reinsertion of the external carotid artery. No patient died perioperatively, one permanent and one transient ischemic neurologic deficit occurred. Three lesions of the cranial nerves recovered completely. As to avoid cerebral embolisation each extracranial carotid artery aneurysm should be operated on if possible. This can be managed with tolerable risk and represents an effective embolic prophylaxis.

Adult↗
PubMed1995

[Multiple slab MR angiography of the A. carotis interna: a preoperative comparative study].

PURPOSE: With the introduction of MR angiography (MRA) into clinical routine, arteriosclerotic lesions of the supraaortic vessels may be well demonstrated. MATERIAL AND METHODS: The comparison between Multislab MRA (gradient echo, TOF) and X-ray angiography (XRA) as reference in 70 patients suspicious of stenotic lesions in the internal carotid artery proved the high reliability of these methods. RESULTS: In determining the degree of stenosis, according to the NASCET study (North American Symptomatic Endarterectomy Trial), a correlation between MRA and XRA of 92.3% could be calculated. The principal problem of MRA is the overestimation of high-grade stenoses; we observed 5 false-positive results in severe stenosis. Sensitivity and specificity were 95.6 and 92.6%, respectively, for detection of severe (> 60%) stenosis. CONCLUSION: Despite its limitations, MRA is a clinically important noninvasive technique for preoperative evaluation of patients undergoing carotid endarterectomy.

Adult↗
PubMed1994

[Infra-inguinal suture aneurysm].

Anastomotic aneurysms represent late complications of reconstructive surgery. They are preferably localized in the inguinal area. From 1975 to 1989 forty patients were operated for 50 infrainguinal anastomotic aneurysms (46 inguinal, 4 popliteal). They developed after a mean time interval of 60.6 months. In nine cases bilateral inguinal aneurysms occurred. Three of the inguinal aneurysms were infected. The inguinal aneurysms were usually treated by total excision followed by prosthetic graft interposition with distal anastomosis to the deep femoral artery. If the superficial femoral artery was patent, it was inserted into the interposed graft. The infected aneurysms were treated with aseptic extra-anatomic bypass procedures. Five patients died after the operation. In one case a transmetatarsal amputation had to be performed and in one case a relapsing aneurysm occurred after three years. In general surgical repair of anastomotic aneurysms following vascular reconstructions should be performed before complications occur. In the inguinal area this can be performed with low local and general risk and with good longterm results.

Adult↗
PubMed1994

[(123 I)-anti-NCA95 antibodies in diagnosis of bacterial wound infections after prosthetic vascular replacement. Comparison with computerized tomography].

Immunoscintigraphy (IS) with [123I]-anti-NCA95 labelled autologous granulocytes and computer-tomography (CT) examinations were performed in 21 patients with clinical suspicion of a vascular graft infection. The results of both IS and CT were compared with bacteriological and surgical findings. In this study the sensitivity was higher for IS compared with CT (92% and 67%, respectively). However, specificity was lower in IS compared with CT (89% and 100%, respectively). No false positive results have been found in CT. False positive results were observed in IS within 30 days after vascular surgery and may be due to a unspecific accumulation of granulocytes in perivascular hematomas. In later infection of a vascular graft (i.e. more than 30 days after surgery) no false positive findings were made by IS. In contrast, CT was false negative in two cases. IS with [125I]-anti-NCA95 labelled autologous granulocytes represents a useful tool for the detection of vascular graft infection, since granulocyte accumulation in infected tissue can be visualized with high sensitivity and specificity.

Antibodies, Monoclonal↗