[Is a so-called elastic osteosynthesis plate more advantageous than a stiff plate in fracture healing?].
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Animals↗
Biomedical subjects
W Hepp
Publications and source records attributed to W Hepp.
[Experiences with the Sparks-prosthesis in the periphery (author's transl)].
According to our own experiences it is not advisable to implant the Sparks-Mandril in an extremity which gangrene. The ideal case for implantation is the patient with short walking distance and an unsuitable vena saphena magna. The prothesis is useful for the femoro-crural bypass procedure. The thrombogenicity of the Mandril can be neglected by heparinization of the patient or after careful perfusion of the prothesis.
Bacterial Infections↗
[A method for no-contact destruction of kidney stones by means of shock waves (author's transl)].
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Humans↗
Present role of extraanatomic bypass graft procedures for aortoiliac occlusive disease.
In a retrospective follow-up the long-term results and present role of axillofemoral and transverse femorofemoral bypass grafts are evaluated. During the period from 1970 until 1989 173 extraanatomic bypass operations were carried out on 150 high risk patients. There were 131 axillofemoral and 42 femorofemoral bypass grafts. In elective operations the mortality ranged from 5.3% for the axillofemoral bypass and 2.4% for the femorofemoral bypass. A five year postoperative follow-up showed a cumulative patency rate of 86.82% for the femorofemoral bypass, 73.74% for the axillo-bifemoral bypass and 43.18% for the unilateral modification. After ten years the results of femorofemoral bypass remained unchanged. In contrast nearly every second axillofemoral bypass showed one to five graft occlusions. Considering the low operative mortality, the short operating time, the late results and the high late mortality independent of the surgical procedure on the one hand femorofemoral bypass has presented more and more as surgical method of choice in cases of unilateral iliac artery occlusion and unilateral branch occlusion of aortoiliac bifurcation grafts as well. On the other hand in cases of bilateral occlusive disease in high risk patients axillofemoral bypass has been displaced more and more by anatomical surgical procedures as endarterectomy or unilateral bypass using retroperitoneal approach. Since 1986 axillofemoral bypass has no longer been performed in elective cases. Nowadays an indication does exist only for deep wound infection in retroperitoneal or inguinal space.
Adult↗
Occlusion of aortofemoral bifurcation grafts: how to improve the results?
Forty-three patients with graft occlusion after aortofemoral bifurcation bypass surgery were analysed (1971-1986, 52 bypass branches, 75 graft occlusions). The late occlusion dominated with 73.1%. A poor run off was the main reason in 40.4%. A reduced inflow was responsible in 36.6%, especially caused by graft kinking. Bypass thrombectomy was performed in 56.7%, in 35.8% in combination with a distal reconstruction. Graft exchange was indicated in 39.6% but in 25.6% extraanatomical reconstruction was performed due to a high risk situation. Perioperative mortality rate measured 13.9%, not depending on the surgical procedures. Four times a major amputation was unavoidable. Therefore, in nine patients (= 20.9%) extremity or life could not be preserved. The rate of bifurcation graft occlusions can be reduced by technical improvement of the proximal anastomosis as to the mentioned guidelines.
Amputation, Surgical↗
Late results following extra-anatomic bypass procedures for chronic aortoiliac occlusive disease.
During the period from 1970 to 1983 150 extra-anatomic bypass operations were carried out on 129 high risk patients revascularizing 157 extremities. There were 124 axillofemoral and 26 femorofemoral bypass grafts. In elective operations the mortality ranged from 4.9% for the axillofemoral bypass and 3.7% for the femorofemoral bypass. A five year postoperative follow-up showed a cumulative patency rate (according to life table method) of 80.21% for the femorofemoral bypass, 79.90% for the axillobifemoral bypass (Type IV) and 45.77% for the unilateral axillofemoral bypass (Type I and II). Considering the low operative mortality, the short operating time, the late results and the high late mortality independent of the surgical procedure, the femorofemoral bypass and in many ways also the axillobifemoral bypass represent suitable and effective methods of operation for high risk patients, whereas unilateral and bilateral axillofemoral grafts showed a high rate of graft thrombosis and poor long term results (Type I and III).
Adult↗
Aneurysms of the infrarenal abdominal aorta: principles and results of surgical treatment.
With the surgical treatment of closed abdominal aortic aneurysms, the patient can have long-term survival and the danger of rupture can be avoided. Surgical repair on asymptomatic closed aneurysms can be performed with a very low risk (a mortality rate of below 1%). The main prerequisite for such protective surgery is an early diagnosis, best done by a routine check-up of all elderly people suffering from arterial hypertension, peripheral occlusive disease or other signs of arteriosclerosis. Computerized tomography (CT) and the ultrasound technique have gained a predominant position in such protective screening programs. Through the standardization and simplification of the operative techniques, surgical repair has been made simpler, safer and shorter, and the operative risk for patients with intact aneurysms has been remarkably reduced. A ten-year retrospective evaluation of 162 operated patients demonstrates a reduction in operative mortality from 14.3% to 2.8% in the group of patients with nonruptured aneurysms in the last period (1975-1979). On the other hand, progress has been made much more limited in surgery for ruptured aneurysms (operative mortality only reduced from 61.1% to 52.3%). The repair of closed or ruptured aortic aneurysms should be mainly restricted to special units with a highly trained surgical team. This type of surgery should no longer be the subject of occasional intervention by general surgeons.
Aorta, Abdominal↗