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At least 1,009 records · Page 56Linked to original sources
PubMed2002

[Endovascular stent-graft repair of abdominal aortic aneurysm].

BACKGROUND: Endovascular stent-graft repair of abdominal aortic aneurysms was introduced in 1991. Long-term results from randomised studies are still not available. Aneurysm ruptures after stent-graft repair have been reported, and there has been a considerable need for redo procedures. MATERIAL AND RESULTS: At Rikshospitalet in Oslo, Norway, 26 stent-graft implantations for abdominal aortic aneurysms were performed during the years 1996-2000, two of which were primary technical failures immediately converted to open repair. During follow-up, two patients have died from unrelated causes after six and 12 months. Eight patients were converted to open repair 8-50 months (median 31) after implantation. Indications for conversion were migration (n = 4), increasing aneurysm diameter (n = 3) and rupture (n = 1). Of the 14 patients still under observation, six have had one or more endovascular interventions (a total of 10) for failing graft. INTERPRETATION: Continuous technology development has been used as an argument to postpone randomised studies, as improved results are expected with new generations of stent-grafts. There is a need for discussion of the strategy for the further use of endovascular repair of abdominal aortic aneurysm.

Aged↗
PubMed2001

[Endoluminal treatment of peripheral aneurysm with covered endoprosthesis].

PURPOSE: To evaluate the feasibility and middle term patency results, for endovascular treatment of peripheral aneurysms, using covered stents. MATERIALS AND METHODS: Between December 1993 and may 2000 25 peripheral aneurysms on 24 patients, mean age 67.8 years (42-81), were treated with covered stents (Cragg EndoPro system or passenger, hemobahn, Word Medical). Aneurysm locations were: 17 iliac, 4 popliteal, 1 femoral, 1 subclavian, 1 carotid. The follow-up range from 1 to 75 months (mean 30.1 months). RESULTS: Successful aneurysm exclusion was achieved in all patients, while maintaining good lower extremity perfusion. All but one stent remained patent during the early follow-up period. At one year 94.4% stents were patent, at two years 90.2. CONCLUSION: Treatment of peripheral aneurysms with covered stents has a high rate of immediate procedural and clinical success. At middle term follow-up patency is encouraging except with popliteal procedure, however long term follow-up and larger series is warranted to assess the place of this procedure as an alternative to the surgery.

Adult↗
PubMedDate not supplied

[Endovascular treatment of arterial occlusive disease of the iliac arteries].

Atherosclerotic disease is one of the most important health problems in the United States and in the entire world. The endovascular techniques for the treatment of peripheral vascular disease have been investigated in recent years. This is a review of the literature of the endovascular techniques used in the treatment of occlusive iliac disease. Angioplasty has showed excellent results in concentric lesions, of less 5 cm of length with a technical success of 96%, primary patency of 90%, 81% and 72% at one, two and three years. The complication rate is 0.5% to 0.8% and the mortality rate is 0.2%. The use of stents has improved the success of arterial recanalization, with a technical success of 97%, and a primary patency of 90%, 84% and 71% at one, two and three years. Major complications appear in less than 1% of the cases. In conclusion the endovascular techniques have been proved to be the treatment of choice for certain selected forms of presentation of atherosclerotic disease in the iliac arteries, specifically short, focal lesions. The results have been excellent with less mortality and morbidity than surgery.

Angioplasty, Balloon↗
PubMedDate not supplied

[Personal modification of Sattler's instruments in subfascial endoscopic treatment of perforating veins].

Authors describe a method of endoscopic interruption of incompetent perforating veins using the Sattler equipment. They insert also, through a 2 mm port, a Foley n. 10 Fr collect to insufflator of CO2 with continuous distension of subfascial space. This technique permits subfascial elimination of incompetent perforating veins using a minimum surgical incision site.

Angioscopy↗
PubMed2002

Robotically-assisted coronary artery surgery with and without cardiopulmonary bypass - from first clinical use to endoscopic operation.

BACKGROUND: Recently, the ZEUS(tm) Robotic Surgical System has been introduced to increase the precision of endoscopic cardiac surgery. This study investigated its clinical use for endoscopic coronary artery bypass grafting. MATERIAL/METHODS: Between 1998 and 2001, 41 patients with single and multivessel disease were operated on using the ZEUS(tm) system. The robotic system was introduced step by step into clinical practice. Initially, the system was used only for endoscopic internal mammary artery (IMA) harvest (n=12), later for coronary anastomoses on the arrested (n=13) or beating heart after median sternotomy (n=6), and finally for endoscopic coronary bypass grafting on either the arrested (n=2) or beating heart (n=8). RESULTS: Endoscopic IMA harvest ranged from 48 to 110 min and was completed in all cases. In the sternotomy group, the robotic anastomosis time averaged 21 min on the arrested and 25 min on the beating heart, respectively (n.s.). In the endoscopic cases, the average time for endoscopic anastomosis was 41 min on the arrested and 36.5 min on the beating heart (n.s.), with an overall duration of surgery between 4.0 and 8.0 hours. One endoscopic case was intraoperatively converted to a MIDCAB procedure with manual anastomosis. The total patency rate of all graft anastomoses, confirmed by early postoperative angiographic control, was 97%. One patient underwent reoperation with an uneventful postoperative course. CONCLUSIONS: The present study demonstrates the feasibility of endoscopic coronary revascularization using a computer-assisted surgical robotic system on the arrested and beating heart in selected patients.

Adult↗
PubMed2002

[Tailored endoprostheses for the endovascular treatment of aorto-iliac aneurysms: current features and perspectives].

We describe here our preliminary experience with the almost exclusive use of a range of made to measure stent-grafts home-made from commercially available components. From January 1996 to December 1999, 188 aortoiliac aneurysms (AIA) were treated with stent-grafts that were home-made to measure using Z autoexpandable stainless steel stents connected with polyester sutures and covered with commercially available polyester vascular prostheses. These stent-grafts were implanted through 18 to 24 (typically 20) Fr. commercially available introducers via a surgical remote access. Made to measure tubular, bifurcated, tapered, and/or blind stents combined with extra-anatomic bypass designs increased the rate of endovascular treatment (ET) of AIA in this series. This rate was further increased through the use of uncovered proximal or distal stents when dealing with short or tortuous necks near major side branches and through use of hybrid, partly surgical designs, one with stented and the other with stentless ends, the latter allowing for a surgically made anastomosis. The results of our experience with these techniques show that use of home-made to measure stent-grafts greatly increases the feasibility of the ET of AIA among unselected patients while offering enough efficiency and safety to deserve further investigation. Future perspectives are discussed.

Angioscopy↗
PubMed2002

Virtual arterial endoscopy as a diagnostic aid in a patient with basilar artery fenestration and thromboembolic pontine infarct.

Focal signal intensity loss of the basilar artery on MR angiograms obtained in a 69-year-old man was considered to be caused by an embolus, and thrombolytic therapy was initiated. On the follow-up MR angiograms, the same oval signal intensity loss of the basilar artery was observed. On the basis of a virtual endoscopic look into the basilar artery, the diagnosis of a rare vascular anomaly--a fenestration of the basilar artery--was confirmed and the presence of a thrombus at the site of the signal intensity loss was excluded.

Aged↗
PubMed2002

Elevated plasma endothelin-1 levels and vascular dysregulation in patients with rheumatoid arthritis.

BACKGROUND: Contradictory results on plasma endothelin-1 (ET-1) levels in patients with rheumatoid arthritis have been reported in previous studies. We therefore evaluated whether plasma ET-1 levels in patients with rheumatoid arthritis differ from those of normal controls. Since systemically increased levels of ET-1 are known to occur in tandem with primary or secondary vascular dysregulation, we also measured peripheral blood flow by means of nailfold capillaroscopy combined with a cold provocation test. MATERIAL/METHODS: We measured plasma levels of ET-1 in twelve patients with different stages of rheumatoid arthritis by means of a specific radioimmunoassay, and compared ET-1 values to those of healthy controls. Capillary blood flow and the frequency of cold-induced vasospasm were studied in parallel, using nailfold capillaroscopy combined with a cold provocation test. RESULTS: Plasma ET-1 levels were significantly increased in patients with rheumatoid arthritis (p = 0.01) when compared to controls (2.38+/-0.95 pg/ml vs. 1.53+/-0.38 pg/ml). Capillary blood flow was reduced when compared to our own normal values, and a cold-induced blood standstill was seen in 58% of the patients. CONCLUSIONS: Patients with rheumatoid arthritis exhibit significantly elevated levels of ET-1, which may be associated with the symptoms of vascular dysregulation observed in nailfold capillaroscopy. Even though the clinical conclusions should be drawn from this study with caution, additional therapy with calcium channel blockers or, possibly in the future, with ET-1 receptor blockers, may be beneficial in patients with rheumatoid arthritis.

Adult↗
PubMed2002

[Crossectomy--exhairesis--stripping--laser therapy. How even refractory varicose veins respond to treatment].

Chronic venous insufficiency affects more than 50% of the German population. Major factors involved in its development are age, family disposition, female sex and an occupation involving much standing. Together with the clinical presentation, Doppler and duplex ultrasonography in particular enable a reliable pre-operative diagnosis, and deep venous thrombosis can also be definitively excluded. Indications for surgical treatment are in particular varicosis of the greater and lesser saphenous vein and perforating vein insufficiency. Commonly used procedures are crossectomy, restrictive stripping of pathological vein segments, resection of varicose side branches, and the endoscopic discission of perforating veins. Recent developments are deep-freezing and extraction of the vein and endovenous laser treatment (EVLT), requiring only tiny incisions. In most cases, these interventions can be performed on an outpatient basis.

Ambulatory Surgical Procedures↗
PubMed2003

[Effect of elastic stockings on edema related to chronic venous insufficiency. Videocapillaroscopic assessment].

AIM: To evaluate the effect of class II (23-32 mm Hg) compression stockings on the edema of the ankle in patients with chronic venous insufficiency (CVI), and to assess the relationship between the microvascular phenomenon and the volume of the leg. MATERIAL AND METHOD: 11 patients (19 limbs, 5 women and 6 men, mean age 57 years) with CVI, CEAP 2-3 were studied through physical examination, Doppler color ultrasound test, measurement of leg volume and videocapillaroscopy. Patients were evaluated before (T0), after 7 days (T1) and 14 days (T2) of daily compression therapy with elastic stockings. Statistical comparisons used the Mac Nemar test for binomial variables and Wilcoxon test for paired quantitative data. RESULTS: All patients experienced significant improvement of symptoms, the volume of the limbs on the average decreased in the first week T0-T1=284.8 cm(3) +/- 307.5 cm(3) (6.27%, p<0.001). During the second week a small increase in volume was observed T2-T1=+ 12.23 cm(3), NS, 0.29%). The width of the capillary halo of edema decreased during the first week by an average of T0-T1=5.77 microm +/- 10.99 microm. During the second week the width of the edema halo continued diminishing, although in smaller proportion (T0-T2=7.89 microm +/- 11.77 microm). CONCLUSION: Daily use of grade II compression stockings induces a reduction in leg volume in patients with CEAP grades 2-3. This improvement of edema is paralleled by a decrease in the size of the pericapillary halo.

Bandages↗
PubMed2002

[Plaque morphology of the carotid bifurcation and incidence of embolisms in relation clinical stage of cerebrovascular insufficiency].

Vascular morphology and determination of plaque surface structure are getting more and more matter of interest before revascularisation procedures are performed. One reason may be the increase of interventional treatment (PTA). For that we investigated the value of ultrasound duplex scanning to predict preoperatively the vascular surface and plaque structure. 368 patients operated on obstructing stenosis of the carotid artery could be enrolled in this investigation. In all patients duplex ultrasound scanning was performed preoperatively. In 127 patient an analysis of TC-Doppler curve was possible. During some operations (eversion endarteriectomie) we performed experimental stent implantation. The evaluation was performed with statistical methods.

Aged↗