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At least 1,351 records · Page 75Linked to original sources
PubMed1993

The intra-aortic balloon pump, a novel addition to staged repair of combined symptomatic cerebrovascular and coronary artery disease.

Five patients with severe symptomatic carotid and coronary artery disease were treated with staged carotid endarterectomy and coronary artery bypass grafting (CABG) under the protection of an intra-aortic balloon pump (IABP) over a 56-month period. All patients presented with unstable angina and multiple ipsilateral transient ischemic attacks. Two of the four patients had four previous myocardial infarctions. Arteriography demonstrated three-vessel coronary artery disease and 80% to 95% stenosis of the ipsilateral internal carotid artery in all patients. An IABP was placed prior to uneventful carotid endarterectomy performed with vein patch angioplasty (three patients) or primary closure (two patients) under general anesthesia. All five patients had remarkably stable blood pressure and cardiac outputs while on the IABP. Twenty-four hours after carotid endarterectomy the patients underwent uneventful CABG of three or more vessels. No complications occurred with either surgical procedure. One patient required femoral embolectomy and repair of a small false femoral aneurysm following removal of the IABP. All patients were discharged home 7 to 13 days after CABG. This initial report suggests that IABP can be used safely in staged operations for carefully selected patients with unstable angina and severe symptomatic carotid artery disease.

Carotid Artery Diseases↗
PubMed1996

Angioscopy in vascular surgery: the state of the art.

Although angioscopy is considered by many vascular surgeons to be a valuable clinical tool, others view it as expensive and unnecessary. To better define the appropriate role for angioscopy in vascular surgery, a critical review of the recent literature was undertaken. Angioscopy allows more complete valvulotomies with fewer endothelial injuries when preparing autogenous veins to be used as arterial conduits, and results in more complete thromboembolectomy of native arteries and grafts. Angioscopy can replace completion arteriography in infrainguinal arterial reconstructions with an equivalent clinical outcome. Angioscopy may be useful in the assessment of carotid endarterectomy, femoral vein valve repair, and pulmonary embolectomy. It has been useful in various research applications. The rate of complications is less than 1%. Angioscopy is of benefit in preparing veins to be used as arterial conduits and in performing thromboembolectomy. In some circumstances it can replace intraoperative arteriography. Other applications await further validation. The risks of angioscopy are acceptably low.

Angiography↗
PubMed1991

Complications of anomalous origin of the right subclavian artery: case report and review of the literature.

A 35-year-old black woman presented with thrombosis of an anomalous right subclavian artery and distal arterial embolization. Initially, her right subclavian artery was reimplanted onto the common carotid artery, and a brachial artery embolectomy plus intraoperative thrombolytic therapy were used to reopen her distal arterial circulation. When her brachial artery repair thrombosed the following day, a distal ulnar artery bypass and repeat thrombolytic therapy were required to restore arterial patency. Six months later, she returned with severe, progressive, neointimal hyperplasia of her brachial artery and a second attempt at arterial reconstruction was unsuccessful. She eventually required a right below-elbow amputation. This patient demonstrated an anomalous right subclavian artery that presented with distal embolization without an antecedent history of severe atherosclerotic disease or the development of a right subclavian artery aneurysm. A review of the medical literature relating to complications of this anomaly is provided.

Adult↗
PubMed1991

Descending thoracic aorta as an inflow source for late occlusive failures following aortoiliac reconstruction.

From November 1984 to March 1990, 10 descending thoracic aorta-to-femoral artery bypass procedures were performed after failure of one or several aortoiliofemoral reconstructions. All patients were men, mean age 60 years. Indications included noninfected false aneurysm of an infrarenal end-to-side aortoprosthetic anastomosis in one case; one occlusion of an axillofemoral bypass; degradation of an aortobifemoral prosthetic graft; two occlusions of aortofemoral bypass; and five occlusions of aortobiliac or aortobifemoral bypasses. Eight bifurcated grafts, one aortoprosthetic tube graft, and one aortopopliteal tube graft were inserted. One patient died 23 days postoperatively of multiple organ failure. Three patients underwent a successful seconary lower limb reconstruction procedure (prosthetic limb thrombectomy, embolectomy, femoral bifurcation angioplasty in one case each). Mean survival time was 14 months (range 3-48 months). Two patients were lost to follow-up, and one died of myocardial infarction six months postoperatively with a patent bypass. Graft thrombosis occurred in two patients. One was treated by thrombectomy at five months, the other was treated by in-situ thrombolysis at 15 months. Both of these patients had patent grafts at 12 and 21 months, respectively. The four other patients had patent grafts at 48 months. Primary patency was 55.5% (5/9 survivors) and secondary patency was 100% (9/9). This is a relatively simple method for constructing an extraanatomic aortofemoral or aortobifemoral bypass in late failures of aortoiliofemoral reconstructive surgery without having to re-enter the abdomen.

Aged↗
PubMed1991

Upper limb embolus: a timely diagnosis.

In a ten year period, 36 patients were treated surgically for embolic occlusion of upper limb vessels. The sources of embolus were cardiac (58%), peripheral aneurysm (22%) and unknown (20%). Brachial embolectomy was performed in all cases. Six out of eight peripheral aneurysms were resected. A patency rate of 94% was achieved at five years. Hospital mortality and morbidity rates were 3% and 10%, respectively. One patient died of a myocardial infarct one week postoperatively. Three patients suffered ischemic contracture or amputation; all three presented after 36 hours. We conclude that upper limb emboli are usually easy to recognize and treat. Prompt surgery (less than 24 hours) produces the most satisfactory results. Late presentation or delay in treatment can result in limb loss.

Acute Disease↗
PubMed1982

Echocardiographic diagnosis of tricuspid valve endocarditis in a child with a normal heart. Special emphasis on surgical considerations.

A previously healthy 8-year-old girl with a normal heart had development of tricuspid valve staphylococcal endocarditis. Serial two-dimensional echocardiograms first demonstrated an enlarging vegetation and later showed reduction in its size coincident with a pulmonary embolus. The occurrence of the pulmonary embolus along with persistent fevers, despite adequate antibiotic treatment, prompted surgical intervention. Surgical excision of a large residual vegetation, valve debridement, and pulmonary embolectomy led to prompt subsidence of fever and improvement in the patient's condition. Three months after surgery, the child remained asymptomatic with minimal tricuspid insufficiency. However, by eight months after surgery, the hemodynamic consequences of the tricuspid insufficiency had progressed, and the patient is mildly symptomatic. Additional tricuspid valve repair or replacement is expected.

Child↗
PubMed1984

[The past, present and future of German surgery].

It is imperative that all surgeons familiarize themselves with the history and development of his chosen field. Until the 18th century, surgery in Germany and other areas of Europe was not performed by physicians but by barber surgeons. Surgeons originated from these ranks. In the second half of the 18th century, Bernhard von Langenbeck was one on the founders of surgery in Germany. He was one of the most respected teachers of his time and his most famous student was Theodor Billroth who formed the school from which von Miculicz and Sauerbruch graduated. This was the time of remarkable innovations, namely the development of asepsis by Bergmann, the first laryngectomy and the first gastric resection by Billroth and the first cholecystectomy by Langenbuch. Bier introduced lumbar anesthesia, Schleich infiltration anesthesia, Kehr developed surgery of the bile ducts and von Esmarch performed amputations of the extremities, under conditions of exsanguination. In 1872, Langenbeck, Simon, and Volkmann founded the German Association of Surgery. The world-known Operationslehre von Bier-Braun-Kümmell and the surgical manual by M. Kirschner was then published. At the beginning of the 19th century, Sauerbruch paved the way for thoracic surgery with use of the low pressure method. Forssmann succeeded in the catheterization of the right heart. M. Kirschner performed the first successful embolectomy and the first bridging of an defect of the esophagus. During world War II, German surgery lost touch with international developments and reestablishment followed with the schools of K.H. Bauer in Heidelberg and of R. Zenker in Marburg and Munich and others. Zenker's contributions to cardiosurgery are particularly remarkable.(ABSTRACT TRUNCATED AT 250 WORDS)

General Surgery↗
PubMed1984

Two cases of spontaneous lysis of arterial thrombi.

Two cases of spontaneous lysis of arterial thrombi are described. The occurrence of spontaneous thrombolysis and the relative ease of performing Fogarty embolectomy (thrombectomy) in peripheral arteries should be considered along with the clinical status of a patient who is viewed as a possible candidate for thrombolytic therapy, a procedure which has a potential for severe hemorrhagic complications.

Adolescent↗
PubMedDate not supplied

Hypothenar hammer syndrome caused by recreational sports activities and muscle anomaly in the wrist.

A 34-year-old man with digital ischemia is reported. Angiography revealed thromboembolic occlusions of the proper digital arteries of the index, middle, and ring fingers and a tortuous ulnar artery in Guyon's canal. Though hypothenar hammer syndrome was suspected, there was no relevant occupational history. Magnetic resonance imaging and magnetic resonance angiography demonstrated an anomalous muscular sling around the ulnar artery immediately adjacent to the hook of the hamate. The ulnar artery showed mural thrombi in its tortuous segment. These findings were confirmed during operative exploration. After thrombectomy and embolectomy the involved segment of the ulnar artery was replaced by an autologous vein graft. Postoperatively there was complete resolution of the symptoms. Only during convalescence did it become clear that the patient was a passionate golfer.

Adult↗
PubMedDate not supplied

Surgical and percutaneous management of contralateral thrombus dislodgement following stent placement and dilatation of iliac artery occlusions: technical note.

Primary stenting of common iliac artery occlusions was complicated by dislodgement of occluding material to the contralateral common iliac artery in 2 of 59 patients following successful stent placement. In both patients, the complication occurred after balloon dilatation of the inserted self-expanding stent. In the first patient the embolus dislodged to the tibioperoneal trunk and required surgical embolectomy. In the second patient, percutaneous insertion of a self-expanding stent into the contralateral common iliac artery prevented distal embolization.

Arterial Occlusive Diseases↗
PubMedDate not supplied

New "mesh basket" for percutaneous removal of wall-adherent thrombi in dialysis shunts.

A new basket, developed for percutaneous removal of wall-adherent thrombi, was tested in model thrombosed hemodialysis shunts and clinically in two polytetrafluoroethylene grafts and one Brescia-Cimino shunt after recanalization by aspiration thrombectomy. The residual wall-adherent thrombus was removed by one or two passes with the mesh basket. The occlusion material was firmly captured within the mesh and was removed through an 8F sheath without hardly any material being sheared off from the basket. The device adapts well even to tortuous vessel segments and exerts a gentle brush effect. It may prove to be a valuable adjunct to aspiration thrombectomy or to balloon catheter embolectomy.

Animals↗
PubMed2002

[Acute mesenteric ischemia--frequently overlooked and often fatal].

BACKGROUND: Acute mesenteric ischemia still carries an appallingly high mortality rate. Subsets of acute mesenteric ischemia comprise mesenteric artery embolism and thrombosis, mesenterial vein thrombosis and non occlusive mesenteric ischemia. DIAGNOSIS: Clinical presentation initially is often dominated by a discrepancy between severe subjective pain and relatively unspectacular findings on physical examination. The key to better survival rates (and the main problem in clinical practice) are early and, if indicated, invasive and aggressive diagnosis and treatment. Unfortunately, there are no non invasive diagnostic tests of sufficient sensitivity and specificity so far, and mesenterial angiography (or abdominal CT, if mesenterial venous thrombosis is suspected) remains the gold standard of diagnosis. TREATMENT: In the obstructive forms of arterial mesenteric ischemia, the main therapeutic step after stabilization of the circulation remains an early laparotomy with embolectomy or revascularization and, if appropriate, resection of infarcted bowel. In patients with nonocclusive mesenteric ischemia, counteraction of mesenteric vasoconstriction is the main therapeutic principle. OBJECTIVES: This review describes the different forms of acute mesenteric ischemia and gives an overview of the currently established and recommended forms of diagnosis and treatment.

Diagnostic Imaging↗
PubMed1999

[Heparin-induced thrombocytopenia (HIT). Importance for anesthesia and intensive care].

For many decades, heparins have been used successfully for prophylaxis and treatment of thromboembolic complications world-wide. Although heparin-induced thrombocytopenia (HIT Type II) is a well-known adverse effect of heparin therapy, thromboembolic complications during heparin therapy are rarely diagnosed exactly to be related to HIT. At present an immunologic etiology of HIT by generation of multimodal immune complexes against a neo antigen of heparin and platelet factor 4 is equivocally accepted. The incidence of HIT seems to be related to the type of heparin (unfractioned/low molecular weight) or other underlying risks such as peripheral occlusive vessel disease. Mortality and complications resulting from HIT is reported to be about 20-30% each. For diagnosis of HIT Type II, clinical observation and simultaneous laboratory testing are essential. Discontinuation of heparin is a simple and essential manoeuvre, and anticoagulation has to be continued by alternative drugs. The heparinoid danaparoid-sodium and the thrombin inhibitor recombinant hirudin have been used successfully world-wide for treatment in many patients with HIT Type II including cardiopulmonary bypass surgery or renal replacement procedures. Furthermore, other therapeutical alternatives (e.g. immunoglobulins, prostaglandines) exist. Randomised controlled studies have to evaluate which drug has to be preferred in the future including risk/benefit ratio. The need of supplementary surgical procedures (e.g. embolectomy) depends on the individual clinical status. The patients have to be informed in detail about their underlying disease and further deleterious consequences of re-exposition with heparin. HIT should be recorded in an emergency certificate and the national Committee on Drugs should be informed about this severe side effect of heparin therapy.

Anesthesia↗
PubMed2001

[Acute Leriche's syndrome in a patient undergoing coronary artery bypass grafting with extracorporeal circulation].

We are reporting a case of an acute thromboembolic obstruction of the aortic bifurcation in a 66-year-old patient undergoing coronary artery bypass grafting with extracorporeal circulation. After declamping of the aorta, the arterial pressure measured in the femoral artery suddenly dropped, whereas the pressure measured in the aortic cannula and in both radial arteries stayed normal. Transoesophageal echocardiography was performed to exclude an acute aortic dissection. While the patient always had a constant sinus rhythm, an angiography following the end of surgery, showed a complete obstruction of the abdominal aorta. Subsequent embolectomy through bifemoral arteriotomies was performed and a histologically fresh embolus (6,5 g in weight) was extracted. Neither the pre- and intraoperative echocardiography, nor the preoperative ventriculography showed signs of an intracardiac thrombus. Insufficient anticoagulation and a lack of inhibitor potential were almost excluded. Considering the histological findings, we assumed that the embolus was formed intraoperatively. Without further complications the patient left our department on the 8th postoperative day.

Blood Pressure↗
PubMed2000

[Fulminant pulmonary embolism after cesarean section].

On the first day after an uneventful emergence caesarean section a 36-year-old woman developed circulatory collapse requiring cardiopulmonary resuscitation for 15 minutes. After resuscitation the patient remained haemodynamically unstable and was clinically highly suspected to suffer from fulminant pulmonary embolism. In this situation the physicians caring for the patient decided to perform a surgical pulmonary embolectomy without previous diagnostic workup. Massive emboli were removed from both pulmonary arteries. Postoperatively the patient recovered and was transferred to a rehabilitation center without severe cerebral sequelae.

Aged↗
PubMed2002

[What is the cost of vascular operations? A prospective cost analysis of conventional and combined endovascular interventions].

Current and future legislation demand improved efficiency in the medical services. The aim of this study was to analyse the costs of vascular surgery in order to reveal potential ways of reducing expense. Taking into account the staff, equipment and operating theatre supplies, we analyzed 58 elective operations comprising 47 conventional and 11 combined endovascular procedures. The mean overall costs calculated for the different operations were: 5.269 DM for a transfemoral embolectomy (n = 3), 8.504 DM for a patchplasik of the profunda arteria (n = 8), 10.265 DM for a femoro-popliteal bypass with a prosthesis (n = 6)--13.180 DM with a vein (n = 2), 9.864 DM for conventional iliac artery reconstruction (n = 7)--iliac endovascular combined procedure (n = 4) 14.494 DM, 14.951 DM for a Y-prosthesis in case of stenosis (n = 3)--13.288 DM in case of infrarenal aortic aneurysm (IAA, n = 4), 11.954 DM for a tube prosthesis in case of IAA (n = 3), 23.571 DMY-stent prothesis for IAA (n = 5), 19.914 DM stent for a thoracic aneurysm (n = 2), 7.153 DM a carotid thrombendarterectomy (n = 6), 5.503 DM for varicosis surgery (n = 5). Because of the high cost of materials, the total outlay for combined endovascular procedures appeared to be high when compared to conventional vascular surgery. Substantial savings concerning the operation may only be achieved if facility structure and qualification of staff meets the particular requirements.

Adult↗
PubMed1998

[Surgical technical guidelines in intestinal ischemia].

Acute occlusive mesenteric ischemia is caused by a local impairment of splanchnic blood flow and poses a particular surgical challenge. Acute superior mesenteric occlusion is a medical/surgical emergency mandating prompt diagnosis (clinical awareness, angiography) and therapy (exploratory laparotomy with possible arterial reconstruction; embolectomy, thrombectomy; and/or bowel resection). The difficulty of early diagnosis is probably the most important cause of the high mortality which varies from 70% to 90% in arterial and functional mesenteric ischemia and from 20% to 70% in an acute thrombosis of the mesenteric veins. Improved survival from nonocclusive mesenteric ischemia is dependent upon the identification of high-risk groups and on aggressive diagnostic and therapeutic measures (intra-arterial infusion of papaverine through the angiographic catheter with or without bowel resection). For assessment of bowel viability, the clinical judgement during first- or second-look exploration is still the most reliable parameter. The surgical management of chronic mesenteric ischemia includes aortomesenteric grafting and transaortic endarterectomy in the majority of patients with comorbidity of cardiovascular arteriosclerotic diseases and results in a high rate of symptom-free patients. Prophylactic reconstruction of visceral arteries is indicated only in certain limited circumstances.

Arteriovenous Shunt, Surgical↗