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At least 145 records · Page 8Linked to original sources
PubMed2001

[The site and extent of arteriosclerosis. Comparative planimetric studies of the left descending coronary artery, internal carotid artery, superficial femoral artery and abdominal aorta in 104 cadavers].

BACKGROUND: Arteriosclerosis is generally considered to be a generalized disease, involving different vascular regions to approximately the same extent. PATIENTS AND METHODS: In order to assess the extent of ateriosclerosis quantitatively, all arteriosclerotic lesions and additionally the complicated (calcified, ulcerated, thrombosed) arteriosclerotic lesions of the abdominal aorta, the superficial femoral arteries, the left descending coronary artery and the internal carotid arteries were measured by planimetry in 102 autopsies (64 male, 38 female; mean age: 62 +/- 16 years). RESULTS: Arteriosclerosis increased with age. The overall extent of arteriosclerotic lesions of each artery was classified to one of the following 4 degrees of intimal involvement (0-25, 26-50, 51-75%, 76-100%). When comparing the 4 different vascular regions of each patient we found maximal deviations by 1 degree in 34%, by 2 degrees in 41% and by 3 degrees in 20%. In only 5% of the patients studied were all arteriosclerotic lesions of the same degree. In order to analyze the complicated plaques 7 degrees were used (intimal involvement: 0, 1-10, 11-20, 21-30, 31-40, 41-50% and > 50%). In 14 patients we found no complicated plaques. The remaining 88 showed complicated lesions in at least 1 vascular region. Deviations by 1 degree were found in 22%, by 2 degrees in 32%, and by 3 or more degrees in 46%. In the paired arteries (carotid, femoral) there were no significant differences comparing the mean values of the extent of arteriosclerotic lesions on the right and left side. In many cases, however, remarkable intraindividual differences occurred. Patients with main risk factors usually had more pronounced arteriosclerotic lesions than those without. In patients who died from coronary artery disease the extent of arteriosclerotic lesions was also usually larger in the other vascular regions as compared to those patients who died from other reasons. Comparing postmortem and intravital extent of arteriosclerotic lesions some peculiarities of postmortem specimens should be considered. CONCLUSIONS: A uniform involvement of all vascular regions by arteriosclerosis occurs only rarely. Considerable intraindividual differences are the rule and a severe, generalized uniform affection is an exception. This, however, does not exclude in patients with severe arteriosclerosis of one region that a larger involvement of other vascular regions may also occur, as this was found for patients with severe arteriosclerosis in coronary arteries. Regarding the extent of arteriosclerosis there are artery- and additional localization-specific features.

Adult↗
PubMed2002

The left internal thoracic artery and radial artery composite graft in off-pump coronary artery bypass grafting.

Arterial multivessel bypass grafting without extra corporeal circulation and manipulation of the ascending aorta should be a good surgical option for the treatment of coronary artery disease. An internal thoracic artery (ITA)-radial artery (RA) composite graft was used for this purpose. Between July 2000 and October 2001, we employed the LITA-RA composite graft for off-pump coronary artery bypass in 15 cases. Mean patient age was 71.3 +/- 5.8 years old. Left main trunk disease was present in six patients and triple-vessel disease in four patients. Preoperative concomitant disease was renal dysfunction in three cases, cerebrovascular disease in four and diabetes mellitus in five cases. Two patients had a so-called bad aorta. Twelve elective operations and three urgent operations were carried out for unstable angina. Two to four (mean 2.6 +/- 0.7) anastomoses were performed per patient. Complete revascularization was achieved in 12 out of 15 patients. Mean operating time was 335 +/- 53 min. Mean intraoperative blood loss was 595 +/- 375 ml and nine patients underwent the operation without blood transfusion. There was no PMI, no brain disorder, and no death. Postoperative coronary angiography in all patients documented a good patency rate (LITA 15/15, RA 21/21, right gastroepiploic artery (RGEA) 2/2, and saphenous vein graft (SVG) 0/2). LITA-RA composite grafting in off-pump coronary artery bypass enables arterial multivessel revascularization using an aortic no touch technique. This can be done with minimum postoperative complications and without risk of cerebral infarction even in patients at high risk for extracorporeal circulation (ECC).

Aged↗
PubMed1992

[Subclavian artery to internal carotid artery bypass with saphenous vein graft in the treatment of bilateral common carotid artery occlusion; a case report].

A case of left common carotid artery occlusion, which was treated by a saphenous vein graft, is reported. A 49-year-old right handed male was admitted to the hospital because of right hemiparesis and aphasia. These symptoms disappeared spontaneously two weeks after admission. However, visual acuity remained impaired on the left side due to occlusion of the central retinal artery. Angiography revealed complete occlusion of the common carotid arteries as well as patency of the internal carotid arteries on both sides. PET and 123I-IMP-SPECT studies showed hypoperfusion in the left cerebral hemisphere. To restore the blood flow as well as to remove the source of the emboli, endarterectomy was performed on the left internal carotid artery. This was followed by a saphenous vein graft between the left subclavian and the internal carotid artery. Postoperative angiography revealed patency of the bypass, and a SPECT study revealed increased blood flow in the left cerebral hemisphere. The patient has remained in stable condition during the following 30 months with no neurological problems. We conclude that in the treatment of complete occlusion of the common carotid artery and subsequent cerebral hypoperfusion, a bypass graft between the internal carotid and the subclavian artery is quite effective, and that the site of the bypass graft should carefully be sought for by using preoperative angiographic studies.

Anastomosis, Surgical↗
PubMed2006

[Aneurysms of the anterior communicating artery and subclavian artery in association with congenital absence of unilateral internal carotid artery].

We encountered a rare case of unilateral internal carotid arterial defect complicated with anterior communicating aneurysm and subclavian artery aneurysm. The patient was a 56-year-old man in whom cerebral angiography and 3D-CTA revealed defects in the right internal carotid artery and the right carotid canal, and an unruptured aneurysm in the anterior communicating artery. In addition, the patient was also found to have an unruptured aneurysm in the right subclavian artery. As both the aneurysms were considered to have a high risk of rupture and such subclavian aneurysms were likely to cause an embolism, radical surgery was performed for each aneurysm. The postoperative course was uneventful, and the patient was discharged without ambulatory limitations. Although the defect in the internal carotid artery is a relatively rare vascular deformity, the incidence of cerebral aneurysm is about 30% in such cases due to the marked hemodynamic stress involved. On the other hand, there have been only two previous case reports of internal carotid arterial defect complicated with a subclavian aneurysm. Moreover, there have been no previous reports of internal carotid arterial defect complicated with both an intracranial aneurysm and a subclavian aneurysm, as observed in the present case. Thus, this case was very rare and is reported here.

Aneurysm↗
PubMed1993

[A successful case report of coronary bypass grafting by utilizing inferior epigastric artery, gastroepiploic artery and bilateral internal thoracic artery].

We performed coronary artery bypass grafting with the bilateral internal thoracic artery (ITA), right gastroepiploic artery (RGEA) and inferior epigastric artery (IEA) on a 53-year-old patient who was associated with familiar hypercholesterolemia. The IEA was extended with right ITA as a composite graft and sequentially anastomosed to the right coronary artery and distal branch of the right coronary artery. Both the LITA to the left anterior descending artery and the RGEA to the circumflex artery were used as in situ graft. The postoperative coronary angiogram showed all the graft patient.

Abdominal Muscles↗
PubMed1997

[Composite arterial conduits with internal thoracic artery and radial artery for a myocardial revascularization].

From April 1996 to December 1996, 15 patients were submitted to myocardial revascularization using composite arterial conduit with internal thoracic artery (ITA) and radial artery (RA). The age ranged from 51 to 76 years (mean age, 65.7 years); Forty patients were male. All patients had double or triple vessel disease or LMT disease. We used 28 arterial conduits including 15 left ITAs, 15 RA, 9 right gastroepiploic artery and one inferior epigastric artery. 15 RAs were anastomosed to LITAs and 15 composite arterial conduits were constructed (branched in 15). There was no operative deaths. Early postoperative angiographic controls demonstrated 93.3% (14/15) patency of composite grafts in 14 of 15 patients. The composite arterial graft using ITA and RA is feasible and the anastomoses so performed are completely safe.

Aged↗
PubMedDate not supplied

[The hemodynamic characteristics of the central retinal artery and ophthalmic artery in atherosclerotic lesions of the carotid arteries based on the data from ultrasonic study methods].

Central retinal artery and orbital artery were examined by ultrasonograph in 348 patients with atherosclerosis of the carotid arteries. Doppler shift of frequency spectrum was detected in the central retinal artery, which is typical of the ischemic syndrome of the eye. Its characteristics include decreased diastolic component of velocity and increased resistance index. The possibility of using duplex scanning with color Doppler flow mapping for assessing the treatment efficacy is demonstrated. A direct relationship between the degree of stenosis in the internal carotid artery and blood flow in the orbital artery is revealed. The detected changes do not notably affect the Doppler spectrum characteristics in the central retinal artery.

Acute Disease↗
PubMed2004

Arterial switch operation with in situ coronary reallocation for transposition of great arteries with single coronary artery.

OBJECTIVES: Transposition of great arteries (TGA) with single coronary artery pattern is one of the high-risk groups for arterial switch operation (ASO). Any traction or kinking during coronary transfer can lead to a fatal outcome. With increase in experience, surgical results improved, but it did not completely eliminate the risks of coronary translocation. Many techniques have been described for transfer of single coronary and each one has its own merits and problems. We here in describe a new technique of in situ coronary reallocation during ASO for TGA with single coronary and also report the early and mid-term results with this new technique. METHODS: From September 1988 to June 2002, five consecutive cases of TGA with single coronary artery were operated employing this new technique. Their age ranged from 16 days to 9 months. ASO was done by transecting the great arteries just above the commissures. For coronary reallocation, hockey stick-shaped incisions were made in the facing sinuses of the proximal aorta and the pulmonary artery. These flaps were sutured in such a way that the coronary ostium was committed to the neo-aorta with the rest of surgical procedure done in the usual manner. RESULTS: All five patients had ASO. Additionally, four patients had closure of an associated ventricular septal defect and one patient had repair of the coarctation of the aorta. There was no in hospital mortality. All patients had follow-up echocardiograms at regular intervals, which showed no significant right or left ventricular outflow obstruction, no regional wall motion abnormalities and no neo-aortic or neo-pulmonary regurgitation. Three of five patients had cardiac catheterization and angiocardiography, which showed normal coronary arteries with no obstructive lesions and no neo-aortic regurgitation. Their follow up ranged from 5 to 50 months and there was no late mortality. CONCLUSIONS: This new coronary reallocation technique avoids problems related to coronary translocation such as traction and kinking. It spares the need for dissection of proximal coronary artery and its branches, and thereby eliminates the risk of development of fibrosis and stenosis. The same technique can be used regardless of the sinus of origin of the coronary artery. It is a reliable and a reproducible technique. The early and mid-term results appear excellent in this series.

Aortography↗
PubMed2004

Arterial switch operations for single coronary artery ostium or intramural coronary artery.

BACKGROUND: Successful transfer of the coronary arteries is the most critical step during arterial switch operations for patients with transposition of the great arteries with a single coronary artery ostium and/or intramural coronary arteries. Various techniques have been reported and the present study was an evaluation of them in 10 neonatal patients. METHODS AND RESULTS: Coronary artery transfers are achieved by implantation of coronary buttons to the previously anastomosed neo-aorta using pericardial or pulmonary artery hood techniques. One patient died perioperatively because of myocardial malperfusion. Following prolonged mechanical ventilation, another died from sepsis on the 28th postoperative day. Coronary artery perfusion abnormality was not observed in the remaining patients. CONCLUSIONS: Transfer of the coronary button by the pericardial or pulmonary artery hood augmentation technique to the previously anastomosed neo-aorta is a practical, easy and convenient combination of methods for the treatment of these patients.

Coronary Vessel Anomalies↗
PubMed2005

Subclinical peripheral arterial disease and incompressible ankle arteries are both long-term prognostic factors in patients undergoing coronary artery bypass grafting.

OBJECTIVES: This study was designed to determine the prevalence of peripheral arterial disease (PAD) in candidates for coronary artery bypass grafting (CABG) and to assess the predictive value of different types of subclinical PAD (peripheral occlusive disease and medial arterial calcification [incompressible ankle arteries]). BACKGROUND: Observational studies report poor prognosis after CABG in the presence of clinical PAD, but data on subclinical PAD are scarce. METHODS: We prospectively enrolled CABG candidates and measured ankle-brachial index (ABI) preoperatively. Patients were divided into four groups: clinical PAD, subclinical PAD (ABI <0.85), incompressible arteries (ABI >1.5), and no PAD. The primary end point was a composite combining death, acute coronary syndrome, stroke or transient ischemic attack (TIA), and coronary or peripheral revascularization. Secondary end points were overall and cardiovascular death, acute coronary syndrome, and stroke or TIA. Statistical analyses were performed using the Cox regression model. RESULTS: We consecutively enrolled 1,022 patients (mean age 66.9 +/- 9.2 years). In addition to the 14% with clinical PAD, we detected subclinical PAD in 13% and medial artery calcification in 12%. During an actuarial follow-up of 4.4 years, 81.2% of patients remained event-free. Adverse factors were (p < 0.05) supraventricular arrhythmia (odds ratio [OR] 2.5), ejection fraction <0.40 (OR 2.3), combined valvular surgery (OR 2.5), clinical PAD (OR 3.6), subclinical PAD (OR 3.3), and medial artery calcification (OR 1.9). The latter three factors were also independently predictive for overall and cardiovascular death. CONCLUSIONS: Beyond clinical PAD, the measurement of ABI before coronary surgery provides substantial information on long-term postoperative prognosis. To our knowledge, this is the first study highlighting the prognostic role of incompressible ankle arteries in secondary prevention.

Aged↗
PubMed1999

The posterior temporal artery as the recipient in superficial temporal artery to posterior cerebral artery bypass. Technical note.

BACKGROUND: While superficial temporal artery (STA) to superior cerebellar artery (SCA) or STA to posterior cerebral artery (PCA) anastomosis has been used for rostral brain stem ischemia, it is reported not infrequently to be associated with serious complications. Although the inferior temporal artery has been proposed as a possible recipient artery for the STA, its advantage is not yet widely recognized. CASE REPORT: A 42-year-old man presented with repeated loss of vision in the left visual field. Angiography disclosed occlusion in the proximal portion of the P2 segment of the right PCA. The second case was a 68-year-old man experiencing swallowing disturbance; the bilateral vertebral arteries were markedly stenotic. Since hemodynamic insufficiency was considered to be responsible for the patients' symptoms, STA-PCA anastomosis was performed using the posterior temporal artery (PTA) as the recipient. The postoperative courses were uneventful with good patency of the bypass. TECHNIQUE: Through a horizontally extended temporal craniotomy with the base of the temporal bone sufficiently drilled away, the inferior aspect of the temporal lobe was searched for a recipient artery for the STA. The anastomosis was performed with less difficulty and at a shallower level, by 20 mm in one case and by 10 mm in the other, than had we anastomosed it to the P2 segment of the PCA. CONCLUSION: Anastomosis of the STA to the PTA is less complicated than anastomosis of the STA to the main branch of the PCA for the treatment of rostral brain stem ischemia.

Adult↗
PubMed1995

Carotid artery duplex scanning in preoperative assessment for coronary artery revascularization: the association between peripheral vascular disease, carotid artery stenosis, and stroke.

PURPOSE: The purpose of this study was to identify high-risk populations for severe carotid artery disease (SCD) and neurologic events (NE) after nonemergency isolated coronary artery bypass graft procedures (CABG). METHODS: Between February 1989 and July 1992, 387 patients underwent preoperative carotid artery duplex scanning as part of a preoperative assessment for nonemergency cardiac procedures. Of these patients, 376 had isolated CABG, and 11 had combined carotid endarterectomy (CEA) and CABG. Patient demographics, risk factors, and preoperative neurologic symptoms were recorded and analyzed. Severe carotid artery disease was defined as a 80% or greater stenosis of either internal carotid artery by carotid artery duplex scanning. Patients were evaluated for neurologic events (cerebrovascular accident, transient ischemic attack, amaurosis fugax, or reversible ischemic neurologic deficits) during the in-hospital postoperative period. RESULTS: The prevalence of SCD was 8.5% (33 patients). The 33 patients with SCD were significantly older (65.6 +/- 6.5 years vs 62.5 +/- 10.4 years, p = 0.02), had previous CEA (27.3% vs 2.0%, p = 0.00001), had preoperative neurologic symptoms (21.2% vs 5.9%, p = 0.002), and had peripheral vascular disease (PVD) (63.6% vs 16.9%, p = 0.00001). The sensitivity of PVD for SCD is 63.6% (n = 21/33) (specificity 83.1%, positive predictive value 25.9%, negative predictive value 96.1%). In patients undergoing CABG alone, those who had postoperative NE were older (69.6 +/- 6.7 years vs 62.5 +/- 10.3 years, p = 0.036) and more likely to have PVD (50% vs 19.7%, p = 0.034), SCD (40% vs 4.9%, p = 0.001) and previous CEA (40% vs 2.7%, p = 0.0002). The incidence of postoperative NE in patients with SCD was 18.2% vs 1.7% in patients without SCD (p = 0.001). The sensitivity of SCD for NE was 40% (n = 4/10) (specificity 95.1%, positive predictive value 18.2%, negative predictive value 98.3%). CONCLUSIONS: PVD may be helpful to identify patients at high risk for severe carotid artery stenosis. Postoperative NE in patients with CABG are associated with increasing age, carotid artery stenosis greater than 80%, previous CEA, and PVD.

Adult↗
PubMed1976

Anomalous origin of the left coronary artery from the pulmonary artery with coronary artery steal in adults. Report of two cases and review of the literature.

Patients with anomalous left coronary artery arising from the pulmonary artery rarely survive to adult life. Those who attain adulthood may present with angina indistinguishable from coronary artery disease and are liable to sudden death. Myocardial infarction, though rare in young adults, may occur and may be due to coronary artery steal. Accurate diagnosis requires coronary arteriography. Two further cases of coronary artery steal in adults with anomalous origin of the left coronary artery from the pulmonary artery are presented. In both patients aortocoronary bypass grafting using a reversed autogenous saphenous vein with closure of the origin of the anomalous left coronary artery was successfully performed. This operation provided complete symptomatic relief and may protect patients against the risk of sudden death.

Adolescent↗
PubMed2001

[Off-pump coronary artery bypass using bilateral in situ internal thoracic artery grafts for left coronary artery system: a case report].

A 63-year-old man with triple vessel disease in the coronary artery and multiple arterial stenoses in intra-cranial vessels underwent off-pump coronary artery bypass (OPCAB). We were able to perform three coronary artery bypass grafting (in situ left internal thoracic artery (left ITA)--left anterior descending artery, in situ right ITA--circumflex artery through the transverse sinus, and saphenous vein graft--right coronary artery) using octopus 2 and "Lima" suture technique without cardio-pulmonary bypass. Operation time was 355 minutes and established blood loss was 440 ml. Postoperative course was uneventful. Postoperative angiogram revealed well patent three grafts. Using bilateral in situ ITAs OPCAB could achieve high quality.

Coronary Artery Bypass↗
PubMedDate not supplied

Duplex Doppler sonography of the carotid artery: false-positive results in an artery contralateral to an artery with marked stenosis.

Anecdotal reports have described a false-positive "jet effect" or velocity increase in the carotid artery contralateral to an artery with significant stenosis or occlusion when using duplex Doppler sonography. In this study, the frequency, significance, and possible reasons for this finding were evaluated by a retrospective comparison of duplex sonography and angiography. Twenty-three patients with unilateral 81-100% carotid artery stenosis who underwent both duplex sonography (16 Acuson, seven Quantum) and angiography were evaluated. In 14 patients, there was an accurate or slight underestimate (less than 20%) of stenosis present in the internal carotid artery contralateral to an artery with tight stenosis/occlusion. In nine, a velocity increase in the internal carotid artery resulted in overestimation (10-80%) of the actual degree of stenosis. In one of these nine patients, real-time images were sufficient to explain the velocity increase on the basis of vessel tortuosity. In one, falsely elevated velocity resulted from inaccurate assignment of the Doppler angle of incidence in a patient in whom real-time visualization of a distal internal carotid lesion was poor. In four of the nine patients, cross filling via the circle of Willis toward the side of greater stenosis occurred. However, seven of 14 patients in whom there was duplex sonography/angiography agreement or slight duplex sonography underestimation also had cross filling. Vertebral artery patency did not correlate well with the presence of a "jet effect."(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Coronary artery spasm of the native right coronary artery during off-pump coronary surgery of the left coronary artery system.

Native coronary artery spasm is a very rare complication during off-pump coronary artery bypass grafting. We report the case of a 74-year-old man who experienced angiographically documentated right coronary artery spasm while undergoing off-pump coronary artery bypass grafting on the diseased left coronary system. Despite two episodes of ventricular fibrillation and persistent ST segment elevation of the posterior wall, the off-pump procedure was successfully completed by grafting the left internal thoracic artery to the left anterior descending artery and a saphenous vein graft to the Ramus intermedius. The immediate postoperatively performed coronary angiography demonstrated patent anastomoses and two areas of significant spasticity within the course of the right coronary artery. Intracoronary nitroglycerin infusion into the ostium of the right coronary artery resolved the spasms of this nondiseased vessel as well as the associated ST segment elevations.

Aged↗
PubMed2001

Arterial myocardial revascularization with in situ crossover right internal thoracic artery to left anterior descending artery.

BACKGROUND: The extra length obtained by skeletonizing the internal thoracic arteries (ITAs) enables versatile use of in situ bilateral ITAs for coronary artery bypass grafting, as the longer skeletonized right ITA more easily reaches the anastomotic site on the left anterior descending coronary artery. METHODS: Between April 1996 and November 1999, 365 consecutive patients underwent revascularization with bilateral in situ ITAs (29% of 1,250 grafting procedures performed with both ITAs in our department during this period). The right ITA was routed anterior to the aorta to graft the left anterior descending coronary artery, and the in situ left ITA was used to graft circumflex branches. Right coronary artery branches were grafted with right gastroepiploic artery or saphenous vein graft. The right ITA crossed the midline above the aorta at the most cranial point to avoid damage in case of a repeat sternotomy in the future. RESULTS: The operative mortality rate was 2.2% (8 patients). Postoperative morbidity included seven strokes (1.9%), eight sternal wound infections (2.2%), and four perioperative myocardial infarctions (1.1%). Follow-up (6 to 49 months) of 97% of hospital survivors showed a return of angina in 3%. Postoperative coronary angiography (22 patients) revealed a 95% patency rate of both ITAs. One-year and 4-year survival rates (Kaplan-Meier) were 95% and 92.4%, respectively. Important predictors of an early unfavorable event were chronic obstructive pulmonary disease, old age (> or = 70 years), emergency operation, and diabetes. Chronic obstructive pulmonary disease was the only independent predictor of sternal wound infection (odds ratio, 15; 95% confidence interval, 2.8 to 80). It also predicted decreased late survival (hazard ratio, 8.3; 95% confidence interval, 3 to 21.5). CONCLUSIONS: With skeletonized dissection of ITAs, the right ITA easily reaches the left anterior descending coronary artery for left-sided arterial revascularization with in situ bilateral ITAs. This procedure is safe, but we recommend avoiding its use in patients with chronic obstructive pulmonary disease.

Aged↗
PubMed2002

Anomalous origin of the left coronary artery from the pulmonary artery A case using the autologous pulmonary arterial wall graft.

A 10-year-old girl with anomalous origin of the left coronary artery from the pulmonary artery underwent a two coronary system reconstruction with a new technique. Her left coronary artery was stenotic next to its origin and had a severe adhesion with the aorta. We made a bypass grafting between the aorta and the left coronary artery with a roll shaped transected main pulmonary arterial wall graft. The postoperative angiogram showed a good patency of a reconstructed left coronary artery. This technique is considered useful surgical option for bypass grafting to the left coronary artery when the left coronary artery has an obstructive lesion or a difficulty to dissect and mobilize.

Blood Vessel Prosthesis Implantation↗