[show abstract][hide abstract] ABSTRACT: Comparison of the immediate and long-term results of three different extrathoracic arterial reconstruction procedures for subclavian obstructive disease.
Retrospective analysis of 51 extrathoracic subclavian artery reconstructions in 49 patients performed in a single centre over an 18-year period (mean follow-up 64 months, range 3-192).
Carotid-subclavian bypass (CSB, n = 21), subclavian-carotid transposition (SCT, n = 21) and subclavian-subclavian or axillo-axillary cross-over bypass (COB, n = 9) was performed. Upper extremity ischaemic complaints were present in 45/49 patients (92%) and vertebrobasilar insufficiency in 25/49 patients (51%). Symptom relief, improvement of haemodynamic parameters and graft patency were compared.
Operation time was significantly shorter (p < 0.001, t-test) in SCT (80 +/- 5 min) compared to CSB (112 +/- 7 min) and COB (116 +/- 6 min). Symptom relief and improvement of haemodynamic parameters were similar for all groups. There were no differences in morbidity rate and there was no mortality. The cumulative patency of SCT was significantly better with 100% at 2, 5 and 10 years postoperatively compared to CSB (75.6%, 62.6% and 52.2%, respectively) (p < 0.005, log-rank test) and COB (76.5%, 63.7% and 63.7%, respectively) (p < 0.02, log-rank test). There was a tendency for a better patency in prosthetic grafts as compared to autologous vein grafts in CSB (NS, log-rank test).
Satisfactory immediate and long-term results were obtained with all of the above techniques. When technically feasible, SCT is the procedure of choice for extrathoracic arterial reconstruction in subclavian obstructive disease.
European Journal of Vascular and Endovascular Surgery 05/1995; 9(4):454-8. · 2.82 Impact Factor
[show abstract][hide abstract] ABSTRACT: Extracranial manifestations of vascular occlusive disease, such as renovascular hypertension, are rare in moyamoya syndrome. Histopathological examination suggests a common denominator. Surgical or endoluminal correction of these lesions is feasible. Moyamoya syndrome is not considered to be a contraindication for organ donation for transplantation.
The Journal of cardiovascular surgery 11/1994; 35(5):441-3. · 1.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: This paper describes, by case histories and a literature review, the cause, diagnosis and therapy of pseudoaneurysm of the superficial temporal artery. Two patients with a traumatic pseudoaneurysm of the superficial temporal artery were examined by physical examination and histology of the excised lesions. Blunt injury caused a histologically proved pseudoaneurysm in two reported cases. A total of 12 additional reports of pseudoaneurysm of the superficial temporal artery were found in the literature. Pseudoaneurysm of the superficial temporal artery is an uncommon complication of blunt head injury. Symptoms are limited and diagnosis can be made by noninvasive means. A high suspicion level for arterial injury and sufficient follow-up of patients is necessary for the detection of arterial injury.
[show abstract][hide abstract] ABSTRACT: The outcome of ruptured abdominal aortic aneurysm repair was reviewed in 83 consecutive patients with special emphasis on the influence of subsequent laparotomy. The overall 30-day mortality was 47%. Causes of death were exsanguination in six, cardiac failure in 15, uncontrolled hypotension in six, multiple organ failure (MOF) in nine, adult respiratory distress syndrome in one and sepsis in two patients. Thirty-three relaparotomies were performed in 21 patients after a mean interval of 10 days. Suspected intraabdominal haemorrhage was the indication in 15 and sepsis in 18 cases. The preoperative diagnosis proved to be correct in 12/15 (80%) and 11/18 (61%) instances, respectively. Negative explorations were mainly performed in patients with an established MOF syndrome. Relaparotomies were associated with a significantly (p < 0.05) increased mortality of 76%. The complications that give rise to the need for surgical reintervention are usually accompanied by a clinical deterioration of the patient and inevitably reduce the chances of survival. However, until a reliable predictor of mortality is developed, treatment should not be denied in individual cases.
European Journal of Vascular Surgery 05/1994; 8(3):342-5.
[show abstract][hide abstract] ABSTRACT: Controversy exists regarding the extent of vascular reconstructive surgery in the presence of unilateral symptomatic iliac obstructive disease. This study reviews the results of unilateral iliac reconstruction, with special emphasis on the need for consecutive contralateral intervention.
The outcomes of 184 unilateral and 350 aortobilateral reconstructions for obstructive disease performed during the same period were retrospectively analyzed. Treatment allocation was based on hemodynamic parameters. Unilateral reconstruction was performed by a way of a retroperitoneal approach through a pararectal incision and bilateral reconstruction by way of a transperitoneal approach through a midline abdominal incision.
Symptom relief, improvement of noninvasively measured parameters, and graft patency were similar after unilateral and bilateral reconstruction. Both groups had a 10-year primary patency rate greater than 80%. There were no differences in morbidity rate, although respiratory complications occurred more often after bilateral reconstruction. Mortality rates were 1.6% after unilateral reconstruction and 4.9% after bilateral reconstruction. Secondary contralateral reconstruction was performed in only 6% of the patients who underwent an initial unilateral operation.
The unilateral vascular reconstruction for iliac obstructive disease is a well-tolerated procedure with an excellent long-term outcome. It is a valuable alternative to conventional aortobilateral reconstruction in carefully selected patients. Prophylactic reconstruction of an asymptomatic iliac stenosis without signs of significant hemodynamic impairment is most often not indicated.
Journal of Vascular Surgery 05/1994; 19(4):610-4. · 2.88 Impact Factor