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ABSTRACT: Timing of surgery remains a controversial subject with some concerns persisting that the benefit of early carotid endarterectomy (CEA) offsets the perioperative risks. We investigated the neurological outcome of patients with symptomatic internal carotid artery (ICA) stenosis after surgery in relation to the timing of treatment.
From January 2005 to June 2010, 468 patients (n = 349 male, 74.6%, median age 71 years) underwent CEA for symptomatic stenosis. Perioperative morbidity and mortality rates were assessed in the 30 days' follow-up.
The median time interval between index event and CEA was 7 days; the overall stroke and death rate reached 3.4%. There was no difference in the 30 days' rate of stroke /death rate, depending on the timing of surgery (n = 5/241, 2.1% in patients treated within 1 week vs. n = 10/215, 4.7% in patients treated thereafter, p = 0.12). Patients with a postoperative neurological deterioration had more often an ischaemic infarction on preoperative cerebral computed tomography (CCT) compared with those without deterioration (n = 6/15, 40.0% vs. n = 39/441, 9.0%, p = 0.003). Logistic regression analysis showed that patients with preoperative infarction on CCT had the highest risk for postoperative neurological deterioration.
An infarction on the preoperative CCT leads to an increased risk for a postoperative deterioration after CEA. Patients should be treated at an early point in time with bland CCTs.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 09/2011; 42(6):732-9. · 2.92 Impact Factor
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ABSTRACT: Intra-articular malunion with step off and gap formation is claimed to be crucial for radiocarpal degeneration. In addition to well-defined intraarticular malunion, the shape of the distal radius is important for unaffected wrist function. In typical intra-articular fracture patterns with a dorsoulnar and palmar ulnar fragment, alterations of the shape of the articular surface, in a kind of a cavity, without obvious step off can be observed. The aim of the present study is to determine the residual articular deformity following intra-articular radius fractures and to analyze their impact on the final clinical and radiological outcome.
Eighty one patients with dorsally displaced distal intraarticular radius fractures were followed up for a mean period of 9 years. Surgical treatment of all patients included open reduction, plate fixation and corticocancellous bone grafting. Radiological measurements included palmar tilt, radial inclination and radial shortening as defined by ulnar variance, intra-articular Stepps and the measurement of the anteroposterior distance of the radial joint surface. Clinical assessment included active range of motion (ARM) of the wrist, pain according to a visual analogue scale (VAS), grip power, working ability, Disability of Arm, Shoulder and Hand Score (DASH Score).
Articular malunion in the form of a cavity in the sagittal plane measured 4.8 mm, 1.3 mm more than on the non-injured side. Anteroposterior distance measured 20.6 mm, 2.1 mm more than on the non-injured side. Articular step-off and gap was noticed in 11 patients. At the final follow-up examination, there was a significant difference in articular cavity depth and the anteroposterior distance between arthritis stage I and II. Arthritis stage was associated with the range of motion (ROM) in the sagittal plane, but had no significant influence on the DASH, pain level, grip strength and ROM in the frontal plane.
ORIF leads to predictable results in the restoration of length and form of the distal radius. Increasing the articular cavity depth should be avoided to prevent degenerative arthritis at the radiocarpal joint at long-term follow-up visits.
Archives of Orthopaedic and Trauma Surgery 12/2010; 131(8):1121-6. · 1.37 Impact Factor
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G Brandacher,
M Ninkovic,
H Piza-Katzer,
M Gabl,
H Hussl, M Rieger,
M Schocke,
K Egger,
W Loescher,
B Zelger,
H Bonatti,
C Boesmueller,
W Mark,
R Margreiter,
S Schneeberger
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ABSTRACT: We herein provide an update on two bilateral hand and one bilateral forearm transplants with emphasis on immunosuppression (IS), function, morphology, and graft vascular changes at 8 years and 2 years after bilateral hand and 5 years after bilateral forearm transplantation. Between March 2000 and May 2006, three patients underwent bilateral hand or forearm transplantation at our institution. Following induction therapy with antithymocyte globulin (ATG) (n = 2) or alemtuzumab (n = 1), tacrolimus, prednisolone +/- mycophenolate mofetil (MMF) were given for maintenance IS. Later, tacrolimus (n = 1) or MMF (n = 1) was replaced by sirolimus/everolimus for long-term IS. Clinical follow-ups with evaluation of hand function, skin biopsies, X-ray, ultrasound, angiography, computed tomography angiography, electrophysiological studies, and somatosensory evoked potentials were performed at regular intervals. Three, six, and three rejection episodes were successfully treated with bolused steroids, anti-CD25 or anti-CD52 antibodies. Subsequently, skin histology remained normal without any evidence of chronic rejection. Hand function continuously improved during the first 3 years and since then remained stable with minor improvements. Investigation of hand arteries revealed no signs of occlusion or stenosis. Motor and intrinsic hand muscle function continues to improve in all patients. Protective sensation was observed in all patients; however, discriminative sensation was only accomplished after hand but not forearm transplantation. No life-threatening adverse events occurred. Despite immunologic challenging postoperative courses, patients are now free of rejection with moderate levels of IS and good functional results. No signs indicating chronic rejection have been encountered.
Transplantation Proceedings 04/2009; 41(2):491-4. · 1.00 Impact Factor
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ABSTRACT: The aim of this retrospective study was to evaluate mid- and long-term results of endovascular stent-graft placement for emergency repair of acute traumatic thoracic aortic rupture. From 1996 through 2005, 22 consecutive patients (mean age: 38.7 years) underwent endovascular repair of acute traumatic thoracic aortic rupture located at the aortic isthmus in most cases. All patients were at high surgical risk due to severe associated injuries. The endografts were inserted via femoral or iliac artery access under fluoroscopic guidance. Follow-up was performed postinterventionally, at 6 and 12 months and yearly thereafter, and included clinical examination and computed tomography (CT) scans. Technical and clinical success rates were 86.3%. Mean follow-up was 31.7 months. Three patients developed early type I endoleak due to the inability of the rigid graft to adapt to the curved aortic contour. In two of them conversion to open surgery was necessary. One patient had late type I endoleak and died. No other complications were observed. The outcome was successful in most patients. The mid- and long-term results of our current study are promising. However, early type I endoleak represents a problem, especially in adolescent patients with a marked curvature of the aortic arch.
European Radiology 08/2007; 17(7):1727-37. · 3.22 Impact Factor
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S Schneeberger,
M Ninkovic,
M Gabl,
H Hussl, M Rieger,
W Loescher,
B Zelger,
G Brandacher,
H Bonatti,
T Hautz,
C Boesmueller,
H Piza-Katzer,
R Margreiter
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ABSTRACT: We here report on the surgical procedure, postoperative course and functional results at 3 years following the first bilateral forearm transplantation. A 41-year-old male underwent bilateral forearm transplantation on February 17, 2003. After ATG induction therapy, tacrolimus, prednisone and MMF were given for maintenance immunosuppression. At 16 months, MMF was switched to everolimus. Hand function, histology, immunohistochemistry, radiomorphology, motor and nerve conduction and somatosensory-evoked potentials were investigated at frequent intervals. A total of six rejection episodes required treatment with either steroids, basiliximab, ATG, alemtuzumab or tacrolimus dose augmentation. At 3 years, the patient is free of clinical signs of rejection despite a persisting minimal perivascular lymphocytic dermal infiltrate. No signs of myointimal proliferation in graft vessels were seen. Motor function continuously improved, resulting in satisfactory hand function. Intrinsic hand muscle function was first observed at 16 months and continues to improve. Although discrimination of hot and cold recovered, overall sensitivity remains poor. The patient is satisfied with the outcome. Bilateral forearm transplantation represents a novel therapeutic option after loss of forearms.
American Journal of Transplantation 08/2007; 7(7):1753-62. · 6.39 Impact Factor
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ABSTRACT: This morphometric and experimental study was designed to assess the dimensions and axes of the subaxial cervical pedicles and to compare the accuracy of two different techniques for subaxial cervical pedicle screw (CPS) placement using newly designed aiming devices. Transpedicular fixation is increasingly used for stabilizing the subaxial cervical spine. Development of the demanding technique is based on morphometric studies of the pedicle anatomy. Several surgical techniques have been developed and evaluated with respect to their feasibility and accuracy. The study was carried out on six conserved human cadavers (average age 85 years). Axes and dimensions of the pedicles C3-C7 (60 pedicles) were measured using multislice computed tomography (CT) images prior to surgery. Two groups consisting of 3 specimens and 30 pedicles each were established according to the screw placement technique. For surgical technique 1 (ST1) a para-articular mini-laminotomy was performed. Guidance of the drill through the pedicle with a handheld aiming device attached onto the medial aspect of the pedicle inside the spinal canal. Screw hole preparation monitored by lateral fluoroscopy. In surgical technique 2 (ST2) a more complex aiming device was used for screw holes drilling. It consists of a frame with a fully adjustable radiolucent arm for carrying the instruments necessary for placing the screws. The arm was angled according to the cervical pedicle axis as determined by the preoperative CT scans. Drilling was monitored by lateral fluoroscopy. In either technique 3.5 mm screws made of carbon fiber polyetheretherketone (CF-PEEK) were inserted. The use of the CF-PEEK screws allowed for precise postoperative CT-assessment since this material does not cause artifacts. Screw placement was qualified from ideal to unacceptable into four grades: I = screw centered in pedicle; IIa = perforation of pedicle wall less than one-fourth of the screw diameter; IIb = perforation more than one-fourth of the screw diameter without contact to neurovascular structures; III = screw more than one-fourth outside the pedicle with contact to neurovascular structures. Fifty-six pedicle screws could be evaluated according to the same CT protocol that was used preoperatively. Accuracy of pedicle screw placement did not reveal significant differences between techniques 1 and 2. A tendency towards less severe misplacements (grade III) was seen in ST2 (15% in ST2 vs. 23% in ST1) as well as a higher rate of screw positions graded IIa (62% in ST2 vs. 43% in ST1). C4 and C5 were identified to be the most critical vertebral levels with three malpositioned screws each. Because of the variability of cervical pedicles preoperative CT evaluation with multiplanar reconstructions of the pedicle anatomy is essential for transpedicular screw placement in the cervical spine. Cadaver studies remain mandatory to develop safer and technically less demanding procedures. A similar study is projected to further develop the technique of CPS fixation with regard to safety and clinical practicability.
European Spine Journal 02/2007; 16(1):47-56. · 1.97 Impact Factor
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ABSTRACT: Radiocarpal fracture dislocation is a rare, complex injury characterised by dislocation of the radiocarpal joint with avulsion of the dorsal or palmar cortical margin of the distal radius. To evaluate the sagittal motion at the radiocarpal and midcarpal levels following dorsal radiocarpal fracture dislocation (Moneim type I) nine cases were investigated clinically and radiologically.
In a retrospective follow-up examination, eight patients could be included. The average follow-up was 4.1 years. One patient had a bilateral injury. The operative approach was bilateral in all cases. Restoration of the radial articular surface, filling metaphyseal defect zones with cancellous bone graft and internal fixation with a special T-plate were performed from dorsal. For refixation of the radiocarpal ligaments a small palmar approach was used. Standard anteroposterior and lateral radiographs, as well as lateral views in full extension and flexion were taken at follow-up. Clinical investigation included measurement of active range of motion, grip strength and pain evaluation using the VAS.
Radiological evaluation of the standard lateral view turned out a mean angle between scaphoid and lunatum of 55.6 degrees, capitatum and lunatum of -11.6 degrees and radius and capitatum of 10.5 degrees. In full flexion the following angles were measured: radius/lunatum 15.3 degrees, capitatum/lunatum 18 degrees and between radius and capitatum 30 degrees. In full extension the angles averaged: radius/lunatum -23.9 degrees, capitatum/lunatum -31 degrees and between radius and capitatum -55 degrees. According to the Knirk and Jupiter classification system, five patients presented arthritis stage 1, three arthritis stage 2 and one a stage 3 arthritis. Clinical evaluation showed a mean wrist motion of 55 degrees for extension, 35 degrees for flexion, 88 degrees for pronation, 70 degrees for supination and 25.5 degrees for the mean radial as well as the mean ulnar motion. The average Mayo Wrist Score was 76.1 points.
Operative treatment of dorsal radiocarpal fracture dislocation using a bilateral approach led to satisfying results in eight of nine cases with decreased but radiologically evaluated sagittal motion of the proximal row.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 02/2007; 39(1):49-53. · 0.88 Impact Factor
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ABSTRACT: To evaluate the sequelae of distal intraarticular radius fracture with regard to the development of arthritis and clinical symptoms.
In a retrospective follow-up examination, 72 patients with a distal intraarticular radius fracture could be included for clinical and radiological investigation 9 years following the trauma. All fractures were treated by ORIF and cortico-cancellous bone grafting.
Radiological evaluation revealed 5.1 degrees palmar tilt, 19.1 degrees radial tilt and the ulnar variance amounted to -0.5 mm. The articular cavity depth in the sagittal plane measured with 4.6 mm, 1.2 mm more than the non-involved side. Articular step-off was noticed in 6 patients. According to the Knirk and Jupiter classification system, two patients healed without arthritis, 43 patients presented arthritis stage 1, and 27 stage 2. Evaluation of the data showed a significant correlation between arthritis and articular cavity depth. But arthritis had neither influence on the DASH, nor the pain level. On the other hand, arthritis led to decreased sagittal wrist motion.
ORIF of distal intraarticular radius fractures led to predictable results concerning restoration of length and form of the distal radius. Arthritis had a minor influence on the clinical end result.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 02/2007; 39(1):54-9. · 0.88 Impact Factor
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ABSTRACT: Most traumatic spinal injuries result from a high-energy process and are accompanied by other injuries. Following the CCSPR study, the presence of all low-risk factors (simple trauma mechanism, fully conscious, ambulatory at any time since trauma, neck rotation exceeding 45 degrees bilaterally) obviates the need to acutely image the cervical spine. Imaging is indicated in all other patients. Emergency spiral CT should be performed as the first imaging method in high-risk and moderate-risk patients; only in low-risk patients should conventional radiography be performed and trusted as the sole modality. The AO classification according to Magerl et al. is used for the subaxial spine, whereas the upper cervical spine should be classified separately because the anatomy is different at each level. Radiological evaluation of traumatic spinal injuries should be done systematically using the "ABCS" scheme.
Der Radiologe 07/2006; 46(6):527-41; quiz 542-3. · 0.61 Impact Factor
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S Schneeberger,
M Ninkovic,
H Piza-Katzer,
M Gabl,
H Hussl, M Rieger,
W Loescher,
B Zelger,
G Brandacher,
H Bonatti,
C Boesmueller,
W Mark,
R Margreiter
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ABSTRACT: Graft survival and function early after hand transplantation is good. It remains unknown, however, whether long-term survival is limited by chronic rejection. We here describe the clinical course and the status 5 years after bilateral hand transplantation with emphasis on immunosuppression (IS), function, morphology and graft vascular changes. Clinical observation, evaluation of hand function, skin biopsies, X-ray, ultrasound, angiography, CT angiography, electrophysiologic studies including compound motor and sensory action potentials (CMAP, CSAP) and somatosensory evoked potentials were performed and results recorded at regular intervals. Following reduction of IS one mild (grade II) rejection episode occurred at 4 years. Subsequently, skin histology remained normal and without signs of chronic rejection. Hand function continuously improved during the first 3 years and remained stable with minor improvement thereafter. CMAP and CSAP progressively increased during the observation period. Latencies of the cortical responses were prolonged but amplitudes were within normal range. Investigation of hand vessels revealed no signs of occlusion but showed revascularization of a primarily occluded right radialis artery. Motor and sensory function improved profoundly between years 1 and 5 after hand transplantation. No signs whatsoever of chronic rejection have been observed.
American Journal of Transplantation 05/2006; 6(4):834-41. · 6.39 Impact Factor
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E Boeckle,
C Boesmueller,
S Wiesmayr,
W Mark, M Rieger,
D Tabarelli,
I Graziadei,
D Hoefer,
H Antretter,
I Stelzmueller,
J Krugmann,
R Zangerle,
H Huemer,
G Poelzl,
R Margreiter,
H Bonatti
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ABSTRACT: Human herpes virus (HHV8) is associated with Castleman's disease, primary effusion lymphoma, and the Kaposi's sarcoma (KS).
Among 3815 solid organ transplants performed at our center between 1977 and 2003, five patients (0.1%) were identified with KS.
There were one cardiac, one liver, and three renal allograft recipients of median age of 52 (range 38 to 60) years, three of whom were females. Three patients were of Italian and one of Turkish descent; only one patient was a native Austrian. The onset of the disease was 2.0, 7.5, 7.8, 9.4 months, and 22 years posttransplant. Diagnosis of KS was based in all cases on histology. The heart recipient developed a tumor on the planta pedis; one renal recipient, on both legs. The liver and the two remaining renal recipients presented with disseminated disease. Treatment in all cases consisted of reduction in immunosuppression, together with surgery (n = 1), chemotherapy (n = 1), or irradiation (n = 2). Furthermore, immunosuppression was switched in two cases from Tacrolimus to Sirolimus. In the liver recipient a complete response was achieved; he died, however, due to noncompliance followed by graft failure. One renal recipient died without evidence of recurrent disease from myocardial infarction. The cardiac and two renal recipients are alive between 4 months and 17 years with well-functioning grafts and no evidence of recurrent disease.
HHV8-associated lesions seem to be extremely rare in the Central European transplant population. Nevertheless, awareness of KS is important for early diagnosis and optimal treatment.
Transplantation Proceedings 06/2005; 37(4):1905-9. · 1.00 Impact Factor
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ABSTRACT: High-resolution computed tomography (HRCT) of the lung is a very valuable method in the evaluation of children with acute and chronic lung disease due to the high spatial resolution and precise display of anatomy and pathology without superposition. The following publication will describe an optimized HRCT technique in order to reduce dose, explain various HRCT pattern and explain typical pediatric lung diseases.
Der Radiologe 01/2004; 43(12):1069-74. · 0.61 Impact Factor
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ABSTRACT: Corrective osteotomy of the malunited distal radius following fracture was performed in six patients using virtual planning and computer-assisted surgery. Radius joint angles and ulnar variance were assessed by CT scan and compared with the uninvolved wrist. Dorsal tilt was improved by 6 degrees, radial inclination by 3 degrees, radius rotation by 7 degrees and ulnar variance by 4.6 mm. Results were almost equivalent to the noninvolved radius. Corrective osteotomy in extraarticular malunited distal radius fracture was optimized by computer-assisted planning and surgery.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 10/2003; 35(5):333-7. · 0.88 Impact Factor
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ABSTRACT: Die hochauflsende Computertomographie (HRCT) ermglicht die optimierte und berlagerungsfreie Darstellung von Erkrankungen des Lungenparenchyms und eine Zuordnung morphologischer Muster zu den entsprechenden Krankheitsbildern. Voraussetzungen sind die optimierte Untersuchungstechnik und die Kenntnis der HRCT-typischen Muster. Im Folgenden werden die technischen Untersuchungsparameter zur Durchfhrung der HRCT der Lunge bei Kindern genannt, typische HRCT-Muster zusammengefasst und hufigen pdiatrischen Krankheitsbilder zugeordnet.High-resolution computed tomography (HRCT) of the lung is a very valuable method in the evaluation of children with acute and chronic lung disease due to the high spatial resolution and precise display of anatomy and pathology without superposition. The following publication will describe an optimized HRCT technique in order to reduce dose, explain various HRCT pattern and explain typical pediatric lung diseases.
Der Radiologe 01/2003; 43(12):1069-1074. · 0.61 Impact Factor
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ABSTRACT: From 1998 to 2002 ten patients underwent surgical correction of pectus carinatum using a new diagnostic preoperative three-dimensional volume rendering mode computed tomography. Particularly the deformed rib cartilages can now also be visualized, which allows exact preoperative planning of the extent of cartilage resection and localization of required sternum osteotomies. This additional information results in a focused surgical approach and hence minimizes scars. As an additional innovation, resorbable plates and screws were used for refixation of the osteotomized parts of the sternum. For postoperative thorax immobilization and hypertrophic scar circumvention, a special keel chest brace was applied in all patients for 6-8 weeks. No complications occurred in any case, and all patients were very content with the aesthetic results achieved.
Der Chirurg 01/2003; 73(12):1191-6. · 0.70 Impact Factor
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ABSTRACT: To evaluate a modified algorithm in the diagnostic management of polytraumatized patients by using whole body multislice CT (MSCT) as primary diagnostic tool.
Between June 1999 and October 2000 532 polytraumatized patients were referred to the emergency department. 336 polytraumatized patients were primarily evaluated using whole body MSCT according to the "Innsbruck Emergency Algorithm". MSCT is performed immediately after cardiovascular stabilization of the patient. During the initial stabilization period free intraabdominal fluid is excluded or demonstrated by abdominal ultrasound. Time-consuming conventional radiographs are omitted with exception of an optional chest X-ray. In patients with suspected or obvious arterial injuries or fractures the multislice-CT-dataset is used to perform 2D and 3D reconstructions in order to optimize visualization of additional skeletal and vascular injuries.
By means of whole body MSCT it was possible to detect all injuries. The diagnostic advantage of whole body MSCT as compared to conventional X-ray was analyzed in 111 consecutive polytraumatized patients with an injury severity score (ISS) of 34.77. The early use of MSCT shortened the time for diagnostic work-up substantially (approximately 50%).
Whole body multislice-CT used as primary diagnostic tool in the management of polytraumatized patients allows for a fast, accurate and comprehensive diagnostic work-up.
Der Anaesthesist 11/2002; 51(10):835-42. · 0.99 Impact Factor
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ABSTRACT: Eighteen patients with stage 3 Kienböck's disease were treated by débridement of the necrotic core of the lunate and implantation of a free vascularized corticocancellous iliac bone. The wrist was stabilized with an external fixator during healing. The efficiency of the procedure for restoring the structure of the fractured lunate, preventing carpal collapse and improving the clinical outcome was assessed at a mean follow-up of 5 years. The graft became incorporated in the lunate in 16 of the 18 patients and no fracture of the reconstructed lunate or carpal collapse occurred in these cases. The graft did not integrate and was resorbed in the other two patients.
The Journal of Hand Surgery British & European Volume 09/2002; 27(4):369-73. · 0.04 Impact Factor
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S Pechlaner,
A Kathrein,
M Gabl,
M Lutz,
P Angermann,
R Zimmermann,
R Peer,
S Peer, M Rieger,
M Freund,
A Rudisch
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ABSTRACT: Since Colles (1814) first described a distal radius fracture and the publication by Dupuytren (1834), the frequency of and problems surrounding these fractures were increasingly recognised. Not only the treatment but also the formation and type of fracture were repeatedly analysed. The various theories concerning the pathomechanism led to names such as: "tear fracture", "bend fracture", "thrust fracture", "compression fracture", "snap fracture" and others. In our experimental studies we attempted to simulate the pathomechanism of distal radius fractures and present them pictorially. With the help of a materials testing machine, 63 prepared cadaver arms were hyperextended in the wrist joint until a radius fracture occurred. The concomitant lesions were registered radiologically and by dissection. Moreover, additional cadaver arms were deep-frozen and examined by means of computer tomography and cryosection according to Kathrein. Through experimental hyperextension it was possible to generate dorsal, central, and palmar types of fractures. We produced 42 dorsal, 14 central and 7 palmar fractures. Fundamentally, it seems that the fracture depends on the extent in which the carpal bones of the proximal row are pressed against the dorsal, central or palmar part of the articular surface of the distal radius. The subsequent dissection showed in 40 cases (63 %) mostly multiple concomitant lesions and in 23 cases (37 %) none of these. The reason for concomitant lesions may be the proportion of bone stability to the strength of ligaments. Most frequently (27 cases, i.e. 43 %), we found a destabilisation of the articular disk with or without a bony avulsion fragment (fracture of the ulnar styloid). We also commonly found ruptures of the interosseous ligaments between scaphoid and lunate (20 cases, i.e. 32 %) and lunate and triquetrum (11 cases, i.e. 18 %). It is difficult to apply knowledge gained from experimental studies on preserved cadaver arms clinically. There are of course no physiological reflexes and the slow fracture process must be taken into consideration. This holds true not only for concomitant lesions but also for the type of fracture. On the other hand, in these experimental studies it was possible to generate many realistic types of fractures with their concomitant lesions.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 06/2002; 34(3):150-7. · 0.88 Impact Factor
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ABSTRACT: Computer assisted navigation-based surgery is a novel and interesting challenge for todays surgeons. One must however keep in mind, that the indications for these techniques (a) should be carefully considered, (b) used only if morbidity is not increased and (c) when previously problematic or inacurate surgical methods can be improved upon. This study reports that, using a non-invasive fixation method (FISCOFIX-Cast), lesions between the ankle- and knee-joints can be precisely localized, registered and treated. Due to the difficult access to lesions especially in the posterior areas of the talus, using conventional arthroscopic methods this procedure is very useful. Percutaneous retrograde drilling (cf. [6, 7, 9, 15, 20, 21]) spared the joint's cartilage in all cases. At the level of the knee joint we see the usefulness of this method for complex situations (cf. [12, 13]) requiring precise drilling.
Der Unfallchirurg 05/2002; 105(4):353-8. · 0.61 Impact Factor
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ABSTRACT: Crossclamping a severely atherosclerotic ascending aorta carries a significant risk of stroke in coronary artery bypass grafting. Besides other techniques aortic no touch concepts are increasingly applied for management of this problem.
Out of 407 patients undergoing epiaortic scanning during coronary artery bypass grafting 38 (9.3%) exhibited severe ascending aortic atherosclerosis. 22 of these patients (18 male, 4 female, age 72 (57-79) years, Parsonnet Score 11 (0-18), Euro Score 8 (2-13), McSPI Stroke Risk Index 6 (1-30) %) were operated on using a beating heart and aortic no touch technique. All patients received at least one internal mammary artery (IMA) in situ graft and additional extraanatomical bypass conduits: venous Y-graft from the IMA (n=14), arterial Y-graft from the IMA (n=3), vein graft from the axillary artery (n=3), vein graft from the IMA stump (n=2), vein graft from the innominate artery (n=2).
No stroke occurred. The rate of perioperative myocardial infarction (CKMB rt; 50 U/l) was 5/22. Median ICU length of stay was 54 (15-1245) h. Hospital mortality was 2/22. Pre- and postoperative angina class (CCSC) were 3.3 +/- 0.9 and 1.4 +/- 0.9 respectively (p<0.001). After a median follow up period of 8 months 3 deaths, one stroke, and one myocardial infarction occurred. On 3D multislice CT scan reconstructions which were performed in 13 patients during the first postoperative year all IMA grafts to the LAD and 11 out of 13 extraanatomical vein grafts were shown to be patent.
Performance of beating heart extraanatomical coronary artery bypass grafts for management of a heavily diseased ascending aorta can result in a very low stroke rate despite a considerable stroke risk. The complexity of the procedures may be reflected by a relatively high rate of perioperative myocardial infarctions. Perioperative mortality as well as short term patency of extraanatomical bypass grafts seem to be acceptable.
Heart Surgery Forum 02/2002; 5 Suppl 4:S272-81. · 0.63 Impact Factor
