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  • 1
    Electronic Resource
    Electronic Resource
    Percutaneous Endoluminal Stent-Graft Repair of an Old Traumatic Femoral Arteriovenous Fistula (1996)
    Springer
    CardioVascular & interventional radiology 19 (1996), S. 120-122 
    Details
    ISSN: 1432-086X
    Keywords: Key words: Endovascular stents〈+〉—〈+〉Graft〈+〉—〈+〉Polymer〈+〉—〈+〉Stent/graft〈+〉—〈+〉Vascular trauma〈+〉—〈+〉Arteriovenous fistula
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A stent-graft was custom made to close a high-flow traumatic arteriovenous fistula of the left superficial femoral artery, present for 30 years, in a 60-year-old man with congestive heart failure and ischemic ulceration in the left foot. A balloon expandable Palmaz stent (P394; 2.5 mm × 3.9 cm) was covered with a polytetrafluoroethylene (PTFE) graft and was inserted percutaneously through an 11 Fr vascular sheath. Follow-up Doppler ultrasound at 6 months demonstrated occlusion of the arteriovenous fistula, patency of the artery, and luminal integrity of the artery and vein.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002709900028
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Does postoperative surveillance with duplex scanning identify the failing distal bypass? (1991)
    Springer
    Annals of vascular surgery 5 (1991), S. 182-185 
    Details
    ISSN: 1615-5947
    Keywords: Duplex scanning ; graft flow velocity measurements ; distal lower extremity bypass ; peripheral vascular disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Duplex scanning used to determine graft flow velocities is an effective means of identifying lower extremity bypass grafts at risk for failure before they occlude. We implemented a graft surveillance protocol using duplex scanning and over a two-year interval evaluated fifty-four lower extremity bypasses utilizing graft flow velocities, ankle/brachial indices, and toe pressure measurements. Three patients were identified with grafts at risk for thrombosis. Of these patients, one had no evidence of arteriographic stenosis, one patient had clinical symptoms of reduced flow velocity measurements, and one's graft subsequently occluded during follow-up. Eight patients with graft flow velocities of greater than 45 cm/sec subsequently developed occlusion or were noted to have a severe associated stenosis. Six patients developed unheralded graft occlusion less than three months following determination of the graft flow velocity. Four of these patients (67%) had bypasses to the dorsalis pedis artery. Graft flow velocity measurements do not always predict an impending graft failure, and other factors may contribute to the sudden occlusion of patent distal bypasses, especially to the pedal arteries. Although the concept of hemodynamic monitoring to identify impending graft failure is an attractive one, more sensitive or refined measurements (especially to the pedal vessels), are required.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02016753
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Limitations of subfascial ligation for refractory chronic venous stasis ulceration (1992)
    Springer
    Annals of vascular surgery 6 (1992), S. 9-14 
    Details
    ISSN: 1615-5947
    Keywords: Deep venous perforators ; subfascial ligation ; ulceration ; skin grafting ; venous insufficiency ; peripheral vascular disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Eighteen subfascial ligations of deep venous perforators were performed on 17 patients with refractory venous stasis ulceration. Thirteen patients also required concomitant or subsequent split thickness skin grafting. Primary indications included: (1) recurrence of ulceration during adequate support therapy with failure to heal using conservative measures (10 cases–55%) and (2) failure to heal with support therapy alone (eight cases 45%). Five limbs had ulcers greater than 30 cm2 and two had giant ulcers (〉50 cm2). Most extremities had evidence of venous reflux by photoplethysmography or Doppler ultrasound (10 of 11) or chronic deep venous thrombosis by venography (six of seven). Mean hospital stay was 23 days±17, range six to 68 days. Early complications, including incisional breakdown or partial skin graft loss, were common and occurred in 10 patients. With a mean follow-up interval of 28 months (range nine to 49 months), most limbs (N=10) were judged cured, including both with giant ulcers, and three significantly improved. By life table analysis, 63% were free from significant ulcer recurrence at 42 months. Four limbs were not significantly improved following surgery. Most patiens with refractory venous ulceration will benefit from subfascial ligation of deep venous perforators and skin grafting, although recurrent or persistent ulceration remains problematic for a significant number of patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02000660
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  • 4
    Electronic Resource
    Electronic Resource
    Distal wound complications following pedal bypass: Analysis of risk factors (1995)
    Springer
    Annals of vascular surgery 9 (1995), S. 53-59 
    Details
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Wound complications of the pedal incision continue to compromise successful limb salvage following aggressive revascularization. Significant distal wound disruption occurred in 14 of 142 (9;8%) patients undergoing pedal bypass with autogenous vein for limb salvage between 1986 and 1993. One hundred forty-two pedal bypass procedures were performed for rest pain in 66 patients and tissue necrosis in 76. Among the 86 men and 56 women, 76% were diabetic and 73% were black. All but eight patients had a history of diabetes and/or tobacco use. Eight wounds were successfully managed with maintenance of patent grafts from 5 to 57 months. Exposure of a patent graft precipitated amputation in three patients, as did graft occlusion in an additional patient. One graft was salvaged by revision to the peroneal artery and one was covered by a local bipedicled flap. Multiple regression analysis identified three factors associated with wound complications at the pedal incision site: diabetes mellitus (p=0.03), age 〉70 years ( p =0.03), and rest pain ( p =0.05). Ancillary techniques (“pie-crusting”) to reduce skin tension resulted in no distal wound problems among 15 patients considered to be at greatest risk for wound breakdown. Attention to technique of distal graft tunneling, a wound closure that reduces tension, and control of swelling by avoiding dependency on and use of gentle elastic compression assume crucial importance in minimizing pedal wound complications following pedal bypass.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02015317
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  • 5
    Electronic Resource
    Electronic Resource
    Is infrapopliteal bypass compromised by distal origin of the proximal anastomosis? (1995)
    Springer
    Annals of vascular surgery 9 (1995), S. 172-178 
    Details
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Distal origination of the proximal anastomosis (DOPA) of an infrapopliteal bypass beyond the adductor hiatus minimizes the length of graft required and optimizes use of scarce autogenous conduit. Sixty-two DOPA infrapopliteal revascularizations using autogenous vein performed for limb salvage over a 7-year period were reviewed and compared with 203 concurrent infrapopliteal bypasses originating more proximally (POPA). Life-table analysis revealed no difference at 54 months between DOPA and POPA bypass with regard to primary patency (57% vs. 50%, respectively) or secondary patency (67% vs. 65%, respectively). Differences in limb salvage at 54 months between DOPA and POPA bypasses did not reach statistical significance (53% vs. 66%,p=0.12), although DOPA fared worse. Inferior limb salvage results in all infrapopliteal bypasses were correlated with the presence of tissue necrosis (52% vs. 70%,p〈0.001), which was more prevalent in patients undergoing DOPA bypass (71% vs. 49%,p〈0.01). The long-term patency of infrapopliteal bypass appears only marginally affected by DOPA. However, the prognosis for limb salvage in this setting is compromised as a result of the virulent behavior of the atherosclerotic disease that spares the superficial femoral artery while predominantly involving the popliteal and tibial vessels.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02139660
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  • 6
    Electronic Resource
    Electronic Resource
    Preoperative evaluation of cardiac risk using dobutamine-thallium imaging in vascular surgery (1990)
    Springer
    Annals of vascular surgery 4 (1990), S. 238-243 
    Details
    ISSN: 1615-5947
    Keywords: Coronary artery disease ; dobutamine-thallium imaging ; ischemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Coronary artery disease is frequently present in patients undergoing evaluation for reconstructive peripheral vascular surgery. Dobutamine-thallium imaging has been shown to be a reliable and sensitive noninvasive method for the detection of significant coronary artery disease. Eighty-seven candidates for vascular reconstruction underwent dobutamine-thallium imaging. Forty-eight patients had an abnormal dobutamine-thallium scan. Twenty-two patients had infarct only, while 26 had reversible ischemia demonstrated on dobutamine-thallium imaging. Fourteen of 26 patients with reversible ischemia underwent cardiac catheterization and 11 showed significant coronary artery disease. Seven patients underwent preoperative coronary artery bypass grafting or angioplasty. There were no postoperative myocardial events in this group. Three patients were denied surgery on the basis of unreconstructible coronary artery disease, and one patient refused further intervention. Ten patients with reversible myocardial ischemia on dobutamine-thallium imaging underwent vascular surgical reconstruction without coronary revascularization and suffered a 40% incidence of postoperative myocardial ischemic events. Five patients were denied surgery because of presumed significant coronary artery disease on the basis of the dobutamine-thallium imaging and clinical evaluation alone. Thirty-nine patients with normal dobutamine-thallium scans underwent vascular reconstructive surgery with a 5% incidence of postoperative myocardial ischemia. Dobutamine-thallium imaging is a sensitive and reliable screening method which identifies those patients with coronary artery disease who are at high risk for perioperative myocardial ischemia following peripheral vascular surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02009451
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