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  • 1
    Electronic Resource
    Electronic Resource
    Progress in the Management of Type I Thoracoabdominal and Descending Thoracic Aortic Aneurysms (1999)
    Springer
    Annals of vascular surgery 13 (1999), S. 457-462 
    Details
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: p 〈 0.003). The adjunct group had more preoperative renal insufficiency (p 〈 0.05), an established risk factor for neurologic deficit (odds ratio = 2.2 in published studies). All other risk factors for neurologic deficit occurred with comparable frequency in both groups. We conclude that the introduction of adjuncts has dramatically reduced the neurologic risk associated with type I thoracoabdominal or total descending thoracic aortic repair. Previously considered high risk for neurologic complications, these aneurysms can now be reclassified as low risk in surgery accompanied by adjuncts. Future investigations will focus on type II thoracoabdominal aortic aneurysm as the major source of neurologic morbidity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100169900284
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  • 2
    Electronic Resource
    Electronic Resource
    Ambulatory Conservative Hemodynamic Management of Varicose Veins: Critical Analysis of Results at 3 Years (2000)
    Springer
    Annals of vascular surgery 14 (2000), S. 376-384 
    Details
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100169910064
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  • 3
    Electronic Resource
    Electronic Resource
    Treatment of Aortic Arch Dissection Using the Elephant Trunk Technique (2000)
    Springer
    Annals of vascular surgery 14 (2000), S. 612-619 
    Details
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: n = 7) or thoracoabdominal (n= 15) aorta. Procedures were performed under hypothermic circulatory arrest at between 15° and 20°C. Antegrade cerebral perfusion was used in three cases. The procedure was associated with aortic valve replacement and/or coronary bypass in 6 cases and bypass of one or more supraaortic vessels in 13. In two patients the distal end of the elephant trunk was attached with an endovascular prosthesis during the same procedure. The ensuing results in these patients indicate that the elephant trunk technique can be highly effective for treatment of complex aortic arch dissection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100169910111
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  • 4
    Electronic Resource
    Electronic Resource
    Occlusive Fibromuscular Disease of Arteries Supplying the Brain: Results of Surgical Treatment (1997)
    Springer
    Annals of vascular surgery 11 (1997), S. 496 -504 
    Details
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: n = 36) or two (n= 29) internal carotid arteries, and one (n= 18) or two (n= 14) vertebral arteries. Twenty-seven patients had simultaneous involvement of both carotid and vertebral arteries. Ten patients had FMD at another site, four had intracranial aneurysm, and four had an aberrant right subclavian artery. Seventy-seven carotid procedures including 67 graduated intraluminal dilatations were performed and 18 vertebral arteries were revascularized. One patient (1.4%) died postoperatively from hemorrhagic stroke and two patients (2.8%) presented nonlethal stroke. Sixty-two patients were followed postoperatively from 2 to 184 months (mean 86.2 ± 54.4). Actuarial survival rates at 5 and 10 years were 96.4 ± 5.0% and 82.1 ± 14.9%, respectively. Actuarial primary patency rate at 5 and 10 years was 94.3 ± 5.5%. Actuarial probability of stroke-free survival rates at 5 and 10 years were 94.2 ± 5.6% and 88.6% ± 10.3%, respectively. We conclude that improvement of symptoms, prevention of stroke, and stable long-term results justify surgical treatment in symptomatic patients with FMD of arteries supplying the brain.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100169900081
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  • 5
    Electronic Resource
    Electronic Resource
    Carotid eversion endarterectomy: Short- and long-term results (1995)
    Springer
    Annals of vascular surgery 9 (1995), S. 9-15 
    Details
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From January 1979 to December 1993, of 2723 carotid revascularizations performed on our service, 168 (6.2%) were isolated carotid eversion endarterectomies (CEEs) for atherosclerotic occlusive disease. Since 10 of these procedures were bilateral, there were 158 patients total (88 men and 70 women). Twenty-six (16.5%) had diabetes, 54 (34.2%) had coronary disease, and 107 (67.7%) had hypertension. The mean age was 68.9±8.9 years (range 38 and 85 years). Preoperative ischemic symptoms were hemispheric in 93 (55.4%) patients, retinal in 31 (18.4%), and vertebrobasilar in 37 (22%). They consisted of one or more strokes in 44 (26.2%) patients and one or more transient ischemic attacks in 99 (58.9%); 25 (14.9%) patients were asymptomatic. The operated lesion contained atherosclerotic stenotic plaque in all cases. The lesion was tightly stenotic (〉75%) and hemodynamically significant in 93 (55.4%) cases and irregular or ulcerated in all others. In 86 (51.2%) patients a coil or kink of the distal internal carotid artery was also present. The contralateral carotid artery was totally occluded in eight (4.7%) patients and tightly stenotic in seven (4.2%). All patients were operated on under deep general anesthesia; they were given systemic heparin and normal blood pressure was maintained. After freeing and cross-clamping of the carotid bifurcation, the end of the common carotid artery or the ostium of the internal carotid artery was sectioned. The section allowed a deep-plane endarterectomy through eversion and excellent control over the endarterectomized surface and its extremities. Since January 1989 completion arteriography has been routinely performed after CEE. There were three (1.9%) postoperative deaths in the series (two due to ipsilateral ischemic stroke and one due to contralateral ischemic stroke in the context of congestive heart failure) and two (2.9%) nonlethal ischemic strokes (one ipsilateral and one contralateral). All CEEs were controlled using arteriography in 60 (35.7%) cases or duplex scanning in all others, and in all except one patency was confirmed in the postoperative period. The mean follow-up was 53 months (5 to 160 months). At 5 years the primary patency rate was 99.4%±1.2% and the ipsilateral ischemic stroke-free rate was 93.2%±5.7%. CEE is a fast, safe, easy, and satisfactory technique that avoids the stenotic consequences of a longitudinal arteriotomy and does not necessitate a patch. Provided that completion arteriography is possible, CEE should be used more often, especially when the carotid artery is elongated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02015311
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  • 6
    Electronic Resource
    Electronic Resource
    Direct transposition of the distal cervical vertebral artery into the internal carotid artery (1995)
    Springer
    Annals of vascular surgery 9 (1995), S. 515-524 
    Details
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From January 1979 to December 1991, 92 revascularizations of the V3 segment of the vertebral artery were performed in 91 patients through a direct transposition of this artery into the internal carotid artery (ICA). These cases represented 15.1% of 610 vertebral revascularizations and 38.8% of 280 distal vertebral revascularizations performed during this period at our institution. The sex ratio of this population was 0.59, and the mean age was 59.4±13.2 years (range 14 to 82 years). Preoperative ischemic symptoms were vertebrobasilar in 87 (94.6%) cases, exclusively hemispheric in one (1.1%), and absent in the remaining four (4.3%). One of these four patients had asymptomatic severe multivessel occlusive disease and three others underwent resection of a spinal tumor involving the vertebral foraminal canal. In 31 (33.7%) cases significant carotid occlusive disease was also present. The distal V3 segment of the artery was directly transposed into the ICA in all cases in this series. In 24 (26.1%) cases the ICA was endarterectomized during the same operation. There were no deaths or strokes in this series but there were two (2.2%) transient ischemic attacks-one vertebrobasilar and the other hemispheric. However, eight (8.7%) transposed vertebral arteries were totally occluded at early follow-up. At 1 month, among the 87 patients with vertebrobasilar insufficiency, 44 (50.6%) were cured, 31 (35.6%) were improved, and 12 (13.8%) remained unchanged. Among the 12 who were unchanged, eight (66.7%) had occlusion or stenosis of the distal transposition at the time of discharge. At 5 years, the primary patency rate in the series was 89.1%±7.2%. At the time of the last follow-up, among the 87 patients with vertebrobasilar insufficiency, 50 (57.5%) were cured, 25 (28.7%) were improved, two (2.3%) had remained unchanged since the operation, two (2.3%) suffered a relapse, and eight (9.2%) exhibited vertebrobasilar symptoms of varying severity and therefore could not be considered improved. Direct transposition of the V3 segment of the vertebral artery into the ICA is a simple, safe, and reliable technique for revascularization of the distal cervical vertebral artery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02018824
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  • 7
    Electronic Resource
    Electronic Resource
    Popliteal aneurysm due to fibromuscular dysplasia (1996)
    Springer
    Annals of vascular surgery 10 (1996), S. 578-581 
    Details
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report herein the case of an asymptomatic popliteal aneurysm due to fibromuscular dysplasia in a 39-year-old woman. The aneurysm was resected and arterial continuity restored by direct end-to-end anastomosis. Pathologic findings were consistent with fibromuscular dysplasia of the media. To the best of our knowledge, this is the fourth case documented by pathologic findings in the literature.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02000447
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  • 8
    Electronic Resource
    Electronic Resource
    Surgical reconstruction of the internal carotid artery with contralateral occlusion without use of shunt (1991)
    Springer
    Annals of vascular surgery 5 (1991), S. 55-60 
    Details
    ISSN: 1615-5947
    Keywords: Carotid artery stenosis ; carotid artery lesions ; neurologic complications ; intraluminal shunt
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Between 1979 and 1989, 133 carotid artery reconstructions were performed in 130 patients with contralateral internal carotid artery occlusion. These 133 reconstructions represent 7.3% of 1815 revascularizations of the internal carotid artery for atheromatous lesions performed during the same period. There were 113 men (87%) and 17 women (13%) whose mean age was 64.8 years (range 38 to 83 years). Forty-two patients (32%) had coronary artery disease and 77 (59%) were hypertensive. Nineteen patients (14%) were asymptomatic; 16 (12%) had symptoms of isolated vertebrobasilar insufficiency; 19 (14%) had ipsilateral carotid symptoms (on the side of operation); 67 (51%) had contralateral symptoms (on the side of occlusion); and 12 (9%) had bilateral carotid symptoms. All procedures were performed under general anesthesia without the use of a shunt. Nine patients (6.8%) died in the postoperative period (eight of neurologic and one of respiratory causes). Twelve patients (9%) sustained a cerebral vascular accident (eight ipsilateral and four contralateral). Four of these cerebral vascular accidents were diagnosed upon awakening, the remaining eight occurred after an initial uneventful recovery. Combined neurologic mortality and morbidity was 9.8%. Patients with occlusive lesions of the contralateral carotid artery undergoing internal carotid artery reconstruction are at high risk for postoperative cerebral vascular accidents. It is in this group of patients that the various methods of monitoring and cerebral protection should be evaluated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02021779
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  • 9
    Electronic Resource
    Electronic Resource
    Stenotic coiling and kinking of the internal carotid artery (1993)
    Springer
    Annals of vascular surgery 7 (1993), S. 530-540 
    Details
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Between January 1979 and December 1991, 174 of a total of 2304 carotid reconstructions (7.5%) were performed in 166 patients for stenotic coiling or kinking of the internal carotid artery. There was a 1.4 male predominance and the mean age of the patients was 66.3 ± 9.6 years (range 38 to 91 years). Seventeen patients (9.8%) were asymptomatic, 54 (31%) were symptomatic because of a previous stroke, and 103 (59.2%) had had transient ischemic attacks. The symptoms were hemispheric in 108 (62.1%) cases, ocular in 19 (10.9%), and vertebrobasilar in 30 (17.2%). The stenotic coiling or kinking was isolated in 35 (20.1%) cases and associated with other lesions of the internal carotid artery in 139 (79.9%). These included 119 atherosclerotic stenoses, 14 aneurysms, and six stenotic lesions due to fibromuscular dysplasia. Angioplasty of the carotid bifurcation was performed in 102 (58.6%) patients, associated with endarterectomy in 84 (48.3%) cases and with dilatation of dysplastic lesions in six (3.5%) cases. A bypass graft and resection and anastomosis of the carotid artery were performed in 36 (20.7%) patients each. There were four postoperative deaths (2.3%): two were due to neurologic causes, one to heart disease, and one to complications of an associated surgical procedure. Five patients (2.9%) had postoperative strokes and eight (4.6%) had transient ischemic attacks. At postoperative follow-up investigations four (2.3%) patients had carotid occlusions and 10 (5.7%) had morphologic abnormalities. At 5 years, actuarial survival was 80.97 ± 8.8%, patency was 96.12 ± 2.95%, and the ipsilateral stroke-free rate was 93.12 ± 4.49%. Treatment of stenotic coiling or kinking of the internal carotid artery yields satisfactory results, comparable to those of endarterectomy, for isolated atherosclerotic carotid stenoses and is effective in the prevention of ipsilateral ischemic stroke.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02000147
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  • 10
    Electronic Resource
    Electronic Resource
    11. Ergebnisse einer französischen Umfrage über die Anwendung von chirurgischen Klammerinstrumenten in der Gastrointestinalchirurgie (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 85-87 
    Details
    ISSN: 1435-2451
    Keywords: Autosuture ; Staplers ; Stapling sutures ; Autosuture ; Klammerinstrumente ; Maschinennaht
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Ein Fragebogen wurde 40 Kliniken zugesandt, darunter 28 Universitätskliniken und 12 Privatkrankenhäuser. Mit Ausnahme von 2 Kliniken benutzen alle 38 anderen regelmässig die Klammerapparate, besonders in der Oesophagus-, Magen- und colorectalen Chirurgie. Im Vergleich zwischen Klammeranastomosen und Nahtanastomosen, behaupten 50% der Befragten, dass die Frequenz der Nahtinsuffizienz sowie der Schweregrad der Fisteln mit beiden Methoden dieselben waren. Als Gegenindikationen für die Benützung von Klammerapparaten wurden angegeben: eine sehr starke Darmdistension mit grossem Kaliberunterschied, Verdickung der Darmwände, kleines Darmkaliber, mangelhafte Erfahrung in der Handhabung solcher Apparate.
    Notes: Summary Results of an inquiry in 40 French hospitals (28 universities and 12 private clinics). With 2 exceptions, all questioned surgeons use stapler instruments in oesophagus, stomach and colon rectal surgery. 50% of the surgeons noticed the same percentage of fistulae by stapler as by hand suturing and the severity of these leakages was more or less identical in both series. As contraindications for using stapler machines oedema of the visceral wall, small size of the lumen, important visceral distension and insufficient practice with such instruments, were mentioned.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01297795
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