In this comparative study of catheter materials used in central venous catheterization (CVC) into... more In this comparative study of catheter materials used in central venous catheterization (CVC) into large veins, the overall frequency of CVC-induced thrombosis was 12%. A 20% incidence of CVC-induced thrombosis with siliconized polyethylene catheter, 9% with Teflon® catheter, and 6% with heparinized polyethylene catheter was seen. Thrombosis thus was significantly less common with Teflon® and heparinized polyethylene than with siliconized polyethylene (p<0.05). Repeat arm phlebography was performed in 15 patients and revealed no late formation or progression of thrombosis. Pulmonary embolism appeared in 2 patients and was fatal in one of them.RésuméL'étude comparative des cathéters employés pour le cathétérisme veineux central (C.V.C.) des grosses veines permet d'affirmer que la fréquence de la thrombose veineuse atteint au total 12%. Elle est de 20% avec les cathéters de polyethylène siliconé, de 9% avec ceux en Téflon et de 6% avec ceux en polyéthylène hépariné. Les 2 derniers types de cathéter sont donc préférable. Dans 15% cas la phlébographie répétée au niveau du bras ne décela aucune formation ou progression d'un élément thrombosant. Cependant 2 cas d'embolie pulmonaire dont 1 mortelle furent observés.AbstractoEn este estudio comparativo de los materiales de catéter utilizados para cateterización venosa central (CVC) de grandes venas, la frecuencia global de trombosis inducida por CVC fue de 12 por ciento. Se observó una incidencia de 20 por ciento de trombosis inducida por catéteres de polietileno siliconizados, 9 por ciento de catéteres de Teflón y 6 por ciento por catéter de polietileno heparinizado. Por consiguiente, la trombosis fue significativamente menor con Teflón y con polietileno heparinizado que con polietileno siliconizado (p<0.05). Se realizaron flebografías repetidas del brazo que no revelaron formación tardía o prograsiva de trombosis. La embolia pulmonar se presentó en 2 pacientes y fue fatal en uno de ellos.
Purpose: To report our experience in establishing a treatment protocol for endovascular aneurysm ... more Purpose: To report our experience in establishing a treatment protocol for endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA), including an investigation of the reasons for patient exclusion and a report of our short-term results. Methods: Between 1997 and July 2002, 21 patients with rAAA underwent endovascular repair according to our protocol and were followed prospectively. A retrospective analysis was also conducted of 23 rAAA patients treated with open repair from January 2001 through June 2002. Procedural and clinical data from this sample were compared to 14 contemporaneous emergent EVAR cases and analyzed to determine why the open repair patients were not treated with an endovascular approach. Results: Among the 21 patients treated with emergent EVAR since the beginning of this protocol, 6 (29%) procedures were performed under local anesthesia and 6 were performed percutaneously. Thirty-day mortality was 19%. In the comparison of 14 emergent EVAR cases to 23 open rAAA repairs, the mean duration of symptoms prior to intervention was 12 hours for the EVAR patients and &lt;1 hour for OR patients. No significant difference was found in operating time, but the EVAR group had significantly less blood loss (p=0.0001) and transfusion needs (p=0.02); duration of intensive care unit stay was significantly shorter in the EVAR group (p=0.02). Thirty-day mortality was 29% (4/14) for EVAR and 35% for OR (8/23) (p&gt;0.05). Reasons for not performing EVAR were unavailability of adequate equipment (n=11) or trained staff (n=7), hemodynamically unstable patient (n=2), mycotic aneurysm (n=2), and unfavorable anatomy in a 60-year old patient with a &lt;5-mm-long, sharply angled infrarenal neck. Conclusions: Endovascular repair of ruptured aortic aneurysms is feasible, and short-term results are promising. Good logistics, adequate training of physicians and staff in an elective setting, and versatile endografts are prerequisites for this type of treatment program.
Chronic mesenteric ischaemia is a rare but serious condition, which if untreated may cause death ... more Chronic mesenteric ischaemia is a rare but serious condition, which if untreated may cause death secondary to starvation or bowel infarction. As the symptoms are sometimes unspecific, its diagnosis may be delayed or missed. Although open surgical revascularisation has been the traditional treatment, a review of published reports suggests it to be associated with operative mortality rates of 6-9 per cent, and major morbidity rates of 22-26 per cent. Reports by others, and our own experience, suggest that endovascular treatment of mesenteric atherosclerotic obstructions with PTA (percutaneous transluminal angioplasty) and stenting may yield patency rates differing little from those associated with surgery, but significantly lower mortality (1.6%) and morbidity (5.6%).
We report on endovascular repair of a ruptured abdominal aortic aneurysm. A bifurcated stent graf... more We report on endovascular repair of a ruptured abdominal aortic aneurysm. A bifurcated stent graft was inserted under local anesthesia. Aortic clamping is rapidly provided by percutaneous placement of an aortic occlusion balloon catheter. Carbon dioxide can usually replace conventional contrast in patients with renal insufficiency. This minimally invasive procedure may reduce perioperative morbidity and mortality in patients with ruptured aortic aneurysms. The advantages and limitations of this novel technique are discussed.
The aim of this study was to investigate whether pretreatment with drugs that interfere with plat... more The aim of this study was to investigate whether pretreatment with drugs that interfere with platelet functions in different ways could modify the pulmonary vascular response in a porcine septic shock model. Septic shock was induced by i.v. infusion of live Escherichia coli bacteria. Bacteriemic animals were divided into five groups: untreated or pretreated with a thromboxane-A2 synthetase inhibitor (UK 38 485), a serotonin-receptor antagonist (ketanserin), a combination of these two drugs, or a platelet antiaggregating drug (dipyridamole). E. coli induced significant pulmonary hemodynamic and respiratory changes. The pulmonary responses to E. coli infusion were attenuated after pretreatment with UK 38 485 but unaffected by prior administration of ketanserin or dipyridamole. The combined pretreatment did not attenuate the pulmonary hypertension or other pulmonary responses to E. coli more than UK 38 485 alone. Dipyridamole did not alter the pulmonary circulation after bacterial infusion. It was concluded that thromboxane-A2 is an important, but not the only, mediator of the pulmonary vascular response in septic-shocked pigs and that factors such as serotonin and platelet aggregability seem to be of minor, if any, importance for the hemodynamic response.
The efficacy of dextran 70 with or without dihydroergotamine as prophylaxis against deep venous t... more The efficacy of dextran 70 with or without dihydroergotamine as prophylaxis against deep venous thrombosis (DVT) was tested prospectively in a randomized series of 65 patients with fracture of the hip. Diagnostic evaluation was made with bilateral ascending phlebography on postoperative day 7. In the dextran 70 group, 5 of the 27 phlebographically studied patients had DVT, an incidence not significantly different from the 10 DVT among 28 patients given dextran 70 + dihydroergotamine. Bleeding complications showed no intergroup difference. The study did not confirm a beneficial effect of dextran 70 in combination with dihydroergotamine as compared with dextran alone in regard to thrombotic complications after surgery for hip fracture.
Initial adherence of 111Indium-oxine labeled, cultured canine venous endothelial cells to expande... more Initial adherence of 111Indium-oxine labeled, cultured canine venous endothelial cells to expanded polytetrafluorethylene (ePTFE) grafts was evaluated using different precoatings of the surface or different pretreated cells. The precoatings evaluated consisted of blood for 5 (Group I) or 15 min (Group II), fibronectin (Group IV), and cryoprecipitate (Group VI). In addition to endothelial cells subcultured immediately before labeling, cells subcultured 48 hours prior to labeling and kept in suspension were studied. Such cells were evaluated on grafts precoated with blood for 5 min (Group III) and fibronectin precoated surfaces (Group V). The amount of fibronectin that adhered to the graft surface with our technique was less den 1%. Seeding efficiency was higher with the blood precoated surfaces (5.3, 3.0, 2.2% in Groups I, II and III respectively) than fibronectin (1.7%, 1.7% in Groups IV, V respectively) or cryoprecipitate (1.9%, Group VI) precoated surfaces. No significant difference between cells immediately subcultured and these kept in suspension for 48 hours regarding adherence to blood (5.3 vs. 2.2%) or fibronectin precoated (1.7 vs. 1.7%) grafts was documented. The seeding efficiency of ePTFE grafts is low and further efforts to improve adherence must be made. From the present studies we recommend the use of blood precoating for about 5 min followed by cell incubation for approximately 10 min in order to achieve optimal seeding efficiency.
In a 10-year period, 80 patients, median age 78 years, were operated on for mesenteric vascular o... more In a 10-year period, 80 patients, median age 78 years, were operated on for mesenteric vascular occlusion--arterial in 50 cases, venous in 24 and of uncertain etiology in six cases. Abdominal pain out of proportion to physical findings occurred in only eight cases. Vague abdominal symptoms with increasing tenderness led to surgical exploration in most cases. Median patient delay was 34 hours and doctor's delay 15 hours. Resection was primarily nonfeasible in 28 cases. Primary resection without second-look operation was performed in 32 cases, in seven of which signs of anastomotic insufficiency appeared. In the remaining 20 cases, primary resection (18) and/or embolectomy (3/2) was followed by a planned second-look operation within 24 hours, when five resections were performed. In a patient with viable anastomosis at second look, there were late signs of anastomotic insufficiency. Although the data do not permit firm recommendations, use of second-look operation in patients with doubtful viability of the intestine may reduce the extent of resection at primary exploration and also the incidence of insufficient anastomosis.
In this comparative study of catheter materials used in central venous catheterization (CVC) into... more In this comparative study of catheter materials used in central venous catheterization (CVC) into large veins, the overall frequency of CVC-induced thrombosis was 12%. A 20% incidence of CVC-induced thrombosis with siliconized polyethylene catheter, 9% with Teflon® catheter, and 6% with heparinized polyethylene catheter was seen. Thrombosis thus was significantly less common with Teflon® and heparinized polyethylene than with siliconized polyethylene (p<0.05). Repeat arm phlebography was performed in 15 patients and revealed no late formation or progression of thrombosis. Pulmonary embolism appeared in 2 patients and was fatal in one of them.RésuméL'étude comparative des cathéters employés pour le cathétérisme veineux central (C.V.C.) des grosses veines permet d'affirmer que la fréquence de la thrombose veineuse atteint au total 12%. Elle est de 20% avec les cathéters de polyethylène siliconé, de 9% avec ceux en Téflon et de 6% avec ceux en polyéthylène hépariné. Les 2 derniers types de cathéter sont donc préférable. Dans 15% cas la phlébographie répétée au niveau du bras ne décela aucune formation ou progression d'un élément thrombosant. Cependant 2 cas d'embolie pulmonaire dont 1 mortelle furent observés.AbstractoEn este estudio comparativo de los materiales de catéter utilizados para cateterización venosa central (CVC) de grandes venas, la frecuencia global de trombosis inducida por CVC fue de 12 por ciento. Se observó una incidencia de 20 por ciento de trombosis inducida por catéteres de polietileno siliconizados, 9 por ciento de catéteres de Teflón y 6 por ciento por catéter de polietileno heparinizado. Por consiguiente, la trombosis fue significativamente menor con Teflón y con polietileno heparinizado que con polietileno siliconizado (p<0.05). Se realizaron flebografías repetidas del brazo que no revelaron formación tardía o prograsiva de trombosis. La embolia pulmonar se presentó en 2 pacientes y fue fatal en uno de ellos.
Purpose: To report our experience in establishing a treatment protocol for endovascular aneurysm ... more Purpose: To report our experience in establishing a treatment protocol for endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA), including an investigation of the reasons for patient exclusion and a report of our short-term results. Methods: Between 1997 and July 2002, 21 patients with rAAA underwent endovascular repair according to our protocol and were followed prospectively. A retrospective analysis was also conducted of 23 rAAA patients treated with open repair from January 2001 through June 2002. Procedural and clinical data from this sample were compared to 14 contemporaneous emergent EVAR cases and analyzed to determine why the open repair patients were not treated with an endovascular approach. Results: Among the 21 patients treated with emergent EVAR since the beginning of this protocol, 6 (29%) procedures were performed under local anesthesia and 6 were performed percutaneously. Thirty-day mortality was 19%. In the comparison of 14 emergent EVAR cases to 23 open rAAA repairs, the mean duration of symptoms prior to intervention was 12 hours for the EVAR patients and &lt;1 hour for OR patients. No significant difference was found in operating time, but the EVAR group had significantly less blood loss (p=0.0001) and transfusion needs (p=0.02); duration of intensive care unit stay was significantly shorter in the EVAR group (p=0.02). Thirty-day mortality was 29% (4/14) for EVAR and 35% for OR (8/23) (p&gt;0.05). Reasons for not performing EVAR were unavailability of adequate equipment (n=11) or trained staff (n=7), hemodynamically unstable patient (n=2), mycotic aneurysm (n=2), and unfavorable anatomy in a 60-year old patient with a &lt;5-mm-long, sharply angled infrarenal neck. Conclusions: Endovascular repair of ruptured aortic aneurysms is feasible, and short-term results are promising. Good logistics, adequate training of physicians and staff in an elective setting, and versatile endografts are prerequisites for this type of treatment program.
Chronic mesenteric ischaemia is a rare but serious condition, which if untreated may cause death ... more Chronic mesenteric ischaemia is a rare but serious condition, which if untreated may cause death secondary to starvation or bowel infarction. As the symptoms are sometimes unspecific, its diagnosis may be delayed or missed. Although open surgical revascularisation has been the traditional treatment, a review of published reports suggests it to be associated with operative mortality rates of 6-9 per cent, and major morbidity rates of 22-26 per cent. Reports by others, and our own experience, suggest that endovascular treatment of mesenteric atherosclerotic obstructions with PTA (percutaneous transluminal angioplasty) and stenting may yield patency rates differing little from those associated with surgery, but significantly lower mortality (1.6%) and morbidity (5.6%).
We report on endovascular repair of a ruptured abdominal aortic aneurysm. A bifurcated stent graf... more We report on endovascular repair of a ruptured abdominal aortic aneurysm. A bifurcated stent graft was inserted under local anesthesia. Aortic clamping is rapidly provided by percutaneous placement of an aortic occlusion balloon catheter. Carbon dioxide can usually replace conventional contrast in patients with renal insufficiency. This minimally invasive procedure may reduce perioperative morbidity and mortality in patients with ruptured aortic aneurysms. The advantages and limitations of this novel technique are discussed.
The aim of this study was to investigate whether pretreatment with drugs that interfere with plat... more The aim of this study was to investigate whether pretreatment with drugs that interfere with platelet functions in different ways could modify the pulmonary vascular response in a porcine septic shock model. Septic shock was induced by i.v. infusion of live Escherichia coli bacteria. Bacteriemic animals were divided into five groups: untreated or pretreated with a thromboxane-A2 synthetase inhibitor (UK 38 485), a serotonin-receptor antagonist (ketanserin), a combination of these two drugs, or a platelet antiaggregating drug (dipyridamole). E. coli induced significant pulmonary hemodynamic and respiratory changes. The pulmonary responses to E. coli infusion were attenuated after pretreatment with UK 38 485 but unaffected by prior administration of ketanserin or dipyridamole. The combined pretreatment did not attenuate the pulmonary hypertension or other pulmonary responses to E. coli more than UK 38 485 alone. Dipyridamole did not alter the pulmonary circulation after bacterial infusion. It was concluded that thromboxane-A2 is an important, but not the only, mediator of the pulmonary vascular response in septic-shocked pigs and that factors such as serotonin and platelet aggregability seem to be of minor, if any, importance for the hemodynamic response.
The efficacy of dextran 70 with or without dihydroergotamine as prophylaxis against deep venous t... more The efficacy of dextran 70 with or without dihydroergotamine as prophylaxis against deep venous thrombosis (DVT) was tested prospectively in a randomized series of 65 patients with fracture of the hip. Diagnostic evaluation was made with bilateral ascending phlebography on postoperative day 7. In the dextran 70 group, 5 of the 27 phlebographically studied patients had DVT, an incidence not significantly different from the 10 DVT among 28 patients given dextran 70 + dihydroergotamine. Bleeding complications showed no intergroup difference. The study did not confirm a beneficial effect of dextran 70 in combination with dihydroergotamine as compared with dextran alone in regard to thrombotic complications after surgery for hip fracture.
Initial adherence of 111Indium-oxine labeled, cultured canine venous endothelial cells to expande... more Initial adherence of 111Indium-oxine labeled, cultured canine venous endothelial cells to expanded polytetrafluorethylene (ePTFE) grafts was evaluated using different precoatings of the surface or different pretreated cells. The precoatings evaluated consisted of blood for 5 (Group I) or 15 min (Group II), fibronectin (Group IV), and cryoprecipitate (Group VI). In addition to endothelial cells subcultured immediately before labeling, cells subcultured 48 hours prior to labeling and kept in suspension were studied. Such cells were evaluated on grafts precoated with blood for 5 min (Group III) and fibronectin precoated surfaces (Group V). The amount of fibronectin that adhered to the graft surface with our technique was less den 1%. Seeding efficiency was higher with the blood precoated surfaces (5.3, 3.0, 2.2% in Groups I, II and III respectively) than fibronectin (1.7%, 1.7% in Groups IV, V respectively) or cryoprecipitate (1.9%, Group VI) precoated surfaces. No significant difference between cells immediately subcultured and these kept in suspension for 48 hours regarding adherence to blood (5.3 vs. 2.2%) or fibronectin precoated (1.7 vs. 1.7%) grafts was documented. The seeding efficiency of ePTFE grafts is low and further efforts to improve adherence must be made. From the present studies we recommend the use of blood precoating for about 5 min followed by cell incubation for approximately 10 min in order to achieve optimal seeding efficiency.
In a 10-year period, 80 patients, median age 78 years, were operated on for mesenteric vascular o... more In a 10-year period, 80 patients, median age 78 years, were operated on for mesenteric vascular occlusion--arterial in 50 cases, venous in 24 and of uncertain etiology in six cases. Abdominal pain out of proportion to physical findings occurred in only eight cases. Vague abdominal symptoms with increasing tenderness led to surgical exploration in most cases. Median patient delay was 34 hours and doctor's delay 15 hours. Resection was primarily nonfeasible in 28 cases. Primary resection without second-look operation was performed in 32 cases, in seven of which signs of anastomotic insufficiency appeared. In the remaining 20 cases, primary resection (18) and/or embolectomy (3/2) was followed by a planned second-look operation within 24 hours, when five resections were performed. In a patient with viable anastomosis at second look, there were late signs of anastomotic insufficiency. Although the data do not permit firm recommendations, use of second-look operation in patients with doubtful viability of the intestine may reduce the extent of resection at primary exploration and also the incidence of insufficient anastomosis.
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