Biomedical subjects
Publications and source records attributed to B Almgren.
The Ehlers-Danlos syndrome is a rare condition, which usually is easily recognized. In one type of this disease, type IV, arterial fragility dominates, and the syndrome may remain undiscovered until the patient has a traumatic or spontaneous arterial rupture. Two cases with a fatal outcome are presented in order to emphasize some important aspects in the management of these patients.
Spontaneous rupture of the splenic vein secondary to hepatic cirrhosis is a rare condition with a high mortality rate. Two case histories are presented with a review of the two other cases in the literature. Survival following rupture depends upon early recognition and immediate operation.
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A posterior midline incision was used for subfascial ligation of incompetent medial and lateral perforating veins in 57 limbs. The indications for surgery were recurrent ulceration in 41 limbs and severe skin changes in 16 limbs. At follow-up two years or more after surgery 48 limbs remained free from ulceration. Wound infection (7%) and necrosis (12%) healed with conservative treatment. In our experience the posterior approach is a good alternative to other methods for ligation of incompetent perforating veins in patients with advanced skin changes, including active ulceration.
A retrospective study was made of 7 patients with infected vascular grafts treated by local debridement, drainage and continuous antibiotic irrigation in combination with systemic antibiotics. The long-term results were excellent in 4 patients in whom infection had occurred along Dacron grafts without involvement of anastomoses but involved a risk of rebleeding. Some general principles in the management of patients with infected vascular grafts are suggested.
Nine operatively treated patients with abdominal aortic aneurysm and associated perianeurysmal fibrosis are reported. The fibrotic reaction closely corresponded to the extent of the aneurysmal disease. In four patients only the periaortic tissue was involved, whereas in the other five there was also involvement of the tissue surrounding the inferior vena cava, the duodenum and one or both ureters. A tentative preoperative diagnosis of perianeurysmal fibrosis was made in three patients and in one of them this was confirmed at computer tomography. In view of the similarity in clinical and microscopic appearance it is suggested that "perianeurysmal fibrosis", "inflammatory aneurysms" and retroperitoneal fibrosis" associated with abdominal aortic aneurysms might represent the same disease or different stages of it.
A 9-yr-old boy with polyarteritis nodosa presented a ruptured ileocolic arterial aneurysm that was resected and ligated at emergency operation. After angiographic examination showing multiple aneurysms of visceral arteries the inferior mesenteric and the common hepatic arteries were also ligated. One year postoperatively and on steroid medication the child is symptomfree with normal laboratory data.
Aortic abdominal aneurysm combined with aorto-caval fistula is a rare condition with a high mortality. We discuss here the sympatomatology and treatment of one such patient.
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The first reported case of abdominal aortic aneurysm complicating homocystinuria is presented. The clinical features and microscopic findings were identical to those of an atherosclerotic aneurysm. Homocystinuria may stimulate Marfan's syndrome but can be differentiated by the cyanide-nitroprusside screening test for homocystine in urine. Although homocystinuria is accompanied by an increased risk of thrombosis, surgical treatment of complicating diseases should not be avoided. Pyridoxine treatment is recommended.
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A brief review of the superior mesenteric artery syndrome is given. A case is reported which occurred after 9 weeks of treatment of a fractured femur by continuous traction with balanced suspension. The condition was successfully treated by conservative measures including a plaster hip spica allowing frequent changes of position. The importance of early diagnosis and prompt treatment is emphasized.
PURPOSE: To determine the efficacy, safety and long-term results of crural artery percutaneous transluminal angioplasty (PTA) in limbs with chronic critical limb ischemia (CLI). METHODS: Patients undergoing crural artery PTA due to CLI were followed at regular clinic visits with ankle brachial pressure index (ABPI) measurements. PTA of the crural arteries was attempted either alone (n = 39) or in combination with PTA of the superficial and/or popliteal artery (n = 55) in 86 limbs (82 patients and 94 procedures) presenting with CLI. The ages of patients ranged from 37 to 94 years (mean 72 years). The indications for PTA were rest pain in 10 and ulcer/gangrene in 84 limbs. RESULTS: A technically successful PTA with at least one crural level was achieved in 88% of cases (n = 83). Cumulative primary clinical success rates at 6, 12, 24, and 36 months were 55%, 51%, 36%, and 36%, respectively. Cumulative secondary clinical success and limb salvage rates at 36 months were 44% and 72%, respectively. CONCLUSION: PTA of the crural arteries might be considered the primary choice of treatment in patients with CLI and distal lesions with localized stenosis or segmental short occlusions.
This retrospective study was conducted to analyze a new concept of evaluation of the effect of distal runoff on patency in infrainguinal bypass surgery for arterial insufficiency. Distal runoff was evaluated on postreconstruction angiograms in 191 limbs undergoing femoropopliteal and femorodistal reconstruction. Runoff was characterized as good, fair, or poor. Determination of graft patency was made by clinical examination, ankle-brachial index measurement, or duplex scanning at 1 month and thereafter at 6-month intervals. Cumulative patency rates were calculated according to the actuarial life table method. Patency rates in limbs with good runoff were better than in limbs with fair and poor runoff; at 6 months, patency rates were 88.2%, 70.9%, and 21.8%, respectively (p < 0.01). Similar patency rates were found for good runoff in femoropopliteal and femorodistal reconstructions (84.7% in femoropopliteal and 75% in femorodistal reconstructions) at 6 months. The authors conclude that this method of angiographic evaluation accurately predicts patency in infrainguinal bypass reconstructions.
A patient with a large, rapidly expanding extracranial carotid artery aneurysm was successfully operated upon during intentional arrest of the circulation. This was accomplished with cardiopulmonary bypass and hypothermia. The advantages and disadvantages of this technique are discussed.
Seventeen patients (18 extremities) with primary deep venous insufficiency underwent femoral vein valve repair. Prior to the valvuloplasty the superficial and perforator systems were treated surgically. Dynamic venous pressure measurement and Doppler examination were done for late objective assessment of the valve repair. At early follow-up the reconstructed valves were competent, and all patients showed symptomatical improvement. Significant improvement in pressure reduction and recovery time was observed at postoperative venous pressure measurements. Good or excellent long-term results were obtained in 67% of the extremities after two to five years. Late recurrence of symptoms and incompetence of the reconstructed valve occurred in five extremities. Valve repair may offer good long-term results, but further studies are required to assess the appropriate place of this procedure in the treatment of primary deep venous insufficiency.
Postoperative renal complications have been investigated in 31 patients subjected to left renal vein ligation during abdominal aortic surgery (11 ruptured and 18 non-ruptured aneurysms, 2 occlusive diseases). A marked increase in s-creatinine values was found in all patients after left renal vein ligation. The increase was significantly longer (p less than 0.01) and higher (p less than 0.005) as compared with control patients subjected to abdominal aortic surgery without ligation of the left renal vein. A sustained increase in postoperative s-creatinine values was found in 6 patients, one of whom had a total loss of left kidney function. Left-sided nephrectomy was necessary in 2 patients to control bleeding from the kidney. Acute haemorrhagic infarction and subinfarction of the left kidney were seen in 2 patients. A restricted application of left renal vein ligation during abdominal aortic surgery is recommended.