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Biomedical subjects

D Buchbinder

Publications and source records attributed to D Buchbinder.

At least 73 records · Page 4Linked to original sources
PubMed1987

B-mode ultrasonic imaging in the preoperative evaluation of saphenous vein.

This prospective study was undertaken to determine if B-mode ultrasonic imaging of the greater saphenous vein can provide reliable information about anatomy, sites of valves, and location of major tributaries or duplicate systems. Preoperative ultrasonic imaging was performed on 15 consecutive patients prior to in situ saphenous bypass. The findings of the ultrasonic evaluations were compared with the intraoperative findings. Preoperative assessment of the greater saphenous vein was performed with a high resolution real-time B-mode ultrasonic imager. The procedure was performed with the patient seated with the leg extended. The saphenous vein was imaged starting at the ankle. A waterproof pen was used to mark the vein. The locations of valves and tributary vessels were marked and the diameter of the saphenous vein was recorded. These results were compared with operative findings. In all 15 patients, the saphenous vein was imaged. There was 100 per cent accuracy in the detection and location of valve sites. In one patient, the proximal portion of the vein was thrombosed and this was detected by the B-mode scan. There was exact correlation in 14 of 15 limbs (93%). The one error was due to the examiners' failure to identify a triple venous system; only a double venous system was identified by scan in this patient. The actual venous diameter was consistently within 0.5 mm of that measured by the ultrasound imager. In all patients, the ultrasound image demonstrated the correct anatomic location and size of the vein. In conclusion, B-mode ultrasonic imaging provides an accurate description of the anatomy of the saphenous vein, without the morbidity associated with contrast venography.

Aged↗
PubMed1986

Results of arterial reconstruction of the foot.

Sixty-five patients with critical ischemia required bypass to foot vessels. These procedures were performed by five different techniques: (1) femoral-foot bypass with in situ saphenous vein; (2) femoral-foot bypass with reversed autogenous saphenous vein; (3) femoral-foot bypass with polytetrafluoroethylene (PTFE); (4) popliteal-foot bypass with reversed autogenous saphenous vein; and (5) popliteal-foot bypass with PTFE. The two-year patency rate of femoral-foot bypass with in situ vein (96%) was significantly higher than femoral-foot bypass with reversed vein (42%), while both procedures demonstrated significantly higher patency than femoral-foot bypass with PTFE (0%). Popliteal-foot bypass with reversed vein (92%) was superior to both popliteal-foot bypass with PTFE (27%) and femoral-foot bypass with PTFE (0%). Femoral-foot bypass with in situ vein and popliteal-foot bypass with reversed vein have appreciably increased vein utilization, graft patency, and limb salvage.

Aged↗
PubMed1986

Efficacy of femorofemoral bypass for intermittent claudication. Clinical and hemodynamic assessment.

Twenty patients treated by femorofemoral bypass were retrospectively reviewed to determine if femorofemoral bypass was efficacious in the treatment of disabling claudication. The data have clearly demonstrated that two criteria are necessary for the successful outcome of femorofemoral bypass. First, the donor artery should be hemodynamically normal in order to support the recipient limb. This can be determined by either a normal treadmill exercise test result or by a normal preoperative intraarterial papaverine test result. Second, the patient's functional improvement will be dependent on the status of the runoff vessels in the recipient limb; therefore, many patients with patent superficial femoral and popliteal arteries will have excellent results (50 percent in this series), whereas those with occluded superficial femoral or popliteal arteries or both will have less improvement (40 percent in this series). Therefore, femorofemoral bypass should be used in the treatment of intermittent disabling claudication in the properly selected patient.

Aged↗
PubMed1986

Intraoperative ultrasonic imaging of the carotid artery during carotid endarterectomy.

Intraoperative real-time B-mode ultrasonography was used to evaluate the technical results of 155 carotid endarterectomies in 143 patients. Technical defects created as a result of the endarterectomy were detected in 43 of the 155 endarterectomies (27.7%) and included intimal flaps (73% of defects); strictures (18%); and arterial kinks, residual plaque, and intraluminal thrombi (9% collectively). Eleven of the 43 endarterectomy sites (7% of all endarterectomies) were reentered to correct a defect; none of these patients had neurologic deficits, which suggests that reentering an endarterectomy and correcting a defect does not, in and of itself, lead to a higher incidence of stroke. The incidence of stroke in patients with normal results of intraoperative ultrasonography was 3.8%, whereas the incidence of perioperative stroke in those patients with insignificant and thus uncorrected defects was 3.3%; this suggests that intraoperative ultrasonography is sufficiently sensitive to detect defects that, when left uncorrected, do not lead to a higher than usual incidence of stroke. Because intraoperative ultrasonography is safe and highly sensitive, we believe it is the method of choice for assessing the technical results of carotid endarterectomy.

Adult↗
PubMed1986

Early experience with in situ saphenous vein bypass for distal arterial reconstruction.

During a 36-month period 74 patients underwent infrainguinal in situ saphenous vein bypass to the popliteal or tibial vessels. The first 54 operations were performed with standard valvulotomes and valve-cutting scissors, while in the last 20 operations a new intraluminal valve-cutting device was used to incise the valves. Ninety-four percent of bypasses were performed for limb salvage, 80% of all operations were done to the tibial vessels, and 31% of bypasses were done to the ankle vessels. The operation was attempted in 81 patients and completed in 74 patients, for a vein utilization rate of 91%. Fifty-five percent of all veins had a distal diameter of less than 4 mm (average 3.6 mm). The patency rates were 92% at 3 months and 90% at 12 and 36 months for all grafts. There were six failed grafts, all within the first 6 months, and eight diabetic patients required reoperation, two for missed valve leaflets, and three needed revision of the distal anastomosis; however, all these grafts were patent at the time of reexploration. There were four perioperative deaths and two patients had nonfatal postoperative myocardial infarctions. This study demonstrates that in situ saphenous vein grafting provides for a high vein utilization rate and suggests that the technique provides for higher graft patency and limb salvage rates than do more traditional types of procedures.

Actuarial Analysis↗
PubMed1985

Internal iliac artery revascularization in the treatment of vasculogenic impotence.

Five impotent men underwent internal iliac artery revascularization in conjunction with end-to-side aortobifemoral bypass after preoperative testing suggested a vasculogenic cause for impotence. All patients had abnormal preoperative penile/brachial arterial pressure indices (mean, 0.42 +/- 0.12). Following operation, all patients regained erectile capability and had normal postoperative penile/brachial indices (mean, 0.80 +/- 0.06). One patient developed retrograde ejaculation, emphasizing the need for meticulous nerve-sparing dissection with this operation. Internal iliac artery revascularization in conjunction with end-to-side aortobifemoral bypass is effective in relieving vasculogenic impotence in properly selected patients.

Aorta↗
PubMed1985

Peripheral vascular trauma from close-range shotgun injuries.

This report summarizes an eight-year experience (1976 to 1983) with 49 close-range shotgun blasts with associated major vascular injuries seen in a large urban hospital. Injuries to the upper extremity (40%), lower extremity (56%), and neck (4%) were seen. A high frequency of associated deep venous injury (82%), nerve injury (37%), fracture (33%), massive soft-tissue loss (43%), and compartmental hypertension (39%) was observed. There were no deaths in this series, and the limb salvage rate was 96%. Neither patient with multiple carotid artery injuries suffered a neurologic deficit. We attribute our success in the management of these complex injuries to rapid fracture immobilization, early and aggressive use of fasciotomy, adequate débridement of devitalized tissue, repair of deep venous injuries, arterial repair with autogenous tissue, and extra-anatomic bypass grafting in selected cases.

Adolescent↗
PubMed1985

Ankle bypass: should we go the distance?

This report reviewed the results of 47 distal arterial reconstructions to or below the level of the malleolus. The operations were performed by the techniques of popliteal-to-distal bypass (20 procedures) and in situ bypass (27 procedures). Seventy-five percent of patients had gangrene of ischemic ulceration, and all procedures were performed for limb salvage. Seventy-three percent of all patients were diabetic. The patency rates for popliteal-to-distal bypass with reversed saphenous vein were 92 percent at 24 months and 57 percent at 60 months, with a limb salvage rate of 70 percent at 60 months; the patency rates for popliteal-to-distal bypass with PTFE were 53 percent at 12 months and 0 at 36 months, with a limb salvage rate of 53 percent at 36 months; and the patency rate for in situ saphenous vein bypass was 96 percent at 24 months, with a limb salvage rate of 80 percent at 24 months. Early results are promising for ankle bypass using the techniques of popliteal-to-distal and in situ bypass.

Aged↗
PubMed1985

Sequential in-situ saphenous vein bypass. Early results and technique.

This report summarizes early results with saphenous vein bypass (SVB) utilizing both sequential and in-situ techniques (SIS SVB) in eight limbs requiring limb salvage. SIS SVB was performed to a variety of vessel combinations using "Y" graft, continuous, or vein extension techniques achieving early patency in all limbs, despite pedal arch disease. Postoperatively, there was a significant increase in ankle/brachial Doppler indices (ABI) (P less than 0.001) at dorsal pedal (0.23-0.88) and at posterior tibial (0.32-0.91). Successful isolated popliteal grafting was confirmed by return of phasic Doppler wave forms. All but one limb healed with minimal tissue loss within 1 month of bypass. Preoperative high resolution angiography and clinical Doppler evaluation of saphenous vein anatomy are mandatory to determine candidacy for SIS SVB.

Angiography↗
PubMed1984

Crossover femorofemoropopliteal sequential bypass for combined ipsilateral iliac and femoropopliteal occlusive disease.

We evaluated the effectiveness of crossover femorofemoropopliteal sequential bypass in 13 patients with combined ipsilateral iliac and femoropopliteal disease. Of them, eight underwent bypass grafting for limb salvage, and five, for disabling claudication. Four of the patients with claudication had relief of symptoms and significant increases in treadmill walking time. The cumulative limb salvage rate in the patients operated on for limb salvage was 88%. At 42 months, the cumulative patency rate for the femorofemoral portion of the graft was 91%, and for the distal segment, 63%. Mean ankle-brachial indices increased from 0.37 +/- 0.12 preoperatively to 0.76 +/- 0.16 postoperatively in the recipient limb. Early experience suggests that crossover sequential femorofemoropopliteal bypass grafts are effective in achieving limb salvage and relief of claudication, especially in patients with relative contraindications to major intra-abdominal surgery.

Aged↗
PubMed1983

Clinical use of the seromuscular jejunal patch for protection of the infected aortic stump.

Pathologic interactions between aortic prostheses and the gastrointestinal tract are very difficult problems in vascular surgery. After excision of the graft and proximal aortic closure, the major unsolved problem has been continued sepsis of the proximal aortic stump with subsequent fatal disruption. To provide healthy tissue for protection of this crucial area, we have devised a method in which a piece of jejunum on its vascular pedicle is opened along its antimesenteric border, the mucosa is removed, and the vascularized muscular wall is anchored to the aortic stump. This seromuscular jejunal patch was used clinically in three patients. Postmortem examinations in two of these patients 4 and 45 days postoperatively revealed no signs of infection, hematoma, or mucocele, and no histologic abnormalities; instead, the examinations did reveal firm tissue adherence between the aortic stumps and the seromuscular patches. The third patient is alive and well 1 year after this procedure. The three patients have demonstrated the feasibility of secure aortic stump protection by placement of well-prepared, vascularized seromuscular jejunal tissue over the potentially infected aortic stump. This technique may prevent postoperative stump dissolution and thus far appears to be a reasonable solution to this usually lethal problem.

Aged↗
PubMed1981

Modified technique to produce valvular incompetence in in situ saphenous vein arterial bypass.

Methods for producing valvular incompetence in the in situ vein arterial bypass have been either traumatic or tedious. We modified the technique of atraumatically incising the venous valves, rendering them incompetent. Using a specially designed long scissors, the valves are excised by introducing the scissors into the proximal end of the vein or, if necessary, one major branch. This requires minimal manipulation and exposure of the vein, almost no disturbance of the venous bed, and makes the operation less tedious.

Femoral Artery↗
PubMed1981

Hypertonic mannitol: its use in the prevention of revascularization syndrome after acute arterial ischemia.

Revascularization of acutely ischemic lower limbs is associated with high mortality and high rates of rethrombosis, limb loss, massive edema, and compartment syndrome. These complications may be due to revascularization syndrome. The effects of hypertonic mannitol used during revascularization of acutely ischemic lower extremities were studied. In an isolated canine hind limb model, revascularization of the limb via a Dacron graft after 90 minutes of ischemia resulted in tissue edema and decreased flow. The low flow state (50% of control) for two hours after reperfusion was associated with thrombosis at the anastomosis. Use of hypertonic mannitol reversed the reperfusion syndrome and prevented graft thrombosis. Therefore, 15 consecutive patients with acute lower extremity ischemia and threatened limb loss were treated with hypertonic mannitol during emergency thromboembolectomy. Fourteen patients survived and had excellent results without any rethrombosis. Compartment syndrome was absent. Results of this clinical trial suggests that hypertonic mannitol may be useful in the management of acute arterial ischemia.

Acute Disease↗
PubMed1981

Use of isovolemic hemodilution in the management of arterial ischemia in patients with polycythemia.

The management of patients with both polycythemia and limb-threatening ischemia presents many difficulties because in this population, vascular surgical procedures carry a particularly high incidence of hemorrhagic and thromboembolic complications. We evaluated the use of acute isovolemic hemodilution in 12 polycythemic patients who required urgent surgery due to severe ischemia and threatened limb loss. Within 48 hours, blood was withdrawn in units of 500 ml and simultaneously replaced with 1,500 ml of lactated Ringer's solution until a hematocrit of 35 to 40 percent was achieved. After hemodilution, two patients had such a marked improvement that no further therapeutic measures were required immediately. Four patients showed definite improvement in pulmonary vascular resistance tracings and segmental Doppler pressures, but ischemia was not fully ameliorated. These patients together with the remaining six patients underwent vascular surgery within 1 to 14 days after hemodilution. A hematocrit of 32 to 40 percent was maintained during the perioperative period. All arterial reconstructions were successfully completed and there were no perioperative failures. No pulmonary emboli, myocardial infarctions, or deaths occurred in this period. These results indicate that in polycythemic patients, urgent vascular surgery can be performed more safely with the concomitant use of acute isovolemic hemodilution.

Aged↗
PubMed1981

Further experience with the saphenous vein used in situ for arterial bypass.

Ongoing experience with use of the saphenous vein in situ as in infrainguinal arterial bypass is presented. One hundred eighty-three bypasses were performed for limb-threatening ischemia, 92 of which were to the popliteal artery, either isolated or in continuity with one or more tibial vessels, and 91 bypasses were carried to single tibial vessels below the termination of the popliteal artery. The results were analyzed by the life table method and show an overall patency rate of 89.8 percent at 3 to 4 years. Separate life table analysis of the tibial bypass group showed a patency rate of 83 percent at 3 to 4 years. Special emphasis is placed on the ability to use veins less than 4 mm in diameter, which comprise 40 percent of those used in these procedures. The superior results provided by the in situ method are explained in part by experimental observations which show that endothelial stability is completely preserved by this method but is severely disturbed during the process of vein removal and reversal.

Aged↗
PubMed1981

Effect of external pressure on axillofemoral bypass grafts.

External compression of axillofemoral grafts has been suggested many times as a cause for graft thrombosis. Thrombosis during sleep is the most common presentation of axillofemoral graft failure. Therefore, external compression of the graft by the body weight has been implicated in graft thrombosis. Six consecutive patients with axillofemoral bypass grafts for aortoiliac disease were studied on routine clinic visits. Pulsatile flow characteristics were studied by pulse volume recordings (PVR) and segmental Doppler pressure measurements in calf and ankle, prior to and during attempted graft compression, by having the patient lay on the graft. External compression by body weight did not alter the PVR and segmental Doppler pressure (P = NS) in the distal circulation. Therefore, these data suggest that external compression by the body weight may not be the primary cause of graft failure.

Axillary Artery↗
PubMed1980

Pathologic interactions between prosthetic aortic grafts and the gastrointestinal tract. Clinical problems and a new experimental approach.

Twenty-one patients presented with pathologic interactions between the gastrointestinal tract and aortic grafts. Seventeen patients were managed by excision of the graft and axillobifemoral bypass. Six patients died. four deaths were due to disruption of the proximal aortic stump after initial therapy that appeared successful. An experimental model of a seromuscular jejunal patch is presented that may be beneficial for closure of the proximal aortic stump.

Animals↗