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Biomedical subjects

F J Criado

Publications and source records attributed to F J Criado.

At least 55 records · Page 3Linked to original sources
PubMed1996

The surgeon as an endovascular interventionist. Why and how?

Catheter-based endovascular techniques have advanced significantly over the past three decades. It is only recently that surgeons have become more interested in these developments, and are now rapidly gaining in training and widening practice opportunities. Endovascular training and credentialing for the surgeon continue to be poorly-defined areas. Several pathways, albeit incomplete, are available for the incorporation of endoluminal/percutaneous skills into the surgical armamentarium. Ultimately, it can only be through established postgraduate residency and fellowship programs that the subspecialty of endovascular surgery can have a more universal applicability. The basic necessary catheter skills have been defined. Imaging requirements, both radiographic and endoscopic/ultrasonographic, are most significant and of great significance for the safe and successful performance of endoluminal vascular techniques. On balance, it is felt strongly that endoluminal catheter techniques are crucially important for the vascular surgeon of today and tomorrow.

Angiography↗
PubMed1996

Endovascular recanalization of the aorto-iliac segment: imaging and approaches.

Endovascular catheter techniques are most useful and successful in the aorto-iliac arteries. As in other territories, wire recanalization, balloon angioplasty, and endoluminal stent placement are most applicable. For the surgeon, imaging considerations are most important since the operating room must be equipped with the proper capabilities for endovascular surgery. Techniques of catheterization and angiographic visualization of the arteries must be learned and understood clearly before these procedures are undertaken. A variety of occlusive lesions involving the aorta and iliac arteries can be treated adequately by means of nonsurgical catheter-based methods which add a significant new dimension to the vascular surgeon.

Angioplasty, Balloon↗
PubMed1996

The role of angioplasty and stenting in the treatment of occlusive lesions of supra-aortic trunks.

PURPOSE: To review the authors' four-year experience with endoluminal treatment of stenotic and occlusive lesions of supra-aortic trunks, and to compare the results obtained with those achievable with more conventional surgical reconstruction. METHODS: The authors' four-year experience (7/1/91-6/30/95) with 30 endoluminal brachiocephalic procedures on 26 patients was reviewed retrospectively. The type of occlusive lesion encountered, arterial involvement, symptoms, and indications for treatment were noted. Patients were followed and reexamined at six-month intervals and information from this assessment constituted the source of information to determine success and patency rates. Only one patient was lost to follow-up at three months post intervention, at which time the recanalized subclavian artery was patent and the patient was asymptomatic. RESULTS: There were no operative mortalities or strokes. One patient developed a large cervical wound hematoma which required surgical evacuation. Immediate (technical) success was achieved in 27 arterial segments out of 30 which were approached with intention to treat, for a success rate of 90%. The three immediate failures involved totally occlusive lesions of the left proximal subclavian artery which proved unresponsive to retrograde transluminal recanalization. Long-term arterial patency was achieved in 24 of 30 instances, for a success rate of 80%. The three failure occurred respectively eight (right common carotid artery), 12 (right subclavian artery), and 18 months (left subclavian artery) after the initial procedure, and they all involved restenosis following angioplasty/stenting. CONCLUSIONS: The retrospective review reported herein demonstrates that angioplasty/stenting of focal stenotic and occlusive lesions of supra-aortic trunks would seem to produce immediate and long-term success rates which are quite acceptable, and may approach those achievable with more conventional surgical reconstruction. Further reporting of larger series of patients followed up for longer periods of time will be necessary for more définitive conclusions regarding these less invasive therapeutic options.

Adult↗
PubMed1995

Carotid-axillary artery bypass: a ten-year experience.

PURPOSE: The purpose of this study was to review our 10-year experience with carotid-axillary artery bypass in the treatment of occlusive lesions of the proximal subclavian artery. METHODS: Our 10-year experience with 26 carotid axillary bypasses for occlusive disease of the subclavian artery was reviewed retrospectively. The review focused on the indication for the operation, the surgical technique used, and the development of immediate and late postoperative complications. Long-term bypass graft patency and clinical success were determined on the basis of information gleaned from the office records of all patients. Only three patients were lost to follow-up at 12, 36, and 38 months. RESULTS: There were no operative deaths. Two patients had small cervical wound hematomas, and two others experienced transient symptoms of brachial plexus irritation, which subsided spontaneously. Permanent nerve or lymphatic complications did not occur. In a mean follow-up of 47 months, carotid-axillary bypass graft patency was 96%, and 88% of the patients enjoyed symptom-free sustained clinical success. CONCLUSIONS: This retrospective review demonstrates that a carotid-axillary bypass constructed with ringed synthetic graft material tunneled under the clavicle performs well and can be considered a reasonable alternative to the more standard carotid-subclavian bypass for the same indications.

Aged↗
PubMed1995

Retrograde iliofemoral endarterectomy facilitated by balloon angioplasty.

PURPOSE: The purpose of this study was to explore the feasibility of iliofemoral endarterectomy performed through a single groin incision. METHODS: Thirty-two patients aged 34 to 75 years (mean age 63.4 years) with a male/female ratio of 20:12 underwent 36 lower extremity inflow reconstructions from July 1989 to September 1994. Surgical indications were for limb-threatening ischemia in 24 patients and for claudication in eight patients. The procedures were done for occlusive disease of the external iliac artery and common femoral artery with patients under either spinal (n = 24) or local (n = 12) anesthesia. Intraoperative balloon angioplasty with fluoroscopic guidance preceded open retrograde iliofemoral endarterectomy. Adjunctive procedures included 18 profundaplasties, eight femorofemoral, nine femoropopliteal, and one femorotibial bypasses. RESULTS: Thirty-three of the 36 cases were initially successful. The three failures were in patients with extensive calcification. The mean follow-up has been 36.4 months, and the patency rate was 80.5% at 3 and 4 years. The four failures noted on follow-up were caused by three common iliac artery stenoses and one iliac system occlusion. The former group was successfully treated with balloon angioplasty/stent, and the latter patient required an aortofemoral bypass. No operative deaths or limb loss occurred in this series. CONCLUSIONS: Retrograde iliofemoral endarterectomy facilitated by balloon angioplasty is a safe, easy-to-perform, and viable option for patients with combined external iliac artery and common femoral artery occlusive disease. Midterm results (36.4 months) are favorable, and most hemodynamic failures are easy to correct with standard endovascular techniques.

Adult↗
PubMed1994

Endoluminal aortic aneurysm repair using a balloon-expandable stent-graft device: a progress report.

We describe our experience with endoluminal repair of abdominal aortic aneurysms using the stent-graft device. Twenty-four patients underwent 25 procedures in the 27-month period ending December 31, 1992. Twenty-one of the patients were considered high-risk candidates for conventional surgical repair. The endoluminal stented grafts were aortoaortic in 16 procedures and unilateral aortoiliac in eight. One patient underwent a second procedure consisting of an ilioiliac graft to repair a separate common iliac artery aneurysm. Technical problems were primarily related to retrograde transluminal access across the iliac arteries, tortuous aneurysms, and misjudgments as to measurement of length. One patient died and another required secondary deployment of a distal stent at 4 months; subsequent aneurysm expansion mandated surgical replacement at 18 months. It is clear that this device and methodology will have to undergo further refinement before the technique is acceptable for wider clinical application. Current experience, however, is encouraging. Aneurysm exclusion with an endoluminal prosthesis is likely to become an important therapeutic alternative over the next several years.

Aged↗
PubMed1994

Endovascular surgery in daily practice: a re-appraisal.

For more than 10 years, endoluminal therapy has been marked by an explosion in the number and variety of devices designed to enhance or supplant its first and still most commonly used technique, balloon angioplasty. Among all these innovative catheter-based technologies, only stents have emerged as a truly effective device capable of achieving results comparable or superior to balloon angioplasty. In combination with thrombolysis and balloon dilation, they form the triadic foundation of endovascular surgery today. The prudent and judicious use of these tools, and a few other "niche" devices, such as atherectomy, in conjunction with classical vascular surgical techniques is the special and unique purview of the vascular surgeon. His development of a therapeutic plan, whose components include patient selection, lesion assessment, device decisions, procedure monitoring completion evaluation, and follow-up, is incumbent upon an appreciation of the capabilities of each available intraluminal device in the various arterial segments and lesion pathologies. The strategies that facilitate optimum matching of endoluminal tools and techniques to each patient situation form the basis of this report. They offer today's vascular surgeon a guide to the use of intraluminal therapies in daily practice. On the horizon is the new and exciting technique of endoluminal grafting, which, if it proves efficacious, will bring about profound changes in our specialty.

Angioplasty↗
PubMed1994

Endovascular therapy of lower extremity arterial occlusive disease: are advanced generation devices worth the cost?

Endovascular recanalization has a relatively small but important role in the treatment of arterial occlusive disease. The balloon angioplasty catheter remains the most versatile and successful tool for transluminal therapy. A multitude of advanced generation devices have been developed in recent years; of these, intravascular stents are gradually emerging as most useful and capable of enhancing the results of angioplasty in selected instances.

Angioplasty, Balloon↗
PubMed1993

New expandable access sheath for endovascular visualization and repair.

Catheter-based endovascular techniques are becoming increasingly important. Access to the vascular lumen is the single most critical common step to all these interventions. This report describes the concept of, and initial clinical experience with, a new expandable access sheath for endovascular therapy.

Angioplasty, Balloon↗
PubMed1993

The role of endovascular therapy in lower extremity revascularization. Lessons learned and current strategies.

Percutaneous endovascular therapy has emerged as an important modality in the treatment of lower extremity ischemia. Its role is relatively small but better defined at present. Balloon angioplasty remains as the most useful and versatile of all catheter interventions. Common iliac artery lesions, if short and stenotic, are best managed with angioplasty. Percutaneous therapy of femoral-popliteal lesions is less satisfactory but applicable in a small subset of patients with favorable lesions. Intravascular stents and thrombolysis are viewed as major developments in the field. Critically ischemic limbs are seldom amenable to endovascular recanalization. The subspecialty of endovascular therapy should become increasingly the focus of attention by the contemporary vascular surgeon. Catheter technology is destined to influence profoundly current strategies and techniques in the treatment of vascular diseases.

Adult↗
PubMed1990

Laser angioplasty in the lower extremities: an early surgical experience.

From July 1988 through December 1988 laser "hot tip" angioplasties coupled with balloon dilations were performed on 95 patients at the Union Memorial and University of Maryland hospitals. The patients ranged in age from 42 to 84 years (mean, 66.4 years), and there were 61 men and 34 women in the study. Indications for the procedure included claudication in 70 (74%) and severe ischemia in 25 (26%). Noninvasive studies were performed on all patients before and after the procedure. One hundred seventeen segments were treated in 28 iliac arteries and 89 superficial femoral/popliteal arteries. No tibial arteries were treated. Fifty-two stenoses and 65 occlusions occurred. The procedures were performed percutaneously in 52 patients (55%), and open surgical technique was used in 43 patients (45%). Nine immediate failures (9.5%) and 86 successes (90.5%) were noted within 24 hours of the procedure. Follow-up ranged from 1 to 6 months with a mean of 3.2 months. Late failures within this time period occurred in 21 patients (22%). The total failure rate was 30/95 or 31.5%. Only one of the patients was made worse by a failed laser-assisted balloon angioplasty. Immediate complications consisted of formation of subcutaneous hematoma in 20 of the 52 patients having percutaneous procedures (38%) and healing difficulty in 3 of the 43 patients having open surgical procedures (7%). Hospital stay was usually 1 day longer in the latter group. No patient required surgical intervention for bleeding as a result of a vessel perforation. However, this phenomenon was noted during the course of three superficial femoral artery laser-assisted balloon angioplasties.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The role of sclerotherapy as an adjunct to Unna's boot for treating venous ulcers: a prospective study.

Ankle ulcers associated with venous disease have been traditionally treated by Unna's compressive bandages. However, successful healing of an ulcer with this therapeutic modality is slow and tedious. The purpose of this study is to investigate whether adjunctive sclerotherapy of large venous channels near the ulcers enhances healing. Twenty-eight patients with perimalleolar venous ulceration were entered into this study. Ulcer size ranged from 6.0 to 25 cm2. All were examined for the presence of large venous channels adjacent to the ulcer bed. A portable continuous-wave Doppler supplemented digital examination of the area. Twenty-five out of 28 patients had easily detectable venous channels, and these were randomized into two groups: group I, treated by weekly changes of Unna's compressive boots; group II, treated by weekly change of Unna's compressive boots and sclerotherapy with 3% sodium tetradecyl sulfate (Sotradecol). All patients had the size of the ulcer measured during their weekly visits. Patients in group II took a mean of 2.1 weeks to exhibit 50% healing and 4.3 weeks to fully heal. Conversely patients in group I took a mean of 3.2 weeks to achieve 50% healing and 6.1 weeks to fully heal. Thus, healing was significantly faster (p less than 0.05) in group II. In conclusion, the therapeutic efficiency of Unna's compressive bandaging is significantly enhanced by the adjunctive sclerotherapy of adjacent venous channels.

Adult↗
PubMed1987

Hernia through the foramen of Winslow: a complication of cholecystectomy. A case report.

In 151 years since first described, there have been 112 reported cases of hernia through the foramen of Winslow (HFW). All thus far have described HFW as a primary entity. The case reported appears to be unique with HFW as a surgical complication. HFW is the least common of internal hernias. The primary symptom is pain referred from the herniated organ and the hepatoduodenal ligament. An interesting sign is that the patient is found curled up or stooped over for pain relief. Anatomic factors implicated in HFW are an enlarged epiploic foramen, a floppy cecum and ascending colon, or abnormal length of small bowel mesentery. Tension on these structures causes pain with the torso extended. Distention of bowel in the lesser sac mimics gastric obstruction. Organs herniated are: small bowel (63%); cecum, ascending colon, and terminal ileum (30%); and transverse colon (7%). Of 25 cases reported since 1966, cecal herniation comprised two-thirds. The diagnosis may be made radiologically and the treatment is surgical. The case and a review of the literature are presented with attention to the anatomy. Also provided are the signs and symptoms of this interesting and perplexing diagnosis.

Aged↗
PubMed1982

Extrathoracic management of aortic arch syndrome.

The English literature on extrathoracic procedures for aortic arch syndrome spanning the 19-year period 1962-1980 has been reviewed. Fifty publications reporting on 787 operations were selected for analysis. The overall results were excellent in terms of safety and long term symptomatic relief. Unilateral carotid-based operations appear preferable to longer crossover bypasses in the majority of patients. It is suggested that transthoracic reconstruction remain the approach of choice for innominate artery disease and multiple bilateral arch branch occlusions in good-risk patients.

Aortic Arch Syndromes↗
PubMed1982

Acute thrombosis of abdominal aortic aneurysm.

Of all the complications of abdominal aortic aneurysm (AAA), complete acute thrombosis has received the least attention in the literature. Its infrequent occurrence, no doubt, accounts for the paucity of reports. The management of a recent patient with an acutely thrombosed AAA prompted this review of the English-language literature for specific information regarding the diagnosis and treatment of AAA.

Journal Article↗