PubMed Health⌕ Search

Biomedical subjects

F Vermassen

Publications and source records attributed to F Vermassen.

At least 19 recordsLinked to original sources
PubMed2005

Excimer laser assisted angioplasty for critical limb ischemia: results of the LACI Belgium Study.

BACKGROUND: The purpose of this study was to assess the safety and efficacy of translating into national practice methodology for infrainguinal excimer laser-assisted angioplasty, for the treatment of critical limb ischemia in poor surgical bypass candidates. METHODS: A prospective five centre Belgian registry enrolled 48 patients, who presented with 51 chronic critically ischemic limbs (Rutherford category 4, 5 or 6) and were poor candidates for bypass surgery. Treatment included crossing the occlusion or stenosis by conventional guidewire followed by excimer laser angioplasty with, or without, adjunctive balloon angioplasty or stenting. A step-by-step technique was used in cases where the guidewire could not pass the occluded site. The primary endpoint was limb salvage, at 6 months, of the treated limb. RESULTS: Initial treatment was successful in all 51 limbs. By 6 months there had been six deaths, six minor and four major amputations and further intervention was required in four patients. Among survivors, limb salvage rate at 6 month was 38/42 (90.5%), with freedom from critical limb ischemia in 86%. CONCLUSIONS: This Belgian study of excimer laser assisted angioplasty, in high-risk patients who were poor candidates for surgical re-vascularisation, had a low incidence of surgical re-interventions and limb salvage rate in excess of 90%.

Adult↗
PubMed2004

Asphyxiating tracheal bronchogenic cyst.

We report on a 7-month old infant with severe respiratory distress secondary to a paratracheal bronchogenic cyst. Respiratory relief was achieved by transtracheal puncture of the cyst. Surgical removal of the cyst was performed 1 week later because of radiological evidence of reaccumulation of fluid.

Airway Obstruction↗
PubMed2003

Endovascular repair of aortic rupture.

OBJECTIVES: To report a single centre experience with endovascular repair of ruptures of the descending thoracic and abdominal aorta. DESIGN: Retrospective non-randomised study in a university hospital. MATERIAL AND METHODS: Between February 1997 and October 2002, endovascular repair of the aorta was performed on 125 occasions. In 20 cases, this was done as an emergency (nine ruptured infrarenal aortic aneurysms and 11 descending thoracic aortic ruptures). All patients underwent spiral computed tomographic angiography to assess the feasibility of endovascular repair and the size of the endoprosthesis. RESULTS: Endovascular repair was successfully completed in all patients. Primary conversion to open repair was not necessary. Postoperative 30-day mortality was 5/20 (25%). There were major complications in 12/20 patients. No ruptures of the aneurysms occurred postoperatively. No primary endoleaks occurred, but in 4/20 (20%) secondary surgical interventions were required after a median follow-up of 12 months (range 1-42 months). CONCLUSION: Our early experience shows the feasibility of this technique with early results that compare favourably to those of emergency open repair. Further studies are required to assess the long-term efficacy.

Adult↗
PubMed2003

How to perform a below-knee amputation.

Even though modern techniques have improved patient survival and limb salvage rates in patients with critical limb ischaemia and end-stage vascular disease, amputation is sometimes the only possible treatment. In younger patients with traumatic avulsion of a foot, infected gangrene of the foot or a peripheral tumour, amputation is out of discussion and commonly accepted. In older vascular patients, amputation should rather be considered as the starting point for revalidation and rehabilitation than as failure of a revascularization technique. The evolution in prostheses permits a rapid revalidation in most patients. However, an accurate amputation technique is still required to produce a good quality stump allowing early fitting of prosthetics.

Amputation, Surgical↗
PubMed2001

PTA and stenting after previous aortoiliac endarterectomy.

OBJECTIVES: to evaluate the feasibility and long-term results of angioplasty and stenting in the treatment of restenosis following aortoiliac endarterectomy. MATERIALS AND METHODS: between 1991 and 1999 19 patients underwent angioplasty with selective stenting for recurrent stenosis after previous aortoiliac endarterectomy. Aortic lesions were treated five times in four patients. At the iliac level 28 lesions (25 stenosis and three occlusions) were treated in 16 patients (one patient had a stenosis at the aortic as well as iliac level). All patients were followed clinically and by ultrasound. In the second half of 1999, an angiogram or spiral CT-angiography was performed in all patients to determine long-term outcome. RESULTS: technical success was obtained in all patients and clinical success was achieved in 18 of the 19 patients. Angiographic cumulative primary patency for aortoiliac lesions was 96% at 1 year and 76% at 3 years. CONCLUSIONS: angioplasty with selective stenting of recurrent aortoiliac disease after previous aortoiliac endarterectomy is feasible and safe. Long-term clinical and angiographic patency rates are in accordance with results of aortoiliac angioplasty in general.

Aged↗
PubMed2001

Treatment of ruptured anastomotic aneurysm by endograft.

Ruptured anastomotic aneurysms after aortobifemoral surgery are potentially life threatening. The preferred technique consists of resection of the pseudoaneurysm and interposition of a new graft. We present a case in which an endovascular approach was chosen for treatment of a ruptured femoral false aneurysm. An endograft was inserted and complete exclusion of the pseudoaneurysm was achieved.

Aged↗
PubMed2000

A single center's clinical experience with quadruple immunosuppression including ATG or IL2 antibodies and mycophenolate mofetil in simultaneous pancreas-kidney transplants.

UNLABELLED: Acute rejection remains a major problem in simultaneous pancreas-kidney (SPK) transplant and occurs in 60-100% of the cases. With the introduction of mycophenolate mofetil (MMF) replacing azathioprine (AZA) as a basis immunosuppressant, reduced rates of rejection have been reported. This study investigates the frequency and clinical relevance of allograft rejection in SPK patients receiving antithymocyte globulin (ATG) or Basiliximab induction therapy and cyclosporine Neoral (CyA), MMF, steroid basis immunosuppression. Between December 1996 and October 1999, 21 consecutive patients (15 males, 6 females) received a SPK transplant at our institution with a mean +/- standard deviation (SD) age of 42 +/- 6 yr. Of these, 14 patients were treated with anti-thymocyte globulin (ATG) Fresenius (rabbit) 3-5 mg/kg for 6 +/- 2 d, cyclosporine Neoral (CyA) (trough levels 350-400 ng/mL), MMF 3 g/d and low dose steroid therapy. Seven SPK patients were treated with Basiliximab (Simulect, Novartis 20 mg on d 0 and d 4 post-transplant) instead of ATG. The patients had an average human leucocyte antigen (HLA) mismatch of 3.9/6 and a negative cross match. All patients remained on triple drug therapy. Three patients were switched to tacrolimus instead of Neoral for CyA intolerance. The mean +/- SD cold ischemia time (CIT) of the organs was 10.1 +/- 2.4 h for the pancreas and 10.5 +/- 2.6 h for the kidney. RESULTS: Biopsy-proven rejection occurred in the kidney of 1 ATG patient (8%), which responded to steroid bolus therapy. One of the patients (14%) with Basiliximab induction developed renal allograft rejection, which was resolved after a 6-d course of anti-CD3 mAb (OKT3) treatment. All patients (100%) were free from rejection in the pancreas, as measured by urine amylase levels and glycemic control without the need for exogenous insulin with a mean glycosylated hemoglobin (HBA1C) of 5.1 +/- 0.7%, and serum creatinine with a mean of 1.24 +/- 0.24 mg/dL in a mean follow-up period of 17 +/- 15 months (median 12, range 2 37). CONCLUSION: Triple drug immunosuppression including cyclosporine, MMF and low dose steroids with ATG or interleukin 2 (IL2) receptor antibodies induction therapy appears to be a very suitable immunosuppressive regimen for combined pancreas-kidney transplant (PKT) with a marked reduction in the incidence of rejection.

Adult↗
PubMed2000

Endograft exclusion of residual common iliac artery aneurysms.

PURPOSE: To describe an endovascular approach for residual common iliac artery (CIA) aneurysm. METHODS AND RESULTS: A residual CIA was discovered in a 73-year-old man during routine examination following straight interposition graft placement for a ruptured abdominal aortic aneurysm (AAA). An aortobifemoral bypass was performed with ligation of both aneurysmal iliac arteries. A year later, aneurysms of both CIA stumps were found. On each side, a Hemobahn stent-graft was percutaneously positioned from the external to the internal iliac artery via the superficial femoral artery. Control angiography at 2 months and spiral computed tomographic angiography at 6 and 18 months confirmed exclusion of the aneurysms and patency of the endoprostheses. CONCLUSIONS: Successful endovascular treatment of residual CIA aneurysm is possible with flexible stent-grafts.

Aged↗
PubMed1999

Cost-benefit analysis of endovascular versus open abdominal aortic aneurysm treatment.

OBJECTIVE: To compare the costs and benefits of open versus endovascular repair of abdominal aortic aneurysm (AAA). METHODS: A consecutive series of 29 elective patients (open treatment, N = 20 and endovascular treatment, N = 9) were compared retrospectively. RESULTS: Operating time was significantly shorter for endovascular treatment (mean 90 vs. 125 min, p = 0.026). No endovascular procedure was converted to open surgery; one early endoleak was seen which sealed spontaneously. Endovascular treatment resulted in a shorter ICU and hospital stay (0 days vs. 2 days, p. 0.001 and 5 days vs. 11 days, p = 0.01 respectively). Mean total cost did not differ 361,938 BEF (9,048 Euro) vs. 382,995 BEF (9,575 Euro), p = 0.46. Endovascular treatment generated significantly less hospitalization costs (73,162 BEF or 1,829 Euro vs. 18,2740 BEF or 4,568 Euro, p = 0.001) but required a more expensive implant (153,293 BEF or 3,832 Euro vs. 38,296 BEF or 957 Euro, p = 0.001). Mean total cost for the patient was significantly higher in the endovascular treatment group (66,309 BEF or 1,658 Euro vs. 24,969 BEF or 624 Euro, p = 0.003). CONCLUSION: Our experience confirms the feasibility and safety of endovascular AAA treatment. It is associated with a shorter ICU and hospital stay and less morbidity. Overall cost for society does not differ significantly as the benefit, of lower hospitalization costs is undone by the high cost of the endovascular graft.

Aged↗
PubMed1998

Management of candidal thrombophlebitis of the central veins: case report and review.

Candidemia and major organ candidiasis are problems that emerged in the past 2 decades and that are partially due to medical progress. Catheter-related thrombosis of the central veins is known to be a frequent but mostly subclinical complication of central venous lines. Although candidemia and catheter-related thrombosis are frequent, candida thrombophlebitis of the central veins is rarely reported. We recently successfully treated a 19-year-old polytrauma patient with candidal thrombophlebitis of the innominate vein. Despite catheter removal and therapy with amphotericin B, recurrent candidemia and signs of infection persisted, and a complete resection of the involved vein had to be performed. Only 16 well-documented cases of candidal thrombophlebitis of the central veins in adults have been reported over the past 20 years. An analysis of these 16 patients, together with our patient, is made in relation to risk factors, clinical features, diagnosis, therapy, and mortality.

Adult↗
PubMed1997

Short-term and long-term neuropsychological consequences of cardiac surgery with extracorporeal circulation.

OBJECTIVE: Cognitive dysfunction after extracorporeal circulation is a major continuing problem in modern cardiac surgery. We designed this prospective study to update the incidence of postoperative neuropsychological changes after routine cardiopulmonary bypass (CPB) and to identify perioperative variables associated with these complications. METHODS: We assessed the patients with a comprehensive neuropsychological test battery 1 day before, 7 days after (n = 109) and 6 months after (n = 91) cardiopulmonary bypass. We used patients undergoing major vascular or thoracic surgery as a surgical control group (n = 20). RESULTS: Repeated measures multivariate analysis of variance (using surgical group as a between-subjects factor) on the group data revealed significant changes early after surgery compared with the preoperative performance (P = 0.001). The early changes are characterized by a significant decrease of visual attention and verbal memory performance (univariate F-tests, always P < 0.05). Cardiac patients showing cognitive impairment after cardiac surgery had lower preoperative ejection fractions (P = 0.014) and a more complicated medical history (P = 0.046). At 6-month follow-up, the patients performed significantly better than before surgery (P < 0.001). CPB patients showing persistent cognitive impairment at follow-up were significantly older at the time of surgery (P = 0.005). Individual comparisons revealed that 45% of the patients undergoing CPB showed evidence of cognitive impairment soon after surgery. In 12% of the patients, the cognitive sequelae persisted at follow-up. Both group data and individual incidence rates revealed neither significant pre-post differences between the surgical groups nor a time-by-group interaction effect. Variables directly associated with CPB were not significantly associated with the occurrence of cognitive impairment after surgery. CONCLUSIONS: We conclude that an important proportion of the cognitive impairment after cardiac surgery is likely to be due to nonspecific effects of surgery.

Adult↗
PubMed1997

Pericystic emphysema in pulmonary hydatid disease.

The case of a 12-year-old Caucasian boy, living in a non-endemic area, with two intrapulmonary masses is presented. Conventional X-rays and computed tomography images were highly suggestive of pulmonary Echinococcus disease because of the presence of pericystic emphysema in one of both masses, a finding known as the "crescent" or "meniscus" sign. This radiological feature and other highly suggestive imaging findings of pulmonary hydatid disease are presented and discussed.

Child↗
PubMed1996

Revascularisation by ingrowth of a free flap: fact or fiction?

Revascularisation of a critically ischaemic extremity by means of a free flap occurs through the development of vascular connections at the free flap-surrounding tissue interface. Three clinical cases are presented showing that in the particular situation of free tissue reconstruction of an ischaemic limb, vascular connections develop which are able at least partially to supply the free flap after occlusion of its arterial pedicle. One other case demonstrates similar vascular connections by angiography.

Aged↗
PubMed1996

Free flap coverage of a gangrenous forefoot in a patient with Buerger's disease: a case report.

A patient with Buerger's disease is described in whom reconstruction of a gangrenous forefoot with a free flap has been successfully performed. In order to limit the amputation level, a more aggressive approach toward reconstruction in young patients seems appropriate. To our knowledge, this is the first described case of free flap reconstruction of a gangrenous defect in a Buerger patient.

Adult↗