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Biomedical subjects

G Pflugbeil

Publications and source records attributed to G Pflugbeil.

8 recordsLinked to original sources

Flow visualization and 1- and 3-D laser-Doppler-anemometer measurements in models of human carotid arteries.

Pulsatile flow, wall distensibility, non-Newtonian flow characteristics of blood in flow separation regions, and high/low blood pressure were studied in elastic silicon rubber models having a compliance similar to human vessels and the same surface structure as the biological intima models of (1) a healthy carotid artery model, (2) a 90% stenosis in the ICA, and (3) 80% stenosis in both the internal and external carotid arteries. Flow was visualized for steady flow and pulsatile studies to localize flow separation regions and reattachment points. Local velocity was measured with a 1-, 2-, or 3-D laser-Doppler-anemometer (LDA). Flow in the unstenosed model was Re = 250. In the stenosed models, the Re number decreased to Re = 180 and 213 under the same experimental conditions. High velocity fluctuations with vortices were found in the stenosed models. The jet flow in the stenosis increased up to 4 m/s. With an increasing bifurcation angle, the separation regions in the ECA and ICA increased. Increased flow (Re = 350) led to an increase in flow separation and high velocity shear gradients. The highest shear stresses were nearly 20 times higher than normal. The 90% stenosis created high velocity shear gradients and velocity fluctuations. Downstream of the stenoses, eddies were found over the whole cross-section. In the healthy model a slight flow separation region was observed in the ICA at the branching cross-section whereas in the stenosed models, the flow separation regions extended far into the ICA. We conclude that a detailed understanding of flow is necessary before vascular surgery is performed especially before artificial grafts or patches are implanted.

Blood Flow Velocity↗

[Orthotopic arteriovenous fistula in dialysis patients: a special application of fluid dynamic processes].

Our experiments describe the flow patterns in translucent models of AV fistulas. The elasticity of the models is similar to human vessels walls. Dying of particular flow threads with methylene blue visualizes the flow and its disturbances in 4 classical models. The flow dynamics were investigated with parallel inflow. The volume flow was constant at 200 and 400 ml/min, with a volume flow ratio of 80:20. The flow pattern in side to side fistulas and in end to side fistulas with a narrow angle show regions of separation. This may lead to microthrombus formation and early failure. High shear stress causes endothelial lesions and thus induces stenosing intimal reactions. A favourable flow pattern was seen in end to side fistulas with a broad angle, as well as in end to end fistulas.

Anastomosis, Surgical↗

[Ablation of venous valves with Nd-Yag laser--an alternative to conventional valvulotomy?].

The careful removal of venous valves during in situ venous bypass procedures is a problem that has not been completely solved. In this experimental study, valve ablation with the Nd-Yag laser was compared with conventional valvulotomy. The investigation was performed in vitro using human vein segments with a length of 20 cm. Conventional valvulotomy was performed 16 times, 20 valves were removed with a 400 mu-fibre and 26 with the hot tip. The results were evaluated by endoscopy, light and electron microscopy. There were no vein perforations with the valvulotome and the hot tip. Endothelial damage was documented in 85% with the valvulotome and was reduced significantly to 58% with the 400 mu-fibre. With the hot tip endothelial lesions were seen in only 30%. Valve remnants were always present with the valvulotome and in no more than 15% with the hot tip. Electron microscopy supported these results in general. There was no endothelial damage in 69%.

Angioscopes↗

Angioscope-guided neodymium yttrium-aluminium-garnet laser valvulotomy for in situ vein bypass.

Valvulotomy for in situ vein bypass is commonly performed with a valvulotome. Although the procedure can be controlled through an angioscope, the dangers of intimal damage and valve remnants remain. An experimental study was designed to evaluate angioscopic laser valvulotomy compared with standard mechanical valvulotomy (n = 16). Two different laser probes, a bare 400-microns fibre (n = 20) and a 2-mm hot-tip (n = 26) were tested. Results were investigated by histology and scanning electron microscopy. Hot-tip laser valvulotomy achieved significantly better results than the 400-microns fibre. The Insitucat valvulotome yielded the worst results, with valve remnants in all cases and an 88 per cent rate of intimal damage. It is concluded that laser valvulotomy can be performed simply and safely with a very low incidence of valve remnants and intimal damage.

Adult↗

[Results of vascular surgery treatment of vertebrobasilar insufficiency].

A retrospective analysis of the data of 64 patients with vertebral-basilar insufficiency is presented who were operated between 1980 to 1919 in our institution. Surgery for vertebral-basilar insufficiency comprises only 5.2% of all 1422 supra-aortic reconstructions performed during this period. The leading symptom was vertigo which was present in 41%. Disturbances of vision occurred in 9.8%. 29 bypass procedures and 35 arterial transpositions were performed. A mean follow up of 5.1 years revealed a patency rate of 83.3% in bypass procedures, 92.8% in subclavian transpositions and 100% in vertebral artery transpositions. These good haemodynamic results correlated with marked improvement of the clinical symptoms in 80% of the patients.

Cerebral Revascularization↗

[What are the prerequisites for surgery of asymptomatic carotid stenosis?].

Asymptomatic patients with carotid stenoses exceeding 75% have an elevated ischemic cerebrovascular event rate of 18% per year (5% strokes). Our combined perioperative stroke and death rate (1980-1990: 1123 operations) is 1.85%. Thus prophylactic surgery may be indicated in the following cases: hemodynamically significant stenoses of 75% and more, especially with marginal or reduced autoregulatory reserve, rapidly progressing lesions in medically treated patients, lesions with a high risk of embolization (ulcerations on B-scan), clear interrelation between arterial lesions and positive (asymptomatic) intracranial findings (CT, NMR, TC, USD).

Brain Ischemia↗