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Biomedical subjects

G Shanik

Publications and source records attributed to G Shanik.

At least 19 recordsLinked to original sources
PubMed2001

Endoluminal stent grafts in the management of infrarenal abdominal aortic aneurysms: a realistic assessment.

OBJECTIVES: transfemoral endoluminal aortic management (TEAM) is technically feasible in the treatment of infrarenal abdominal aortic aneurysms but its advantage over conventional repair is unproved. We report our initial experience, learning curve and technical difficulties encountered during the process of establishing this novel technique in our institute. MATERIAL AND METHODS: over a 3-year period 400 cases of abdominal aortic aneurysms were reviewed; only 58 cases (15%) were suitable for endovascular repair under our TEAM protocol and 36 (9%) were offered endovascular intervention. They were mainly high-risk patients (85% ASA III and IV) with a mean age of 72 years. Thirty-three bifurcated grafts, two straight tube grafts and one aorto mono-iliac graft were deployed. We oversized the graft by 15-20% to the diameter of the aortic neck and both common iliac arteries. RESULTS: two cases (6%-95% CI: 1-19%) had on-table conversion because of ruptured common iliac arteries. Peri-operatively there were two deaths from multi-organ failure. Transient renal failure occurred in two patients and three patients (9%) suffered a non-fatal myocardial infarction. Sixteen percent of patients had a groin wound problem. The mean hospital stay was 7 days. Five minor endoleaks (15%) were identified and sealed at 30 days. One secondary endoleak was identified at 18 months because of a patent juxta-renal lumbar artery. No secondary cuffs or extensions were used. Mean follow-up was 29 months and all grafts remained patent. The technical, clinical, continuous and secondary success rates were 78%, 91%, 89% and 91% respectively with TEAM. CONCLUSION: endovascular training, patient selection and learning curve impose an impact on the final outcome. Until a reliable hard point is reached so that endovascular repair could be exercised in routine practice, the use of TEAM must be questioned in high-risk patients, and should be performed under clinical trial conditions using strict selection criteria.

Aged↗
PubMed2001

Ultrasound guided human thrombin injection. A new modality in the management of femoral artery pseudo-aneurysms.

OBJECTIVES: We report our initial results of a prospective study of duplex ultrasound-guided injection (UGTI ) of thrombin in the management of femoral artery pseudo-aneurysms. We used human thrombin to avoid the increase in the human antibodies directed against fibrinogen, with the use of bovine thrombus, that preclude further utilisation of the bovine fibrin glue during cardio-thoracic surgery. METHODS: From 1999 to 2001, 19 patients, aged 69 (range 52-85) years presented with 21 femoral pseudo-aneurysms were treated. The mean pseudoaneurysm diameter was 30 (15-55) mm. All but two were secondary to cardiac procedures and the common femoral artery was the injured vessel in all instances. Patients were referred within 2-21 days following their iatrogenic injury. RESULTS: Immediate thrombosis of the sac occurred in 19 (90%) of the 21 pseudo-aneurysms. After a second injection, complete occlusion occurred in the remaining two patients. Two patients (CI 95%; 1-19) with three femoral pseudo-aneurysms developed leg pain. Duplex ultrasound follow-up showed two recurrences (9.5% - CI 95%; 1-19) and both were treated by repeat UGTI. There was no conversion to surgical repair. CONCLUSION: This percutaneous minimally invasive technique is safe and effective in the management of iatrogenic pseudo-aneurysms in this high-risk group of patients. Human thrombin has significant advantages over bovine thrombin.

Aged↗
PubMed1999

Fifteen-year experience of transperitoneal management of inflammatory abdominal aortic aneurysms.

OBJECTIVES: to assess the long-term outcome of patients with inflammatory abdominal aortic aneurysms. MATERIALS AND METHODS: over a fifteen-year period 598 cases of abdominal aortic aneurysm were treated and, of these, 32 cases (5.3%) were inflammatory in nature. The diagnosis was made on preoperative (CT) computed tomography in fifteen cases. Twenty-six patients were symptomatic on presentation and ten cases were repaired on an emergency basis. Only six were repaired electively. The transabdominal transaortic approach without dissection on the nearby adherent structures was used routinely. RESULTS: there was one postoperative death from a respiratory arrest leading to a thirty-day mortality of 3.1%. Early graft thrombosis occurred in three cases (9.3%) and all underwent successful thrombectomy. Colonic ischaemia was encountered in one patient who later developed an aortoenteric fistula. Two patients suffered a non-fatal myocardial infarction postoperatively leading to an overall morbidity of 18.7%. CONCLUSIONS: patients with inflammatory aortic aneurysms fare worse than patients with aortic aneurysms in general. Preoperative suspicion assists in planning surgery. We believe that the transperitoneal approach with an anterolateral aortotomy and minimal dissection of adherent structures offers excellent results in dealing with this difficult group of patients.

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PubMed1999

Aorto-left renal vein fistula: is there a place for endovascular management?

PURPOSE: To describe the endovascular treatment of an aorto-left renal vein fistula. METHODS AND RESULTS: A 77-year-old man with multiple comorbidities presented with low back pain, hematuria, cyanosis, and a pulsatile abdominal mass. Imaging confirmed a 7-cm abdominal aortic aneurysm with a contained rupture into the left renal vein. Owing to the patient's high surgical risk, a Talent Endoluminal Stent-Graft was implanted to satisfactorily exclude the aneurysm. Hemodynamic stability and normal renal function were restored; however, continued perfusion of the sac prompted an attempt to percutaneously repair the renal vein defect. This effort failed, so open laparotomy was necessary. CONCLUSIONS: Although total endovascular management was not successful in this case, the initial use of a minimally invasive approach allowed the patient's clinical status to improve and lower the risk of subsequent surgery.

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PubMed1997

Alpha 2C-adrenoceptors mediate contractile responses to noradrenaline in the human saphenous vein.

We have investigated the subtype of alpha 2-adrenoceptor mediating isometric contractions of human saphenous vein in comparison with alpha 2-adrenoceptor ligand binding sites. Postjunctional alpha 2-adrenoceptors in the human saphenous vein were investigated in terms of the ability of alpha 2-adrenoceptor antagonists to shift the contractile potency of noradrenaline. The following antagonists were employed (potencies, pKB, in human saphenous vein in parentheses): chlorpromazine (6.98 +/- 0.24), BDF 8933 (7.60 +/- 0.06), prazosin (6.62 +/- 0.15), ARC 239 (7.19 +/- 0.15), yohimbine (7.23 +/- 0.09), HV 723 (7.52 +/- 0.14), WB 4101 (7.90 +/- 0.06), SKF 104078 (6.55 +/- 0.08), BRL 44408 (5.72 +/- 0.21). Antagonist potency at postjunctional alpha 2-adrenoceptors was correlated with antagonist affinity at alpha 2-adrenoceptor ligand binding sites in membranes of human platelet (alpha 2A), rat kidney (alpha 2B) and Sf9 cells expressing human recombinant receptors (alpha 2C), labelled with [3H]yohimbine. The correlation with the postjunctional alpha 2-adrenoceptor mediating contraction of the human saphenous vein was best for the human recombinant alpha 2C-adrenoceptor ligand binding site (r = 0.92, n = 8, P < 0.001), as compared to correlations with the alpha 2B-adrenoceptor ligand binding site of rat kidney (r = 0.62, n = 8, n.s.) and with the alpha 2A-adrenoceptor ligand binding site of human platelet (r = 0.23, n = 8, n.s.). It is concluded that the functional postjunctional alpha 2-adrenoceptor mediating contractions of the human saphenous vein closely resembles the human recombinant alpha 2C-adrenoceptor ligand binding site.

Adrenergic alpha-2 Receptor Agonists↗
PubMed1991

Upper limb embolus: a timely diagnosis.

In a ten year period, 36 patients were treated surgically for embolic occlusion of upper limb vessels. The sources of embolus were cardiac (58%), peripheral aneurysm (22%) and unknown (20%). Brachial embolectomy was performed in all cases. Six out of eight peripheral aneurysms were resected. A patency rate of 94% was achieved at five years. Hospital mortality and morbidity rates were 3% and 10%, respectively. One patient died of a myocardial infarct one week postoperatively. Three patients suffered ischemic contracture or amputation; all three presented after 36 hours. We conclude that upper limb emboli are usually easy to recognize and treat. Prompt surgery (less than 24 hours) produces the most satisfactory results. Late presentation or delay in treatment can result in limb loss.

Acute Disease↗
PubMed1991

Prospective randomized multicenter comparison of in situ and reversed vein infrapopliteal bypasses.

We have performed a prospective, randomized, multicenter study to compare in situ and reversed vein grafts for long limb salvage bypasses from the proximal thigh to an infrapopliteal artery. Three hundred eighty-four patients required an infrapopliteal bypass for critical lower extremity ischemia. Of these, 259 were excluded because a short vein bypass was performed or because the vein was considered inadequate. The remaining 125 patients had a randomized vein bypass, 63 reversed, 62 in situ. The two groups were similar with regard to risk factors, indications, graft dimensions, and outflow. Secondary patency at 30 months was similar for both techniques: reversed 67% +/- 9% (+/- SE); in situ 69% +/- 8%. For veins less than or equal to 3.0 mm in minimum distended diameter 24-month patency rates were 61% +/- 22% for 12 in situ veins and 37% +/- 29% for 10 reversed veins (p greater than 0.05). Angiographic evaluation of failing grafts revealed lesions similar in type and frequency in both types of grafts. These included focal (in situ, n = 4; reversed, n = 7) and diffuse vein hyperplasia (in situ, n = 2; reversed, n = 1), and inflow and outflow stenoses (in situ, n = 4; reversed, n = 3). The incidence of wound complications and the mortality rate were similar for the two groups. These data show no significant difference in overall patency rates for the two types of vein grafts at 2 1/2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Mixed connective tissue disease with arterial thrombosis, antiphospholipid antibodies and heparin induced thrombocytopenia.

We report a patient with mixed connective tissue disease (MCTD) who presented with thrombosis of the right femoral artery in association with antiphospholipid antibodies (aPL). When treated surgically and with heparin prophylaxis, she developed heparin induced thrombocytopenia and thrombosis which necessitated amputation of a lower limb. Thus our patient developed 2 separate groups of autoantibodies associated with thrombotic events. Our case highlights an association between thrombosis, aPL and MCTD. Furthermore, it emphasizes a need for intensive monitoring when hypercoaguable individuals with connective tissue disorders are treated with heparin.

Adult↗
PubMed1984

Stenosis following carotid endarterectomy. Its implication in management of asymptomatic carotid stenosis.

Carotid endarterectomy is established in the treatment of atherosclerosis of the carotid bifurcation, but the incidence of restenosis and the role of endarterectomy in the management of asymptomatic carotid stenosis are variable. During a four-year period, we performed 80 endarterectomies of the internal carotid artery in 73 patients. Patients were prospectively studied by means of Doppler ultrasonography in combination with real-time spectral analysis to determine the incidence of restenosis postoperatively. A concomitant study of 116 patients with 79 asymptomatic carotid stenoses was undertaken. We found a 12.5% incidence of stenosis following carotid endarterectomy and a 3% risk of transient neurologic deficit in the patients with asymptomatic carotid stenoses.

Aged↗
PubMed1977

Value of concomitant sympathectomy in aortoiliac reconstruction. Results of a prospective, randomized study.

The efficacy of concomitant lumbar sympathectomy in improving results of aortoiliac reconstruction was assessed by a prospective, randomized study of 51 patients undergoing operation for occlusive or aneurysmal disease. Sympathectomy was performed on 50 limbs, while 52 extremities served as controls. Sympathectomy resulted in a significant reduction in foot vascular resistance determined by plethysmography. However, the procedure had no effect on leg circulation, assessed by ankle/arm pressure indices determined by Doppler ultrasound. In the sympathectomy group, there were three early postoperative amputations for ischemia, despite patent grafts. In the control group, there was one late graft occlusion, caused by progressive atherosclerotic disease. Although sympathectomy may improve pedal circulation, the procedure does not appear to improve the results of aortoiliac reconstruction.

Adult↗