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G Szendro

Publications and source records attributed to G Szendro.

At least 19 recordsLinked to original sources
PubMed2004

Haemodynamic effect of intermittent pneumatic compression of the leg after infrainguinal arterial bypass grafting.

BACKGROUND: Intermittent pneumatic compression (IPC) may increase blood flow through infrainguinal arterial grafts, and has potential clinical application as blood flow velocity attenuation often precedes graft failure. The present study examined the immediate effects of IPC applied to the foot (IPC(foot)), the calf (IPC(calf)) and to both simultaneously (IPC(foot+calf)) on the haemodynamics of infrainguinal bypass grafts. METHODS: Eighteen femoropopliteal and 18 femorodistal autologous vein grafts were studied; all had a resting ankle : brachial pressure index of 0.9 or more. Clinical examination, graft surveillance and measurement of graft haemodynamics were conducted at rest and within 5 s of IPC in each mode using duplex imaging. Outcome measures included peak systolic (PSV), mean (MV) and end diastolic (EDV) velocities, pulsatility index (PI) and volume flow in the graft. RESULTS: All IPC modes significantly enhanced MV, PSV, EDV and volume flow in both graft types; IPC(foot+calf) was the most effective. IPC(foot+calf) enhanced median volume flow, MV and PSV in femoropopliteal grafts by 182, 236 and 49 per cent, respectively, and attenuated PI by 61 per cent. Enhancement in femorodistal grafts was 273, 179 and 53 per cent respectively, and PI attenuation was 63 per cent. CONCLUSION: IPC was effective in improving infrainguinal graft flow velocity, probably by reducing peripheral resistance. IPC has the potential to reduce the risk of bypass graft thrombosis.

Aged↗
PubMed2003

Brachial artery pseudoaneurysm in a premature infant.

A case of brachial artery pseudoaneurysm in a premature infant is reported. The lesion was surgically resected, and arterial continuity restored by end to end anastomosis. The postoperative period and follow up were uneventful.

Aneurysm, False↗
PubMed2001

Improved hemodynamic effectiveness and associated clinical correlations of a new intermittent pneumatic compression system in patients with chronic venous insufficiency.

PURPOSE: A new intermittent pneumatic compression device (SCD Response System) has recently been shown in healthy volunteers to have the ability to detect the postcompression refilling of the calf veins and to respond by initiating the subsequent cycle when these veins are full. This has proven to be more effective in expelling blood proximally than the conventional intermittent pneumatic compression device (SCD Sequel System). The aim of this study was to test the influence of venous disease on the postcompression refill time detected by means of the SCD Response and the effectiveness of the new system in expelling blood in patients who have venous reflux caused by post-thrombotic syndrome or varicose veins. METHODS: This open, controlled trial was conducted in an academic vascular unit with 10 patients who had post-thrombotic syndrome and 10 patients who had varicose veins. The new SCD Response System was tested against the existing SCD Sequel System in both legs in the supine, semirecumbent, and sitting positions. The refilling time sensed by means of the device was correlated with the venous filling index by using air plethysmography. The total volume of blood expelled per hour during compression was compared with that expelled by the SCD Sequel System in the same volunteers and in the same positions. RESULTS: An inverse association was found between the mean postcompression refilling time in the sitting position and the venous filling index of the apparently healthy or less severely affected leg (r = -0.52, P =.019), the refill time being significantly shorter in patients with advanced venous disease. The SCD Response System increased the volume expelled per hour in the post-thrombotic leg, when compared with the SCD Sequel System, by 109.9% (P =.005) in the supine position, by 85.1% (P =.009) in the semirecumbent position, and by 40.2% (P =.005) in the sitting position. The corresponding results in the more severely affected leg in patients with varicose veins were 71.9% (P =.005) in the supine position, 77.9% (P =.005) in the semirecumbent position, and 55.7% (P =.013) in the sitting position. Similar improved results were also found in the contralateral leg in both groups. CONCLUSIONS: The deflation settings of the new SCD Response System are able to be adjusted selectively, correlating with the physiological severity of chronic venous insufficiency. By achieving more frequent compression cycles, the new system is more effective than the current one in expelling blood proximally, confirming our earlier findings in healthy volunteers. Further studies testing a possible improved efficacy in preventing deep venous thrombosis in this high-risk group are justified.

Blood Flow Velocity↗
PubMed2001

[Computed tomographic angiography of the peripheral vasculature--role and applications in vascular surgery].

Computed tomographic angiography (CTA) is a relatively new diagnostic modality in the field of vascular surgery. Despite being new it has already been introduced into a wide range of diagnostic applications in this field and in many cases it can precede or replace the conventional intra-arterial angiography. During a 12 month period between 1.8.98 and 1.8.99 sixty five peripheral arterial imaging scans were performed using a CT Twin--2 helical scanner (Spiral Twin Flash., Elscint, Israel) with a 100% technical success rate and no complications at all. Twelve patients (18.5%) were operated upon and 20 (30.7%) underwent endovascular procedures with full intra-procedural agreement with the pre-operative or pre-procedure CTA findings. Despite possible pitfalls and a few disadvantages the technique carries major benefits and significant advantages to both the patient and the clinician. Therefore we recommend considering CTA as a first line diagnostic modality whenever peripheral vasculature has to be demonstrated whether electively or urgently and to spare the conventional angiography for selected cases only.

Angiography↗
PubMed2001

Arterial false aneurysms and their modern management.

BACKGROUND: Both diagnostic and therapeutic options in the management of iatrogenic false aneurysms have changed dramatically in the last decade, with surgery being required only rarely. OBJECTIVE: To describe our experience, techniques and results in treating pseudoaneurysms at a large medical center with frequent arterial interventions. We emphasize upper limb lesions. MATERIALS AND METHODS: We reviewed the data of all consecutive patients diagnosed by color-coded duplex Doppler between August 1992 and July 1998 as having upper limb and lower limb pseudoaneurysms (mainly post-catheterization). We accumulated 107 false aneurysms (mainly post-catheterization lesions): 5 were upper limb lesions and 102 were groin aneurysms. RESULTS: In the lower limb cases 94 of the 102 lesions were not operated upon (92.1%). Seventy lower limb cases were treated non-operatively by ultrasound-guided compression obliteration with a 95.7% success rate (67 cases). Two cases were treated by percutaneous thrombin injection (2%) and 23 by observation only (22.5%). Altogether 12 patients underwent surgery (11.2%): 4 upper extremity and 8 lower extremity cases. None of the lower limb group suffered serious complications regardless of treatment, but all five upper limb cases did, four of them necessitating surgical intervention. Three of the five upper limb cases had a grave outcome with severe or permanent functional or neurological damage. CONCLUSION: Most post-catheterization pseudoaneurysms can be managed non-surgically. False aneurysms in the upper extremity are rare, comprising less than 2% of all lesions. However, upper extremity pseudoaneurysms present a potentially more serious complication and require early diagnosis and prompt intervention to minimize the high complication rate and serious long-term sequelae. Prevention can be achieved by proper puncture technique and site selection, and correct post-procedure hemostatic compression with or without an external device. Some upper limb lesions are avoidable if the axillary artery is not punctured.

Adult↗
PubMed2001

[Surgery in patients over 100 years of age--5-year experience (1995-2000)].

The age distribution of a given national population is of utmost importance when dealing with public health and analyzing the use of various national health facilities. This is based on the totally different use of health sources by different age groups. Despite continuous prolongation of life expectancy and the related aging of the western hospitalized population the sub-group of patients over 100 year old of age is unusual demographically and accounts for only a very small portion of the total number of patients hospitalized in surgical wards. During the 5 year experience between 1995 and 2000 seventeen such patients were admitted to our surgical departments. Eight of those underwent 11 operations with zero peri-operative mortality and no significant complications. These 11 operations in this elderly population are the basis of our report.

Aged↗
PubMed2000

Duplex-guided thrombin injection for iatrogenic femoral artery pseudoaneurysm is effective even in anticoagulated patients.

BACKGROUND: The aim was to evaluate the efficacy and safety of percutaneous thrombin injection as an alternative non-operative method for treating postcatheterization femoral artery pseudoaneurysm in both anticoagulated and non-anticoagulated patients. METHODS: Thirty consecutive patients with a femoral artery pseudoaneurysm secondary to radiological catheterization confirmed by duplex imaging were included. Thrombin 200-2000 units (1000 units/mi) in a titrating dose was injected into the centre of the cavity under duplex ultrasonographic guidance. Thrombosis was assessed in real time using B mode and colour flow. No sedation or anaesthesia was required during the procedure. The distal pulses and ankle pressures were evaluated before and immediately after the injection, to exclude propagation of thrombus into the femoral artery. RESULTS: Successful rapid thrombosis of the false cavity was induced in all 30 patients. There were no immediate or mid-term procedure-related complications, or recurrences at 6 weeks. Eighteen patients were anticoagulated therapeutically at the time and following the procedure with either heparin or warfarin. CONCLUSION: Percutaneous thrombin injection is a simple, quick, painless, safe and effective technique, particularly in patients taking anticoagulants.

Aged↗
PubMed2000

The efficacy of the new SCD response compression system in the prevention of venous stasis.

OBJECTIVE: The current commercially available sequential intermittent pneumatic compression device used for the prevention of deep venous thrombosis has a constant cycle of 11 seconds' compression and 60 seconds' deflation. This deflation period ensures that the veins are filled before the subsequent cycle begins. It has been suggested that in some positions (eg, semirecumbent or sitting) and with different patients (eg, those with venous reflux), refilling of the veins may occur much earlier than 60 seconds, and thus a more frequent cycle may be more effective in expelling blood proximally. The aim of the study was to test the effectiveness of a new sequential compression system (the SCD Response Compression System), which has the ability to detect the change in the venous volume and to respond by initiating the subsequent cycle when the veins are substantially full. METHODS: In an open controlled trial at an academic vascular laboratory, the SCD Response Compression System was tested against the existing SCD Sequel Compression System in 12 healthy volunteers who were in supine, semirecumbent, and sitting positions. The refilling time sensed by the device was compared with that determined from recordings of femoral vein flow velocity by the use of duplex ultrasound scan. The total volume of blood expelled per hour during compression was compared with that produced by the existing SCD system in the same volunteers and positions. RESULTS: The refilling time determined automatically by the SCD Response Compression System varied from 24 to 60 seconds in the subjects tested, demonstrating individual patient variation. The refilling time (mean +/- SD) in the sitting position was 40.6 +/- 10. 0 seconds, which was significantly longer (P <.001) than that measured in the supine and semirecumbent positions, 33.8 +/- 4.1 and 35.6 +/- 4.9 seconds, respectively. There was a linear relationship between the duplex scan-derived refill time (mean of 6 readings per leg) and the SCD Response device-derived refill time (r = 0.85, P <. 001). The total volume of blood (mean +/- SD) expelled per hour by the existing SCD Sequel device in the supine, semirecumbent, and sitting positions was 2.23 +/- 0.90 L/h, 2.47 +/- 0.86 L/h, and 3.28 +/- 1.24 L/h, respectively. The SCD Response device increased the volume expelled to 3.92 +/- 1.60 L/h or a 76% increase (P =.001) in the supine position, to 3.93 +/- 1.55 L/h or a 59% increase (P =. 001) in the semirecumbent position, and to 3.97 +/- 1.42 L/h or a 21% increase (P =.026) in the sitting position. CONCLUSIONS: By achieving more appropriately timed compression cycles over time, the new SCD Response System is effective in preventing venous stasis by means of a new method that improves on the clinically documented effectiveness of the existing SCD system. Further studies testing its potential for improved efficacy in preventing deep venous thrombosis are justified.

Adult↗
PubMed2000

Nomograms used to define the short-term treatment with PGE(1) in patients with intermittent claudication and critical ischemia. The ORACL.E (Occlusion Revascularization in the Atherosclerotic Critical Limb) Study Group. The European Study.

Infusional, cyclic PGE1 treatment is effective in patients with intermittent claudication and critical limb ischemia (CLI). One of the problems related to chronic PGE1 treatment in vascular diseases due to atherosclerosis is to evaluate the variations of clinical conditions due to treatment in order to establish the number of cycles per year or per period (in severe vascular disease reevaluation of patients should be more frequent) needed to achieve clinical improvement. In a preliminary pilot study a group of 150 patients (mean age 67+/-12 years) with intermittent claudication (walking range from 0 to 500 m) and a group of 100 patients with CLI (45% with rest pain, and 55% gangrene; mean age 68 +/-11 years) the number of PGE1 cycles according to the short-term protocol (STP) needed to produce significant clinical improvement was preliminarily evaluated. Considering these preliminary observations, the investigators established a research plan useful to produce nomograms indicating the number of cycles of PGE1-STP per year needed to improve the clinical condition (both in intermittent claudication and CLI). A significant clinical improvement was arbitrarily defined as the increase of at least 35% in walking distance (on treadmill) and/or the disappearance of signs and symptoms of critical ischemia in 6 months of treatment in at least 75% of the treated patients. With consideration of the results obtained with the preliminary nomograms a larger validation of the nomograms is now advisable. A cost-effectiveness analysis is also useful to define the efficacy of treatment on the basis of its costs. The publication of this report in two angiological journals (Angeiologie and Angiology) will open the research on nomograms to all centers willing to collaborate to the study. The data are being collected in the ORACL.E database and will be analyzed within 12 months after the publication of this report.

Aged↗
PubMed2000

[Femoral artery pseudo-aneurysms--changes in treatment, report of 7 years].

The femoral artery remains the most used peripheral site for radiological catheter access. With a greater number of both diagnostic and therapeutic procedures being performed by interventional radiologists and cardiologists, and with larger catheters being used for stenting and endovascular grafting, the incidence of iatrogenic pseudo-aneurysms reported has reached as high as 0.5-2%. Ideally, they should thrombus spontaneously. However, when this does not occur, management options include: observation, ultrasound-guided obliterative compression, direct thrombin injection, embolization, stent graft insertion, and very rarely-surgery. During a 7-year period (1992-1999) we treated 131 cases of femoral artery false aneurysms. Until 1998 ultrasound-guided compression-obliteration, with a 95% success rate, was our method of choice. Since 1998, direct thrombin injection, with 100% success in 24 cases, has become our preferred method. It is pain-free, fully successful even in anticoagulated patients, and is currently our treatment of choice.

Aneurysm, False↗
PubMed1999

Mobile carotid plaques: the natural history of two asymptomatic and non-operated cases.

We studied two cases of mobile internal carotid artery lesions in symptom-free patients. Both cases were diagnosed by means of routine carotid duplex ultrasound scanning, and neither patient was operated on. With medical therapy with oral anticoagulants, the two lesions spontaneously disappeared without any clinical sequel, and no evidence of infarcts was shown by means of repeated computed tomography brain scans. After uneventful 2- and 3-year follow-up periods, there was no evidence of recurrence. This is the first published data on asymptomatic mobile carotid lesions and their natural history that shows a benign course in a long-term follow-up period. We suggest that a non-surgical approach may be considered selectively in high-risk symptom-free patients who have mobile and floating internal carotid artery lesions.

Aged↗
PubMed1996

[Carotid endarterectomy based on preoperative duplex ultrasound].

Carotid endarterectomy is the most common vascular procedure. Recent studies have suggested that carotid endarterectomy can be performed safely, based solely on ultrasound duplex evaluation in selected patients. We evaluated 12 men and 8 women who underwent carotid endarterectomy, 12 for significant symptomatic disease and 8 for tight, asymptomatic stenosis of the carotid artery. All had duplex ultrasound scans without angiography before operation. They all survived. 2 had hoarseness due to vocal cord paralysis which resolved 5 months later in 1, while in the other it still persisted 2 months after operation. There were no other neurologic complications. During follow-up all have remained symptom-free. We conclude that clinical assessment of carotid artery stenosis with duplex ultrasound scan of good technical quality provides appropriate information on which to base carotid endarterectomy, and is a safe alternative to preoperative angiography.

Aged↗