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Biomedical subjects

G Walterbusch

Publications and source records attributed to G Walterbusch.

At least 19 recordsLinked to original sources
PubMed1992

[Regional hyperthermic fibrinolytic perfusion in postoperative deep venous thrombosis of the leg].

Four days after an operation for fusion of lumbar and sacral vertebrae a 30-year-old man developed bilateral deep-vein thrombosis in the legs, extending on the left from the fibular group of veins to the popliteal vein. On the right all deep veins of the lower leg were occluded, including the confluence of the popliteal vein. As systemic fibrinolysis was contraindicated, surgical thrombectomy was undertaken. After incomplete removal of the thrombi, regional hyperthermic perfusion with streptokinase was performed using a heart-lung machine. After a compression bandage had been applied to the right leg above the veins the leg was perfused via the common femoral vein at 40 degrees C from the heart-lung machine, at a flow rate of 600-800 ml/min, for 60 min with a solution containing 1 million IU streptokinase. Measurement of various components in the perfusate indicated marked fibrinolysis (fibrinogen: not measurable; fibrinogen breakdown products: > 80 micrograms; streptokinase: 100 FU/ml after 30 min, 62 FU/ml after 60 min). At the same time there was no demonstrable fibrinolytic activity in the systemic circulation. Fibrinogen concentration fell from 340 mg/dl 30 min before the onset of perfusion to 245 mg/dl 90 min after it. After 60 min of perfusion the blood from the right leg was discarded and the leg flushed through with 1.5 l of an electrolyte solution and then filled up with previously obtained and stored patient's own blood concentrate. Subsequent phlebography and venous occlusion plethysmography demonstrated complete recanalization of the deep-vein system with normal venous valve function.

Adult↗
PubMed1986

[Knee joint exarticulation in arterial occlusive disorders of the lower extremity].

In 35 patients suffering from peripheral ischemic disease of the legs, disarticulation of the knee joint was performed instead of above-knee amputation. Operations were executed primarily or after failed bypass procedures for the salvation of the limb. 24 cases (67%) showed primary or delayed secondary stump healing. In 11 cases (31%), however, no stump healing was achieved due to either a wound infection (4 cases) or a necrosis of the anterior flap covering the weight bearing area of the stump (7 cases). Factors influencing the outcome of stump healing are discussed and different techniques of knee disarticulation are evaluated as to their benefits and disadvantages in ischemic limbs. As the method offers several advantages over above-knee amputation, a more frequent use of knee disarticulation in the surgical treatment of ischemic legs which cannot be preserved by other surgical measures and usually would be amputated at above-knee level is recommended.

Adult↗
PubMed1986

Extra-intracranial bypass procedure with saphenous vein grafts.

This study reports on 13 cases of extra-intracranial bypass procedures using saphenous vein grafts. Ten patients had arteriosclerotic occlusive vascular disease, one patient had a giant aneurysm of the internal carotid artery, another 2 females, 18 and 28 years of age, respectively, suffered from Takayasu's disease. Preoperatively all patients had severe neurological symptoms. To keep the venous graft as short as possible, as a first choice the carotid artery, in case of occlusive disease of the latter as a second choice the ipsilateral subclavian artery, or as a third choice the ascending aorta, were used as donor vessels. Perioperatively, one patient sustained an intracerebral/intraventricular hemorrhage and, despite immediate reoperation, died in a vegetative state early postoperatively. Another patient had a minor perioperative cerebral stroke with complete recovery. None of the other patients had any additional neurological deficit perioperatively, and they had complete relief from ischemic attacks postoperatively. There was one early occlusion due to high competitive collateral flow, and one late occlusion due to technical problems. The overall patency rate of surviving patients was 83.3% (follow-up 3 to 23 months).

Adolescent↗
PubMed1984

Restoration of cerebral blood flow by extraanatomic bypass in acute aortic dissection.

This report describes a case of acute type A aortic dissection which had resulted in coma. Angiography had revealed obstruction of the right common carotid artery. Since signs of impending aortic rupture or severe aortic insufficiency were missing, an extraanatomic femoro-carotid bypass was inserted and resulted in the patient's regaining consciousness. Two days after the first operation, the ascending aorta and aortic valve were reconstructed successfully anastomosing the divided caudad end of the bypass to the ascending aortic graft.

Acute Disease↗
PubMed1983

[Percutaneous transluminal angioplasty in proximal subclavian stenoses].

Between August 1980 and June 1982, 12 left-sided proximal subclavian stenoses were dilated with balloon catheters. The dilatation was successful in all patients. Differences in blood pressure in the arm could be demonstrated subsequently. Recurrences occurred in two patients after seven and eleven months. Follow-up of nine patients up to 24 months showed them to be symptom-free.

Adult↗
PubMed1982

[Use of the TDMAC heparin shunt for operations on the descending thoracic aorta (author's transl)].

This report summarizes our experience with the TDMAC heparin shunt for aortic bypass in descending thoracic aortic surgery. Between 1977 and 1981 twenty-four operations were performed with this shunt (19 men, 4 women, mean age 42 age). Indications for surgery were acute traumatic aortic rupture (6 patients), chronic aortic rupture (6 patients), acute aortic dissection (1 patient), chronic aortic dissection (4 patients), atherosclerotic aneurysms (3 patients), aortic aneurysms combined with PDA (1 patient), aortic aneurysm secondary to coarctation repair (1 patient), and infection of a vascular prosthesis (1 patient). Four patients died (hospital mortality 16.7%). One patient suffered perioperative paraplegia. In this patient the small size (7 mm) shunt hat been used. Therefore we suggest the large bore (9 mm) shunt be applied whenever possible, since even this larger size device displays a significant pressure gradient. When insertion of the shunt into the left subclavian artery is difficult, the ascending aorta or the apex of the left ventricle may be cannulated instead. In our cases we did not encounter any complications arising from shunt cannulation. The advantages of the TDMAC heparin shunt focus on the reduction of bleeding complications more common under systemic heparinization, and on less pronounced hemodynamic and metabolic sequelae following aortic clamping and declamping. With this shunt nearly all possible ischemic organ damage can be avoided.

Adult↗
PubMed1982

Evaluation of fibrin seal in animal experiments.

This paper presents experimental investigations to evaluate fibrin seal for bleeding control under systemic heparinization as well as some of the benefits and limits of fibrin-presealing vascular prostheses. Local hemostasis using fibrin seal plus collagen fleece was achieved in 3 standardized sources of bleeding produced in mongrel dogs under full heparinization. Water porosity was measured in 3 standard prosthetic materials of different porosity. It could be shown that all graft types investigated were sufficiently sealed up to a pressure of 600 mmHg. The influence of fibrinolysis on the stability of the fibrin network in vascular grafts was tested by in vitro experiments using urokinase incubation. While water permeability increased in fibrin-sealed fabric without aprotinin added, no fibrinolysis-induced leakage was observed in those exposed to aprotinin. Surface thrombogenicity of the fibrin-sealed grafts was higher than in blood-preclotted prostheses, if not rinsed with isotonic saline. After rinsing, thrombogenicity decreased below values obtained in grafts preclotted conventionally. Survival studies in animals show no difference between blood-preclotted and fibrin-presealed prostheses both 3 and 7 days after implantation.

Animals↗
PubMed1982

Clinical experience with fibrin glue for local bleeding control and sealing of vascular prostheses.

This report concerns our clinical experience with fibrin glue for local bleeding control and for sealing of vascular prostheses. Hemostasis could be achieved in 90% of 124 applications of the glue under different indications. Local application of fibrin adhesive is recommended in all types of bleeding difficult either to approach or control by conventional surgical technique. Complete sealing of low pore vascular grafts could be obtained in all operations under extracorporeal circulation and full heparinization. Highly porous grafts sealed with fibrin glue also were explored under conditions thus far requiring tightly woven grafts.

Aorta↗
PubMed1982

Fibrin adhesive: an important hemostatic adjunct in cardiovascular operations.

Fibrin adhesive was applied 413 times in a group of 340 patients undergoing extracorporeal circulation whenever conventional suturing appeared impossible, difficult, or dangerous, with a success rate of 95%. Fibrin-presealed woven or knitted fabric was inserted in 60 heparitized patients, 45 of whom underwent cardiac procedures. There was perfect sealing of the fabric in all but one instance. Fibrin gluing has become a routine method, reducing man-hours and blood loss and occasionally salvaging patients' lives. Fibrin-presealed knitted prostheses are expected to replace woven fabric because of its known poor healing qualities.

Blood Vessel Prosthesis↗
PubMed1982

Congenital obliteration of the suprahepatic inferior vena cava: case report.

A rare case of congenital obliteration of the suprahepatic portion of the inferior vena cava (IVC) associated with early liver cirrhosis is presented. The clinical signs of the condition and the standard methods of diagnosis are outlined. A survey of the available surgical management is given and a new alternative operation described. It consists of an indirect transatrial-transdiaphragmatic reconstruction of the IVC. For the first time, it has been used successfully for reconstruction of the interrupted vessel. Ten months following the operation, the patient shows no signs of portal hypertension or caval obstruction.

Child, Preschool↗
PubMed1981

The use of fibrin glue for sealing vascular prostheses of high porosity.

Vascular prostheses of different porosity (Cooley Very Soft; Miliknit Lo-Por; Microvel; Sparks Mandril) were pretreated with fibrin glue and the permeability was assessed both in vitro and in 12 dog experiments by descending aorta replacement under full systemic heparinization. It was found that all types of prostheses were completely sealed after the pretreatment. In 28 patients undergoing descending or abdominal aorta replacement under systemic heparinization high porosity knitted Dacron grafts were pretreated with the fibrin glue only. There was no blood loss across the prosthetic wall. It is concluded that graft-pretreatment with fibrin glue allows for combining full heparinization and the use of high porosity vascular grafts.

Animals↗