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Biomedical subjects

H C Baron

Publications and source records attributed to H C Baron.

At least 19 recordsLinked to original sources
PubMed2004

Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure.

BACKGROUND: Before 1985, corrective surgical procedures for patients with chronic venous insufficiency and venous ulcers were performed using long incisions through diseased skin and subcutaneous tissues. The procedure, involving ligation of incompetent perforator veins, known as "the Linton operation," often was complicated by wound infections and poor healing. This changed in 1985 when G. Hauer demonstrated a new surgical technique for direct visual identification of the incompetent perforator veins using an endoscope in the subfascial space. This seminal contribution marked the advent of subfascial endoscopic perforator vein surgery (SEPS). METHODS: From 1996 to 2004, the authors group prospectively collected data on 110 patients with chronic venous insufficiency who underwent a SEPS procedure. Preoperative assessment of the limb's vascular status consisted of color-flow duplex ultrasound imaging and ascending and descending phlebography to locate vein valve incompetence, along with venous mapping. The ages of the patients ranged from 42 to 82 years (mean, 60 years). A total of 128 limbs underwent the SEPS procedure in the cohort of 110 patients. According to CEAP classification for venous limb disease, 60 limbs belonged to group C5 (skin changes, pigmentation, venous eczema, lipodermatosclerosis, healed ulcer) and 68limbs to group C6 (skin changes and active ulceration). RESULTS: The 110 patients underwent 128 SEPS procedures without significant morbidity. Of the 68 limbs in class C6, 54 showed ulcer healing within the follow-up period of 12 weeks. The remaining 14 limbs in class C6 achieved ulcer healing within 24 weeks. In this latter group, 10 patients had venous ulcers larger than 4 cm in diameter. These patients underwent a split-thickness skin graft at the time the SEPS procedure was performed. The grafts remained healed during a 2-year follow-up period. CONCLUSIONS: This study demonstrated the effectiveness of the SEPS procedure when incorporated into the overall treatment strategy for patients with chronic venous insufficiency. Minimal postoperative complications accompanied by ulcer healing and relief of lower extremity symptoms were achieved for all the patients, underscoring the important role of incompetent perforator veins in the formation of chronic venous insufficiency.

Adult↗
PubMed2001

Endoscopic subfascial surgery for incompetent perforator veins in patients with active venous ulceration.

BACKGROUND: Previously, subfascial ligation of perforator veins to treat venous ulceration in the lower extremities required long skin incisions through diseased skin and subcutaneous tissue. This was known as "the Linton operation." In 1985, Hauer described an endoscopic technique for ligating incompetent perforator veins; this seminal contribution marked the advent of subfascial endoscopic perforator surgery (SEPS). METHODS: From 1996 to 1998, we prospectively collected data on 41 patients with chronic venous insufficiency (CVI) who underwent a SEPS procedure at our institution. Preoperative assessment consisted of color-flow duplex ultrasound scanning, as well as ascending and descending phlebography. RESULTS: Some 45 SEPS procedures were performed on the 41 patients. Ages ranged from 42 to 84 years (mean, 60). Active venous ulcers were present in 37 legs; healing occurred within 9 weeks in 33 of them. No new ulcers developed in the follow-up period, a mean of 44 weeks. CONCLUSION: The results suggest that the SEPS procedure incorporated into the overall treatment plan for patients with CVI produces active healing with a minimum of postoperative complications. The study demonstrates the safety and efficiency of this procedure; it also underscores the important role incompetent perforator veins have in the formation of venous ulcers.

Adult↗
PubMed2000

Iliac vein compression syndrome: a new method of treatment.

Iliac vein compression syndrome (May-Thurner syndrome) is caused by compression of the left iliac vein against the pelvic rim by the right iliac artery. Serious vascular sequelae to the leg can result if this is not recognized and corrected in a timely fashion. The condition, often underdiagnosed, is thought to be present in approximately 20 per cent of the adult population. Previously, a major vascular operation with a significant hospital stay was required to correct this compression. As a nonsurgical option, we elected balloon dilation of the stenosed iliac vein, with insertion of a venous stent to maintain the restored lumen. Two patients who had this procedure have been followed for 12 months; venograms show continued patency of the iliac vein with no pressure gradient present. This procedure is safe and cost effective, and it requires a minimal hospital stay.

Adolescent↗
PubMed1999

Bilateral iliac vein filter deployment in a patient with megacava.

An 85-year-old-woman presenting with low back pain developed shortness of breath and right-sided chest pain. She was found to have perfusion defects indicative of pulmonary embolus (PE). Heparin was at first employed, but had to be discontinued because of gastrointestinal bleeding. Caval filtration was the obvious course, but it was found on computed tomography (CT) scan that the suprarenal portion of the inferior vena cava was 55 mm in diameter, and the infrarenal portion 44 mm. These measurements were too large for insertion of a Greenfield filter, for which the maximum diameter should be 28 mm. The right common iliac vein was 28 mm in diameter, and the left external iliac vein 25 mm. Two filters were inserted percutaneously in these vessels. The patient was followed for 9 months. No clinical evidence of recurrent PE or venous insufficiency occurred.

Aged↗
PubMed1987

Continuous epidural analgesia in the heparinized vascular surgical patient: a retrospective review of 912 patients.

Nine hundred twelve patients received continuous epidural analgesia administered through an indwelling plastic catheter while undergoing vascular reconstruction of a lower extremity. During a portion of the operative event, the patients were totally, transiently anticoagulated with heparin. None of the patients had an untoward neurologic event that could be attributed to an epidural hematoma. Our results and those of others show that this form of regional analgesia is safe and far outweighs theoretic contraindications when anticoagulation with heparin is planned as a part of the operative event. In the patients with impaired pulmonary ventilation or a cardiac disorder, this method of analgesia offers many advantages over a general anesthetic, such as obviating aspiration pneumonitis and averting prolonged support in the recovery period after completion of the surgical procedure. The regional vasodilation ensuing from the epidural blockade is an additional advantage in patients undergoing vascular reconstruction for lower extremity ischemia.

Adult↗
PubMed1986

The role of arteriovenous shunts in the pathogenesis of varicose veins.

Varicose veins and venous insufficiency are causes of significant morbidity. In North America 10% to 17% of the adult population is affected, an incidence 10 times that of arterial disease. Despite this, origin and mechanism of disease remain obscure. This study was designed to illustrate the presence of patent arteriovenous shunts in the varicosed limb and to assess their role. Twenty-eight women and twenty-one men with primary varicose veins were studied. Thirty-six men and seven women without venous disease served as a control group. Blood samples were collected from an arm vein and a limb varicosity in the study group along with an arterial blood sample. Blood samples were also drawn from an arm vein and the femoral vein in the control group along with an arterial blood sample. Venous partial oxygen pressure (PVO2) and hemoglobin saturation (HbSat) were measured and venous oxygen content (CVO2) calculated. Mean values were then obtained and statistical comparisons made between each group. A statistically significant increase (p less than 0.001) in all three parameters--PVO2, HbSat, and CVO2--was demonstrated in the patients' limbs with varicose veins, consistent with a functioning arteriovenous shunt.

Adult↗
PubMed1981

The papaverine test for blood flow potential of the profunda femoris artery.

In reconstructive surgery of the arteries, the inflow tract is as important as the distal runoff. Since information about the hemodynamic significance of either cannot be obtained from an arteriogram , accurate assessment of flow within the arterial segment to be reconstructed must be obtained by other means. A functional pharmacologic test, consisting of the intra-arterial injection of 30 milligrams of papaverine hydrochloride which, under normal circumstances, can usually induce a 100 per cent increase, or more, in basal blood flow has been used to define theoretic maximum flow capacity by means of a linear quantitative relationships. The test also can unmask any undetected lesions in the inflow tract or technical errors occurring at the time of operations. From the results of this study, it is apparent that the use of a pharmacologic test for flow rate has demonstrated that profundaplasty makes a significant contribution to relieving symptoms of ischemia in the lower limb. This, in turn, brings about the resolution of certain types of tissue necrosis distally and safely improves the quality of life.

Aged↗
PubMed1979

Undesirable effects of hemometakinesia induced by vascular reconstruction.

Hemometakinesia, the borrowing of blood by one part of the body for use by other parts or tissues, is a well regulated physiologic mechanism involving selective vasodilation and vasoconstriction. It has been shown, however, that diversion of blood flow following vascular reconstruction may impoverish tissues from which the blood flow is borrowed, causing ischemia in these vascular beds. Observations on 12 patients out of a group of 100 who had undergone vascular reconstruction of a limb deterioration. It is suggested that the type and site of the vascular disorder and the expected diminution of blood flow in other involved arterial circuits should be considered in selecting the most appropriate vascular surgical procedure. Searching for and recognizing the hemodynamic significance of a silent lesion in the carotid or gastrointestinal circuit or in a contralateral limb may avert a vascular crisis after the primary lesion has been successfully treated.

Aged↗
PubMed1979

Significance of ankle blood pressure in the diagnosis of peripheral vascular disease.

Lower extremity blood pressure, an accurate indicator of peripheral arterial disease and a sensitive means of evaluating therapy, is easily determined by the Doppler detector either at the bedside or in the physician's office. In conjunction with the exercise tolerance test and the ankle to arm ratio, it permits the physician to follow the course of the disease and assess the results of therapy. The test may also detect and determine the extent of presymptomatic arteriosclerosis obliterans when present in the opposite limb.

Aged↗