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Biomedical subjects

H Haimovici

Publications and source records attributed to H Haimovici.

At least 19 recordsLinked to original sources
PubMed1987

Role of precapillary arteriovenous shunting in the pathogenesis of varicose veins and its therapeutic implications.

The conventional pathogenesis of varicose veins and their subsequent development is essentially based on primary valvular insufficiency of the main saphenous trunk and incompetence of the perforating veins. In contrast, the concept of the pathogenesis of varicose veins presented in this review is based on the presence of arteriovenous (AV) shunting that occurs primarily in the venous tributaries and rarely in the main trunks of the saphenous system. Identification of arteriovenous communications (AVCs) with varicose veins has been documented by visual observation during surgery and especially by use of high-powered microscopes or magnifying lenses. The AVCs have been found consistently to originate subfascially and to terminate in tributaries extrafascially, thus bypassing the capillary network. By means of serial arteriography it was shown that in more than 80% of varicose veins there is premature venous opacification. By means of Doppler ultrasonography, it was demonstrated that AV shunting was present in 80% of the cases. A correlative study of these parameters has shown that the initial significant pathology in varicose veins is mostly confined to the tributaries, although at an advanced stage the main trunk may also be subsequently affected to a lesser degree. In terms of management, these data strongly imply that sclerotherapy or surgical treatment (ligation or excision) should be confined to the tributaries and that high saphenofemoral ligation and stripping should be avoided except in cases where evidence shows valvular involvement and incompetency of the latter. As a result, this study strongly suggests that one could most often spare the main trunk of the saphenous vein for eventual use as a vascular graft.

Arteriovenous Anastomosis↗
PubMed1986

Congenital microarteriovenous shunts. Angiographic and Doppler ultrasonographic identification.

We describe herein two cases of vascular malformations, one classified as hemangioma and the other as Klippel-Trenaunay syndrome. Clinical investigation in each case failed to demonstrate the presence of arteriovenous (AV) shunting. Arteriographic findings revealed only indirect evidence of AV shunting in each case. In contrast, systematic scanning with a Doppler ultrasonographic probe of the involved extremities provided evidence of AV shunting and pinpointed it in suspected arteriographic areas. Good correlation between the two methods was confirmed in the hemangioma case both preoperatively and intraoperatively. In the case of Klippel-Trenaunay syndrome, evidence of multiple AV shunts was obtained primarily with Doppler ultrasonography. In addition to arteriography, serial phlebography, when indicated, is also necessary for complete evaluation of concomitant venous malformations. The pathogenic mechanism of these vascular malformations was briefly reviewed, emphasizing AV shunting as a common link between the various anatomicoclinical forms.

Adult↗
PubMed1985

Arteriovenous shunting in varicose veins. Its diagnosis by Doppler ultrasound flow detector.

The use of the Doppler ultrasound detector is described for the diagnosis of arteriovenous (AV) shunting in varicose veins. This investigation was carried out in 34 patients, 27 women and seven men. A total of 68 limbs with varicose veins and 48 control limbs with either no varicose veins or occlusive arterial disease are the basis for the clinical material. Twenty patients had had no prior surgery for their varicose veins and 14 had recurrent varicosities after bilateral ligation and stripping. Five patients had postphlebitic syndrome associated with varicose veins. All five had venous stasis ulcerations and edema. The Doppler flow detector uncovered AV shunting in areas outside the location of known arterial pulsations. The pulsatile venous flow was obtained at sites of "hot spots" and along markedly dilated veins. Maximum AV shunting was found in the lower third of the leg but much less often in the upper leg or thigh. The clinical implications of the role of AV shunting are discussed. The Doppler ultrasound findings appear to offer a simpler method to detect AV shunting than serial arteriography or thermography.

Adult↗
PubMed1984

Staging of arterial complications of cervical rib: guidelines for surgical management.

Subclavian artery compression by a cervical rib is an uncommon but potentially disabling condition. A series of 12 patients with 15 arterial lesions is reviewed and a staging system proposed to provide guidelines for managing patients with this condition. Stage I lesions have only arterial stenosis and minor poststenotic dilatation and are managed by thoracic outlet decompression, usually consisting of cervical rib resection. Stage II lesions have intrinsic arterial damage usually with subclavian aneurysm formation and require rib resection, aneurysmectomy, and arterial reconstruction. Stage III lesions present with distal thromboembolic complications and require thrombectomy or embolectomy in addition to thoracic outlet decompression and arterial reconstruction. The anatomic and pathophysiologic bases of the syndrome are reviewed and clinical and angiographic examples of each stage are presented.

Adult↗
PubMed1983

Removal of a thrombosed graft.

In the present report, a procedure for the removal of a late occluded graft which is firmly attached to the surrounding tissues is described which consists of disrupting mechanically the perigraft fibrous capsule by means of an external metal ring passed around the graft and, thus, allowing its easy removal.

Blood Vessel Prosthesis↗
PubMed1981

Progress in limb salvage by reconstructive arterial surgery combined with new or improved adjunctive procedures.

In the past nine years, 1196 patients whose lower extremity was threatened because of infrainguinal arteriosclerosis have been treated at Montefiore Hospital. In the last six years, limb salvage was attempted in 679 or 90% of 755 patients. Femoropopliteal (318), small vessel (204) and axillopopliteal (29) bypasses were used along with transluminal angioplasty (128) and aggressive local operations to obtain a healed foot. Immediate (one month) limb salvage was achieved in 583 or 86% of the 679 patients in whom revascularization was possible. The 30-day mortality rate was 3%. The cumulative life table (LT) survival rate of all the patients undergoing reconstructive arterial operations was 48% at five years. The cumulative LT limb salvage rate after all reconstructive arterial operations was 66% at five years. The cumulative LT patency rate of femoropopliteal bypasses was not influenced by angiographic outflow characteristics of the popliteal artery but was increased 15% by appropriate reoperations to 67% at five years. Cumulative LT patency and limb salvage rates of small vessel and axillopopliteal bypasses were more than 50% at two years. Of patients undergoing arterial reconstruction, 88% of those who died within five years did so without losing their limbs. Of all the patients in whom limb salvage was attempted, 68% lived more than one year with a viable, useable extremity, and 54% lived over two years with an intact limb. We believe this aggressive approach to limb salvage is justified, and can be undertaken with a low cost in mortality, knee loss and morbidity.

Aged↗
PubMed1979

Muscular, renal, and metabolic complications of acute arterial occlusions: myonephropathic-metabolic syndrome.

Acute arterial occlusions of the extremities may result, in approximately 7.5% of cases, in a severe and complex metabolic syndrome which often leads to loss of limb and life. The manifestations of this syndrome are divided into two stages: (1) the ischemic or devascularization phase, and (2) the revascularization phase. The ischemic phase includes severe clinical manifestations, of which the rigidity of the limb ("rigor mortis") is an outstanding sign, as are nephropathic-metabolic changes (oliguria, acidosis, myoglobinuria, azotemia, hyperkalemia). Their identification and correction at this phase may minimize their impact on the revascularization syndrome. The clinical and metabolic manifestations during the latter phase are more severe and may determine the outcome of the viability of the limb and the survival of the patient. Amputation rates are quite high (40% to 50%) and mortality rates range between 30% and 80%. The ischemic rhabdomyolysis appears to be the initiating event which leads to the biochemical and metabolic alterations that dominate the prognosis as to limb and life. The guiding principles of the management in these severe ischemic cases consist of early revascularization with emphasis on concurrent fasciotomy, alkalinization of the patient, reestablishment of acid-base balance, hemodialysis for renal shutdown, and often early amputation for better control of the metabolic omplications.

Acidosis↗
PubMed1978

Expanded polytetrafluoroethylene grafts in reconstructive arterial surgery. Preliminary report of the first 110 consecutive cases for limb salvage.

One hundred ten arterial reconstructions, including several new and extended bypasses, were performed with polytetrafluoroethylene (PTFE) grafts and were observed for three to 16 months. Patency rates were 100% with 15 bypasses to the femoral artery, 95% with 66 bypasses to the popliteal artery, and 76% with 29 bypasses to the arteries of the leg and foot. These encouraging preliminary results justify continued use and evaluation of PTFE as an arterial prosthesis.

Arteries↗
PubMed1978

Comparison of expanded polytetrafluroethylene and autologous saphenous vein grafts in high risk arterial reconstructions for limb salvage.

Polytetrafluoroethylene bypasses were used in a series of 56 reconstructions, to the popliteal artery in 45 instances or below in 11 instances. These were performed in high risk situations in patients who usually did not have a suitable saphenous vein. Autologous saphenous vein bypass grafts were performed in a comparable series of 56 high risk situations. The polytetrafluoroethylene reconstruction was patent at four to 14 months in 43 of 45 patients having femoropopliteal bypasses, with limb salvage in 39 of the 45. The saphenous vein bypass was patent at eight to 14 months in 39 of 45 patients having femoropopliteal reconstructions, with limb salvage in 36 of the 45. Distal--small vessel--bypass patency rates were similar for reconstructions with polytetrafluoroethylene and saphenous vein. No increase in the number of deaths or complications was observed in the polytetrafluoroethylene group, rather, a general reduction was noted in the operating time and in the incidence of wound complications. These results justify the continued use of polytetrafluoroethylene grafts in patients without saphenous veins who require arterial reconstructions of the lower extremity for limb salvage. The exact place of polytetrafluorethylene grafts in reconstructive surgery of arteries in the lower extremity awaits definition based upon longer periods of observation.

Blood Vessel Prosthesis↗
PubMed1978

New approaches to limb salvage by extended extra-anatomic bypasses and prosthetic reconstructions to foot arteries.

Because our femoropopliteal reconstructions with expanded polytetrafluorethylene (PTFE) and saphenous vein have comparable patency rates up to 22 months, we used this prosthetic for longer, more complex bypasses for limb salvage. Fourteen axillopopliteal or cross-over axillopopliteal bypasses were performed largely because groin infection or deep femoral artery disease precluded standard procedures; 12 are patent up to 14 months. Five patients required a bypass from one femoral artery to an opposite leg artery; four are patent up to 17 months. Because of progressive necrosis, eight patients required a secondary extension from a femoropopliteal bypass to a distal artery; five are patent up to 12 months. Three patients required extra-anatomic bypass for leg or popliteal space infections; all achieved limb salvage up to 12 months. Twenty patients without other suitable proximal arteries required a bypass to the dorsalis pedis or anterior tibial artery at the ankle; 10 are patent up to 14 months. Eleven patients required posterior tibial bypass at or below the ankle; seven are patent up to 18 months. One postoperative death followed these 61 procedures. Thus these operaions with long PTFE grafts that cross multiple joints can salvage limbs for important periods of time with low risk.

Aged↗