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Biomedical subjects

H Imig

Publications and source records attributed to H Imig.

At least 37 records · Page 2Linked to original sources
PubMed1998

Semiclosed iliac recanalisation by an inguinal approach--modified surgical techniques integrating interventional procedures.

OBJECTIVES: Technical success and early outcome of modified surgical techniques integrating interventional procedures for iliac recanalisation performed through an incision in the groin. MATERIALS: Sixty-one consecutive iliac arteries in 59 patients with long occlusions in 16, occlusions of the common iliac in 11, occlusions of the external iliac in 24 and multiple stenoses of the iliac in 10 cases underwent semiclosed recanalisation through a groin incision. METHODS: Passage of the lesion by guidewire permits retrograde ring-stripper endarterectomy over the wire as a guiding splint or thrombectomy with a double lumen balloon catheter. Residual lesions are corrected by balloon or stent angioplasty. Adequate outflow is established by femoral patch plasty. RESULTS: Conversion to a standard operation was required in 10 limbs (failure to recanalise the lesion in nine, rupture after angioplasty in one). Initial technical success was achieved in the remaining 51 limbs (recanalisation by ring stripper endarterectomy in 36, thrombectomy in 14, both in six, additional intraoperative angioplasty in 42). Five postoperative thromboses were successfully treated by a combined surgical and interventional approach accounting for a 1-month 100% secondary patency. CONCLUSION: Iliac recanalisation through the groin by modified ring stripper endarterectomy or modified thrombectomy in combination with intraoperative angioplasty is a safe and effective procedure. Long-term results are required to evaluate the procedure.

Adult↗
PubMed1998

[The possibilities and risks of outpatient PTA in patients with peripheral arterial obstructive disease].

PURPOSE: To evaluate risk and feasibility of outpatient PTA in patients with iliac-femoral artery disease we conducted a prospective study. MATERIAL AND METHOD: Out of a total group of 263 patients we selected 100 p. (38%) according to pre-defined criteria. The following criteria and others excluded the patients from outpatient procedures: insulin-dependent diabetes, poorly controlled hypertension, cardiac failure grade III and IV, chronic haemodialysis, severe overweight, elective stent implants. RESULTS: 90 of 100 patients for whom we had planned an outpatient procedure, could leave the day-clinic after a maximum of 10 hours of observation. For 10 patients we changed the procedure to an inpatient stay because of prolonged heparinisation, sudden elevation of arterial pressure, secondary stent implants and the need for local fibrinolysis therapy. Complications showed a trend to be lower in the outpatient group than in the inpatient group (2.0% vs 4.3%). CONCLUSIONS: Performing iliac-femoral PTA on an outpatient basis demands strict selection criteria and a close tie-up to a day clinic. In 2/3 of our patients we preferred to perform PTA on an inpatient basis. A higher incidence of risks was seen in the inpatient group.

Adult↗
PubMed1997

Long-term in vivo alterations of polyester vascular grafts in humans.

OBJECTIVES: To examine the influence of in vivo hydrolysis on the physical properties of polyester grafts and their correlation to the period of implantation in the human body. MATERIALS AND METHODS: Sixty-five explanted vascular grafts were obtained after 0-23 years of implantation due to suture aneurysms (18), occlusion (12), graft infection (12), failure of graft material (7) and post-mortem (16). The surface was examined by scanning electron microscopy, the molecular integrity by infra-red spectroscopy and physical strength by probe puncture. RESULTS: Scission of macromolecular chains and loss of strength were shown. It was demonstrated that hydrolytic degradation of polyester takes place with increasing time of implantation in humans. Analysis by linear regression showed that polyester grafts lose 31.4% of their bursting strength in 10 years and 100% in 25-39 years after implantation. CONCLUSIONS: Regular follow-ups of patients with aged vascular grafts and the precise documentation of implanted materials are necessary to estimate graft degradation.

Blood Vessel Prosthesis↗
PubMed1997

[Guidelines in vascular surgery--aneurysm of the abdominal aorta].

The standard treatment of abdominal aortic aneurysm, including diagnosis, indication and method of operation, is being extended by the new method of stent-graft implantation. Currently it is too early to comment on the optimal technique and material. There is too much variation among different stent-graft combinations and long-term outcome is unknown, especially concerning the longevity of the prosthesis.

Aortic Aneurysm, Abdominal↗
PubMed1996

[Infrarenal abdominal aortic aneurysm--indications for surgery and survival].

PURPOSE: Elective operation is an established therapy in the management of infrarenal aortic aneurysms. Surgery has an acceptable low risk in the presence of experienced surgeons and anaesthetists. Indication for surgery nevertheless remains a difficult problem, because diagnostic procedures and evaluation of different criteria do not exactly predict the likelihood of rupture. Indication for surgery is moreover dependent on operative mortality and late survival. This study analyses early and late results associated with the repair of abdominal aortic aneurysms in our institution in Hamburg and comments on indication for elective surgery. METHODS: Life-Table analysis was used to determine survival rate. Calculation of expected prevalence of abdominal aortic aneurysms in the Hamburg population was based on demographic statistics and results in the literature. RESULTS: Between January 1981 and April 1995 1242 patients underwent abdominal aortic aneurysm repair, 1018 electively, 224 for ruptured aneurysm. Operative mortality was 4% and 50% respectively. The survival rate after elective operation was 64% at 5, 43% at 10 and 35.4% at 14 years, while after emergency surgery for ruptured aneurysm it was 40% at 5, 31.9% at 10 and 29.8% at 14 years. The survival rate of survivors after repair for ruptured aneurysms is similar to that after elective surgery. Over a 13 years period the rate of ruptured aneurysms did not decrease. Comparison of surgical data and calculated prevalence data show that a three times higher operative activity is requested to repair all occurring abdominal aortic aneurysms larger than 5 cm in diameter. CONCLUSIONS: In order to reduce the still high mortality associated with aneurysm rupture there is still a need for more prophylactic surgery.

Aged↗
PubMed1991

[Corrective interventions after operations on the femoral arteries].

Increasingly we are forced to perform a correction after vascular surgery (in our hospital: 1980, 4%; 1990, 15%). The groin is one of the main areas affected by this problem. Two principle methods of reconstruction must be distinguished. 1. First operation in the inflow area, 2. First operation in the outflow area. Operation procedure, special features, results, and complications are presented.

Arterial Occlusive Diseases↗
PubMed1990

[Late results after surgery of ruptured abdominal aortic aneurysm].

From 1981 to 1989, 695 patients with an infrarenal aortic aneurysm underwent surgery. In 114 cases the aneurysm was ruptured. The late results demonstrated, that after successful operation a patient's subsequent course was similar to that after an elective operation. Infarct and insult were the main causes of death in the postoperative period. Sonographic findings complete the postoperation analysis of the patient's later course.

Aged↗
PubMed1989

[Lower leg amputation--vascular surgery aspects].

Of 2,816 arterial reconstructions performed between 1984 and 1988 at the AK Hamburg, 341 amputations were necessary. Only 32 lower-leg amputations were possible. Although all facts indicate that the knee joint is best preserved, it is not always possible due to underlying arteriosclerosis. If a well-vasculated dorsal skin-patch can be formed, the operation is surgically unproblematic.

Amputation, Surgical↗
PubMed1988

Results of a bovine collagen vascular graft (Solcograft-P) in infra-inguinal positions.

A new bovine collagen prosthesis (SOLCOGRAFT P) was tested clinically. Previous biophysical and animal experiments had yielded promising results, including a modulus of elasticity closely resembling that of human arteries. Eighty-four prostheses were implanted in the femoro-popliteal and 20 in the femoro-infrapopliteal positions. While the cumulative patency rates were acceptable (86% after one year, 74% after two years, 69% after 3 years, and 59% after four years), the cumulative aneurysm rate was unacceptably high (2.2% after one year, 16.9% after two years, 36.6% after three years and 42.6% after four years). We comment on the reasons why the actual incidence of aneurysms in biografts has been underestimated in the past. The management of graft aneurysms and the remaining indications for reconstructive surgery with the SOLCOGRAFT P are also discussed.

Bioprosthesis↗
PubMed1988

[Venous diseases of the extremities--surgery and demands on radiology].

Surgery in the low-pressure system primarily means surgical treatment of varicosis. Reconstructive treatment is rather rare. That is the reason why for the radiologist phlebography is the most important method of examination in venous affections. The assessment of valve failures and the differing anatomy in the orifices of the major and minor saphenous vein show the high ranking of this examination from the surgeons point of view. No vascular surgeon would like to do without it.

Humans↗
PubMed1978

[Intrapartal retrograde jejunogastric invagination after gastrectomy].

This is a case report on a rare intrapartum complication consisting of a jejunogastric invagination 17 years after gastrectomy. The clinical systoms such as pain and tender mass in the epigastric region as well as vomiting are similar to an ileus. Immediate interdepartmental consultation is essential because of the very high mortality rate in case of diagnostic failure. Several possible reasons for the invagination are being discussed. The increased intraabdominal pressure during labor is most probably responsible for this life threatening event.

Adult↗
PubMed1976

[Ischemic necroses of the colon and rectum following alloplastic vessel substitution of the abdominal aorta].

Arterial insufficiency to the colon and rectum followed by ischemic necrosis of this bowel portion is considered to be a rare complication after resection of abdominal aortic aneurysms and alloplastic replacement of the abdominal aorta in arterial occlusive disease. The main symptom is diarrhea and mucus or blood in stool. Sigmoidoscopic examination is of diagnostic value; the treatment of choice has to be colostomy and resection. A causative factor for the development of large bowel necrosis is diminution of collateral blood supply, which is discussed in detail.

Aged↗
PubMed1976

[Radiologic diagnosis of retrograde jejunogastric invagination following gastrectomy].

Retrograde jejunogastric invagination is a rare late complication of operations on the stomach. Clinically signs and symptoms (colic-like upper abdominal pain, cyclindrical resistance and hematemesis) resemble that of high ileus. This complication, when wrongly interpreted or unknown, has a high mortality. One case following delivery shows the radiologic signs.

Abdomen, Acute↗
PubMed1976

[Perforation of the esophagus by gastric tubes (author's transl)].

Esophageal lesions caused by gastric tubes are not rare nowadays. Perforation at the physiologically narrow sites of the esophagus is a wellknown mechanism as is the use of inflexible polyethylen tubes containing a mandrin. Within 12 months perforation of the esophagus caused by gastric probes occurred in four patients of our intensive care unit. Clinical symptoms, diagnostic procedures and therapy of this complication are discussed, especially emphysizing the need of early diagnosis. The extent of complications arising from and the process of healing of this iatrogenic lesions depend upon the localization of the lesion and ypon early diagnosis.

Adolescent↗
PubMed1975

[Quantitative determination of fragment erythrocytes (schistocytes) in healthy subjects and patients after surgery].

Fragmented erythrocytes (schistocytes) were counted in blood subjects and from 50 patients who underwent various surgical procedures. The results showed to be as follows: 1. The average number of schistocytes in healthy controls of both sexes was 1-20/00 (medium in Thoma chamber 1.4%0/00, in blood smears 2.030/00, with a range from 0-50/00 and 0-60/00, respectively). 2. There was an increase in the number of schistocytes two hours after a surgical procedure (average 60/00), the degree of which correlated with the extent of the operation. Higher values of fragmented erythrocytes were counted after intraoperative blood transfusion (average 100/00). In most cases schistocyte values returned to normal at about 24 hours after surgery. 3. The highest schistocyte counts (18-350/00) were observed in two patients undergoing splenectomy with persistence of elevated counts for a longer period. 4. The average schistocyte number in stored blood of various age was 2.50/00. 5. Both counting of schistocytes in Thoma chambers and in blood smears are applicable, though the values obtained with the latter technique are slightly higher. Quantitative estimtion of schistocytes proves a useful method for evaluating disturbances in microcirculation.

Adult↗