Technical innovations in nonreversed translocated saphenous vein bypass.
Explore the source record for details and available documents.
Humans↗
Biomedical subjects
H L Fleisher
Publications and source records attributed to H L Fleisher.
Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): repair by a new stenting procedure.
Compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta has been termed the nutcracker syndrome. Although often asymptomatic, this syndrome may result in varicocele, ovarian vein syndrome, and rarely LRV hypertension, pelviureteral varices, hematuria, and flank pain. Previous surgical approaches have included nephrectomy, variceal ligation, nephropexy, or renocaval reimplantation. We report a new LRV stenting procedure that provided relief for a young woman incapacitated by daily left flank pain and microscopic hematuria. Phlebography of the LRV revealed mesoaortic compression associated with a pressure gradient of 12 mm Hg and preferential outflow down large pelviureteral varices. At operation compression of the LRV was corrected with an external stent of reinforced polytetrafluoroethylene. The patient was asymptomatic and free of hematuria for 9 months after operation and follow-up phlebography documented normal renocaval flow, elimination of the pressure gradient, and reduction of the pelviureteral varices. This represents the first description in the vascular surgical literature of this venous compression syndrome, which has been recognized in previous urologic and radiologic reports reviewed herein. Vascular surgeons should be cognizant of the nutcracker syndrome, and we recommend this new stenting procedure as a more simple and physiologic therapy than previous approaches to this problem.
Adolescent↗
Replacement of the carotid artery using nonreversed saphenous vein.
Carotid artery replacement has been performed with a nonreversed saphenous vein in one patient who had carotid artery resection in association with resection of a squamous carcinoma at the carotid bifurcation. An excellent result was obtained. The technical aspects of this procedure are described herein.
Carcinoma, Squamous Cell↗
Human percutaneous laser angioplasty. Patient selection criteria and early results.
Percutaneous transluminal laser angioplasty is a new method for treating atherosclerotic disease previously not amenable to routine percutaneous transluminal angioplasty techniques. Our results compared favorably with other clinical trials. Patient selection criteria include lesions in the superficial femoral or popliteal system not capable of being treated with routine percutaneous transluminal angioplasty. We think that these lesions include high-grade stenoses or short segmental occlusions. Heavily calcified vessels and long segment occlusions measuring greater than 12 cm in length are probably not amenable to percutaneous transluminal laser angioplasty. The long-term results of this form of therapy for peripheral vascular disease remain unknown.
Aged↗
Chylous ascites after abdominal aortic aneurysmectomy: successful management with a peritoneovenous shunt.
Postoperative chylous ascites is a rare complication of aortic aneurysmectomy. Although increasing numbers of abdominal aortic aneurysms are being resected annually, there have been only eight previously reported cases of chylous ascites after this operation. This article describes the ninth case of postoperative chylous ascites after abdominal aortic aneurysm resection and emphasizes the value of management with peritoneovenous shunting.
Aged↗
Human percutaneous laser angioplasty.
Explore the source record for details and available documents.
Aged↗
Angioscopically monitored saphenous vein valvulotomy.
Angioscopy was used during in situ saphenous vein bypass grafting in seven patients. We were able to visualize valve incision, immediately identify and correct incomplete valvulotomy, identify side branches as potential arteriovenous fistulas, and assess distal anastomotic integrity. We encountered no retained valve cusps after angioscopy, as verified by Doppler ultrasound and completion angiography. Angioscopy verified distal anastomotic integrity in all patients with distal vein grafts large enough to accept the angioscope. Angioscopy requires minimal time, is relatively easy to use, serves as an adjunct to Doppler ultrasound and completion angiography, and has future potential as a therapeutic tool.
Aged↗