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Biomedical subjects

H Schweiger

Publications and source records attributed to H Schweiger.

At least 19 recordsLinked to original sources
PubMed2003

Graft patency and clinical outcome of femorodistal arterial reconstruction in diabetic and non-diabetic patients: results of a multicentre comparative analysis.

OBJECTIVE: in diabetic patients with critical limb ischaemia (CLI) an inferior success rate following infrainguinal bypass surgery is quite often suggested. The aim of this retrospective analysis was, therefore, to evaluate the graft patency and, particularly, the clinical outcome at 1 year in diabetic compared with non-diabetic patients. MATERIAL AND METHODS: two hundred and eleven patients (diabetics 94; non-diabetics 117) with femorodistal reconstruction for CLI were studied. Groups were comparable with regard to the Fontaine classification, the distribution of vascular risk factors, graft material, distal anastomosis site, and the angiographic runoff grading. RESULTS: diabetes did not adversely affect graft function. For diabetics and non-diabetics primary cumulative patency rate at 1 year was found to be 66 and 56%, respectively (p=0.10) and a virtually identical limb salvage rate of 85 and 83% was achieved (p=0.76). With regard to healing of ischaemic foot ulcers a trend against diabetics was noted with a healing rate of 81% compared to 96% in non-diabetics at 1 year (p=0.067); gangrenous foot lesions could be equally remedied in 94% and in 87% among patients with and without diabetes (p=0.44). The survival rate of diabetics, however, was significantly lower with 78% at 1 year compared with 95% in non-diabetic patients (p=0.0004). CONCLUSIONS: our preliminary results support the view that infrainguinal bypass grafting can be safely done even in diabetics. Despite increased mortality in this group, liberal indication for reconstructive vascular surgery seems to be justified by favourable patency rates and clinical outcome in selected patients.

Aged↗
PubMed2000

[Carotid surgery].

Explore the source record for details and available documents.

Angioplasty, Balloon↗
PubMed2000

[Natural history and indications for surgery in carotid stenosis].

Atherosclerotic stenoses of the internal carotid artery are often the underlying cause for ischemic stroke. Several studies show a strong correlation between the grade of stenosis and stroke risk. When cerebral symptoms occur in patients with a carotid artery stenosis of 60% or more the risk of stroke within the following 12 months is over 10%. Large randomised studies show that patients with a high grade carotid artery stenosis benefit clearly from carotid endarterectomy. Surgical treatment reduces stroke risk by more than 70% in these patients. Symptomatic patients with stenoses less than 40% do not benefit by endarterectomy even when surgical complication rate is low. The benefit of carotid endarterectomy is proven for asymptomatic stenoses, too. In asymptomatic patients, however, an operative procedure is justified only when surgical complication rate is 3% or less.

Carotid Stenosis↗
PubMed1999

Extraanatomic bypass in the treatment of prosthetic vascular graft infection manifesting in the groin.

BACKGROUND: Infection of an alloplastic vascular graft is a serious complication and often involves the groin. We propose a therapeutic concept using extraanatomic bypass to avoid the septic groin in case of an infected alloplastic vascular reconstruction. PATIENTS AND METHODS: The course of 25 patients (18 men, 7 women, mean age 61 years) with a grade III inguinal infection following placement of an aortic or femoro-distal synthetic graft made of Dacron or PTFE was analysed. The treatment consisted of excision of the infected graft material and extraanatomic reconstruction with ringed PTFE grafts in all patients. Mean follow-up after the extraanatomic procedure was 21 months (1-91 months). RESULTS: Direct surgical exploration definitely secured graft infection in almost three-quarters of the cases. The most common organism isolated was Staphylococcus aureus (13/22 = 59%). At the time of infection 60% of the patients had critical limb ischemia necessitating vascular reconstruction simultaneously with total or partial excision of the infected graft. Complications of the extraanatomic bypass occurred in 7 cases (overall morbidity 28%). Postoperatively, one patient required major amputation. Hospital mortality was 8%. Primary patency and secondary patency rates of extraanatomic grafts amounted to 78.0% (+/- 10.0 SD) and 84.1% (+/- 8.7 SD) respectively after two years. Limb salvage rated 78.4% (+/- 11.6 SD) after 2 years, the 2-year-survival rate was 73.8% (+/- 9.3 SD). CONCLUSIONS: According to the favourable long-term limb salvage and survival rates, we support simultaneous vascular reconstruction by extraanatomic bypass and explanation of the infected graft material in case of grade III inguinal infection of alloplastic vascular reconstructions.

Aged↗
PubMed1998

[Post-traumatic arteriovenous fistula between splenic artery and vein as a rare cause of acute myocardial ischemia].

Arteriovenous fistulas of the portal system are rare. Congenital fistulas have to be differentiated from acquired fistulas; the latter are of posttraumatic or iatrogenic origin. The case presented demonstrates a history of diffuse abdominal pain and the first description of myocardial ischemia caused by a posttraumatic splenic arterioportal fistula. After diagnostic and therapeutic difficulties, the definitive treatment consisted in resection of the fistula system including the pancreatic tail.

Adult↗
PubMed1998

The influence of the state of the vertebral arteries on the peri- and postoperative risk in carotid surgery.

OBJECTIVES: To assess the significance of the vertebral arteries (VA) as a prognostic factor within the framework of carotid surgery. DESIGN: Prospective observational study. MATERIALS: A total of 1338 operations were performed on 1182 patients. Three hundred and six of the patients had angiographically confirmed unilateral (299) or bilateral (seven) involvement of the VA. In 31 cases it was not possible to assess the VA. METHODS: Life table analysis. RESULTS: Thirty-day mortality rate was 1.6% (21 out of 1338) for all reconstructions of the internal carotid artery. In addition to three fatal strokes, 22 hemispheric events were noted (1.6%, 22/1338). Follow-up varied between 1 and 96 months (mean 34, S.E.M. 0.76, median 29) and covered a total of 3361 patient years. The cumulative 5-year survival rate was 69%. Irrespective of age, cardiac events were the leading cause of death. In patients with VA involvement, both the 30-day stroke and mortality rate (p < 0.01) and the long-term survival rate (p < 0.01) were significantly poorer. CONCLUSION: Concomitant vertebral artery disease increases the morbidity and mortality of carotid surgery, presumably due to reduced collateral perfusion during cross-clamping. However, the overall risk of surgery remains acceptable.

Aged↗
PubMed1998

[How can the prognosis of acute mesenteric artery ischemia be improved? Results of a retrospective analysis].

AIM: Acute mesenteric ischemia is difficult to diagnose and is combined with a high mortality. In a retrospective analysis it was investigated how to improve the poor prognosis of the disease. PATIENTS AND METHODS: Between January 1988 through December 1994 a total of 46 patients were operated on for acute mesenteric ischemia. Mesenteric artery occlusion was present in three quarters of the cases (n = 35). These were analysed according to symptoms, diagnosis, mechanism of occlusion, operative procedure and prognosis. Distribution of gender was almost balanced (19 women, 16 men) with a median age of 70.5 years. RESULTS: Embolic arterial occlusion was predominant (n = 22). Most frequently, the superior mesenteric artery was exclusively concerned (n = 22). Serum levels of lactate and leucocytes were preoperatively elevated in over 90% (median values: lactate 53 U/l, leucocytes 15050/ml). In 16 patients diagnosis was made on the ground of clinical parameters and/or angiography, but 19 patients were not diagnosed until operation. 19 patients were operated within 6 hours, 12 patients within 24 hours after admission (> 24 hours: n = 4). Vascular reconstructive procedures only, such as thrombectomy and/or aortomesenteric bypass were performed in 9 cases, in a further 7 cases combined with bowel resection. Bowel resection alone was done in 7 patients, 12 patients had only diagnostic laparotomy. 13 patients survived, 10 of them had been treated with vascular reconstruction. CONCLUSION: Acute mesenteric ischemia ought to be suspected in every patient with uncertain abdominal pain, because only early diagnosis can improve prognosis. Measurement of serum lactate is diagnostically helpful, although not proving. In case of elevated lactate levels and uncertain abdominal symptoms angiography of the mesenteric vessels should be performed early. At operation, blood flow in the mesenteric arteries should be restored whenever possible.

Acute Disease↗
PubMed1998

Knitted double-velour Dacron prostheses in aortobifemoral position--long-term performance of different coating materials.

BACKGROUND: The purpose of this prospectively randomized study was to evaluate intraoperative as well as long-term performance of different coating materials for knitted Dacron aortobifemoral prostheses. PATIENTS AND METHODS: Between 1989 and 1992 a total of 150 consecutive patients who underwent aortobifemoral bypass were randomized for three different coating materials: gelatine (Unigraft; n = 49), collagen (Hemashield; n = 50) and human albumin (USCI; n = 51). Intra- and perioperative data such as duration of operation, clamping time, blood loss, and early complications were obtained as well as yearly follow-up examinations up to five years. Frequency of late complications, graft patency, and patient survival were observed. RESULTS: No statistically significant difference of intraoperative data could be obtained. In every group 6% of patients presented with anastomotic aneurysm in the groin. Primary patency rates were Unigraft 92%, Hemashield 91%, USCI 92% (no significant difference, n.s.), secondary patency rates after 5 years were Unigraft 98%, Hemashield 95%, USCI 94% (n.s.). CONCLUSIONS: Overall superiority of one particular type of prosthesis could not be stated. In order to prevent sudden graft failure associated with progressive arteriosclerotic disease or from late anastomotic aneurysm regular follow-up examinations should follow aorto-bifemoral bypass.

Aorta, Abdominal↗
PubMed1997

[Acute peripheral arterial occlusion].

Acute embolic occlusion of a normal artery is best treated by simple "Fogarty" maneuver. This procedure is mostly successfully performed even by less experienced surgeons. However, if atherosclerotic disease is the underlying cause for acute occlusion of the vessel, an experienced vascular surgeon and the use of interventional techniques is demanded. In this case, deficits in both experience and technical equipment in the operating room frequently lead to avoidable limb loss.

Angioplasty, Balloon↗
PubMed1996

[Service intervention for prevention of recurrence].

The decision for or against a service procedure after arterial reconstructions in older patients needs some knowledge about life expectancy, natural course of the lesion and the risk of the procedure. There is no clear definition of a "failing reconstruction". The natural course of pathological lesions of arterial reconstructions is almost unknown. Especially in very old patients there are no general rules for service procedures.

Aged↗
PubMed1995

[Spontaneous and heparin-induced recanalization of the completely occluded internal carotid artery--a neglected phenomenon? 2 case reports and review of the literature].

This report presents two cases of totally occluded internal carotid arteries, verified by angiography. In both cases the vessel was recanalised under heparinisation. This was first detected by duplex carotid sonography. Angiographic follow-up showed a high-grade stenosis at the origin of the internal carotid artery. Both female patients were then operated successfully. It is important to consider the possibility of spontaneous recanalisation of an occluded internal carotid artery because there are clear indications for operative treatment in such a case. In case of total occlusion, as a rule no operative treatment is possible.

Aspirin↗
PubMed1995

[Endoscopic dissection of perforating veins].

Endoscopic subfascial sectioning (ESDP) is an effective method for the interruption of incompetent perforating veins. From March 1993 to April 1994 27 patients underwent ESDP in 35 legs. ESDP was performed in combination with Babcock's operation in 31 cases. Most patients demonstrated chronic venous insufficiency stage II or III (n = 25). A venous ulcer was found in 9 patients. Intraoperative complications were not seen. Postoperative complications were delayed wound healing (n = 1) and subfascial hematoma (n = 1). At follow-up examination after a mean interval of 8 months persistent insufficient perforating veins were seen in 3 of 88 Cockett veins (4%). A local dysesthesia of the saphenous nerve was found in 6 legs. Prior active venous ulcers had healed in 8 of 9 cases.

Adult↗
PubMed1994

[Diagnosis of phlebothrombosis using color-coded duplex sonography. A prospective comparison with phlebography].

In a prospective study the reliability of colour-coded duplex-sonography (CCDS) and phlebography in the diagnosis of deep leg and pelvic vein thrombosis was compared. In 82 consecutive in- or out-patients (42 men, 40 women; mean age 53 [19-86] years) with clinically suspected leg or pelvic vein thrombosis the results of 275 phlebographies (reference method) and 275 CCDS were compared on admission and during follow-up. The two methods were performed less than 6 hours apart. In the diagnosis of thrombosis the sensitivity of CCDS was 99%, specificity 80%. In 88% of all tests, the different thrombosis levels, as diagnosed by phlebography, were also demonstrated by CCDS. These data indicate that, if the clinical picture of suspected deep leg or pelvic vein thrombosis is unclear, CCDS should be done first. Phlebography should be performed only if the results of the former are inconclusive.

Adult↗