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Biomedical subjects

J J van den Dungen

Publications and source records attributed to J J van den Dungen.

17 recordsLinked to original sources
PubMed2003

Non-suture methods of vascular anastomosis.

BACKGROUND: The main aim of performing a vascular anastomosis is to achieve maximal patency rates. An important factor to achieve that goal is to minimize damage to the vessel walls. Sutures inevitably induce vascular wall damage, which influences the healing of the anastomosis. Over time, several alternatives to sutures have become available. METHODS: A Medline literature search was performed to locate English, German and French language articles pertinent to non-suture methods of vascular anastomosis. Manual cross-referencing was also performed and many historical articles were included. RESULTS AND CONCLUSION: The non-suture techniques can be categorized into five groups based on the materials used: rings, clips, adhesives, stents and laser welding. With all these techniques a faster and less traumatic anastomosis can be made compared with sutures. However, each device is associated with technique-related complications. As a consequence, suturing continues to be the standard approach. The disadvantages of the non-suture techniques include: rigidity and a non-compliant anastomosis with rings; toxicity, leakage and aneurysm formation with adhesives; early occlusion with stents; cost, reduced strength in larger-sized vessels and demand for surgical skills with laser welding. Further refinement is needed before widespread adoption of these techniques can occur. Clips, however, may be particularly promising but long-term evaluation is required.

Anastomosis, Surgical↗
PubMed2001

Outcome of surgical treatment for carotid body paraganglioma.

BACKGROUND: The present study reviewed a 30-year experience of managing carotid body paraganglioma (CBP) and analysed clinical findings associated with perioperative morbidity. METHODS: Clinical records, radiological findings and pathological reports of all patients who presented with CBP between 1966 and 1997 were reviewed. There were 39 consecutive patients with 45 tumours and median follow-up was 10 years. The Shamblin classification was used to define complication rates and long-term surgical results. RESULTS: Preoperative information derived from magnetic resonance angiography (MRA) and colour Doppler imaging (CDI) was comparable to that from standard four-vessel arteriography. Forty-one CBPs were resected in 35 patients. Six patients had bilateral tumours and seven had multicentric tumours. The median duration of operation and blood loss were substantially higher for Shamblin type III tumours. All major vascular complications (four of 39 patients) and permanent neurological complications (three of 39) were observed in type III tumours. CONCLUSION: Surgical planning and prediction of perioperative complications can be obtained by staging derived from MRA and CDI. Severe complications occur predominantly in type III CBPs.

Adolescent↗
PubMed2001

Flow analysis in vascular shunts that bypass the carotid artery.

When blood flow through a carotid artery is impaired and vascular surgery is necessary to restore adequate circulation a vascular shunt can be applied to maintain cerebral blood flow. Several vascular shunts are commercially available, but there is only limited test data on their flow capacity. The purpose of this study is to determine the flow capacity of three vascular shunt systems. A theoretical model has been developed for this purpose. To validate the model, in vitro flow measurements were taken. Application of the model showed that all shunts cause a decrease in blood flow. The amount of flow decrease varied widely from 13% (Javid shunt) to 55% (Pruitt-Inahara). In vitro measurements confirmed the validity of the model. In conclusion, it is important for the vascular surgeon to realise that vascular shunts show large differences in flow capacity. Of the three investigated shunts, the Javid has the highest flow capacity.

Arteriovenous Shunt, Surgical↗
PubMed2000

Nonpenetrating vascular clips for small-caliber anastomosis.

In the search for better anastomosing techniques, an improved vascular stapler device (VCS clip applier system(R)) has been introduced. The system uses nonpenetrating clips to approximate everted vessel walls. The objective of this study was to determine the effects of nonpenetrating vascular clips on endothelial wound healing. Aortic end-to-end anastomoses were performed in male Wistar rats. A comparison was made between clipped (n = 12) and conventional hand-sewn (n = 6) anastomoses. Patency rates were verified at different time intervals (after 1, 4, and 8 weeks), after which the anastomotic sites were removed. Morphological evaluation was carried out using scanning electron microscopy. All rats survived the procedure. Closure with clips took less time than closure with conventional sutures, with decreasing aortic clamping times for the clipped procedures during the course of the experiments. Patency rates were 100% in both the "clipped" and "sutured" groups. Microscopic examination showed favorable endothelial healing at the clipped anastomotic sites, with less inflammatory reaction at 1 week, and a more complete endothelial regeneration at 4 and 8 weeks follow-up, as compared with the sutured anastomoses. The clip applier holds the promise of a useful device in anastomosing small-caliber vessels, since clip closure takes less time than suturing, while patency rates are identical, and morphological results are favorable. Training is mandatory to obtain technical skills and to achieve optimal results.

Anastomosis, Surgical↗
PubMed1999

Fluorescence labeling to study platelet and leucocyte deposition onto vascular grafts in vitro.

Platelets and leucocytes are important participants in the response of the body to small diameter vascular grafts implanted into the arterial circulation. A sensitive and quick method for measuring platelet and leucocyte deposition contributes to material evaluation. With a newly developed fluorescence labeling method we examined the deposition of platelets and leucocytes onto vascular grafts in vitro. Human platelets and leucocytes were isolated and labeled with the fluorescence label Europium trichloride (EuCl3). After reconstitution of the labeled cells in plasma their functionality appeared intact and competitive with unlabeled cells. Eu-labeled platelets or leucocytes were then incubated with expanded polytetrafluoroethylene (ePTFE), Dacron and polyurethane (PU) vascular grafts in autologous plasma. Beta-thromboglobin and thromboxane release from platelets and beta-glucuronidase release from leucocytes during the incubation experiments were measured. Platelets and leucocytes deposited significantly less onto ePTFE compared to Dacron and polyurethane (P < 0.01). Our results are in accordance with results of in vivo studies using radio-active labeling to study platelet and leucocyte deposition. However, a new finding was that this reduced cell deposition may in part be due to possible toxic effects of ePTFE, shown by increased haemolysis and beta-thromboglobin release.

Biocompatible Materials↗
PubMed1998

[A swelling in the distal part of the thigh].

A swelling in the distal thigh may be caused by a tumour of bone or soft tissues, an aneurysm or an inflammation. Signs of inflammation may render interpretation more difficult. Four males aged 60, 48, 15 and 81 years had had a swelling in the popliteal space or above the knee, in some cases with pain. Supplementary examinations, especially MRI scanning and arteriography did not always result in a diagnosis. The diagnosis could be made, however, during operation: an empyemic thrombosed popliteal artery aneurysm, a liposarcoma, pyomyositis and suture dehiscence of a plastic prosthesis of the popliteal artery. After treatment, consisting of or started during the operation, uneventful recovery occurred.

Adolescent↗
PubMed1998

The use of the gastroepiploic artery for peripheral revascularisation. A study in pigs.

OBJECTIVES: To use the autologous gastroepiploic artery (GEA) as arterial bypass graft for peripheral revascularisation. We compared the development of intimal hyperplasia and nitric oxide (NO) capacity in GEA and internal jugular vein (IJV) implanted as peripheral grafts. MATERIALS AND METHODS: In pigs the GEA was implanted into the right peripheral circulation as a femoropopliteal bypass graft. In the left peripheral circulation the IJV was implanted as a femoropopliteal graft. After 21 days all grafts were harvested. Vascular rings of each graft before and after operation were studied for NO capacity. The distal half of each graft was prepared for histomorphometric studies. RESULTS: Administration of bradykinin to IJV and GEA induced relaxation. After implantation bradykinin resulted in contraction in IJV grafts, whereas in GEA grafts relaxation was reduced. In IJV grafts extensive intimal hyperplasia was formed, whereas in GEA grafts only small areas of intimal hyperplasia were formed. CONCLUSIONS: The functional studies lost NO capacity in IJV grafts, whereas NO capacity in GEA grafts remained intact. Intimal hyperplasia in IJV grafts was extensive, whereas GEA grafts demonstrated preservation of pre-existent intimal architecture. These results may encourage the application of the human GEA as bypass graft for reconstruction of arteries in the lower limb or foot.

Anastomosis, Surgical↗
PubMed1996

ROC analysis of noninvasive tests for peripheral arterial disease.

The purpose of this study is to evaluate the diagnostic accuracy of selected noninvasive tests for assessing peripheral arterial disease. The ankle/brachial index (ABI) and the femoral and popliteal pulsatility indices (PI), and combinations of these tests, were evaluated using receiver operating characteristic (ROC) analysis to determine their diagnostic accuracy depending on the localization of the disease. Verification bias, introduced by the preferential selection of patients for angiography based on the noninvasive test results, was examined. This study suggests that, in assessing whether a patient has significant peripheral arterial disease (lesions > or = 50%), determining an ABI is justified (ROC area 0.95 +/- 0.02). For disease localized to the aortoiliac segment, performing a single test, the femoral PI, is sufficient (ROC area 0.80 +/- 0.04). For disease including the femoropopliteal and infrapopliteal segments, a combination of tests is necessary. Utilized threshold values need to be adjusted for verification bias.

Adult↗
PubMed1996

Thromboendarterectomy for obstructive disease of the common iliac artery.

A retrospective case study was carried out from 1971-1990, with a median follow-up of 7 years, to assess the long-term results of thromboendarterectomy of the common iliac artery. The study included 94 consecutive patients, median age 52 years, of whom 84 suffered from atherosclerotic obstructive common iliac disease causing claudication, and 10 suffered from rest pain. Bilateral disease was present in 67 patients, and unilateral disease in 27. A total of 163 semiclosed endarterectomies (with the ringstripper) were performed. The mean ankle:brachial pressure index rose from 0.66 to 0.98. All patients with claudication became symptom-free after endarterectomy. Postoperative morbidity was low and there was no postoperative mortality. Recurrent aortoiliac symptoms were seen in 25 patients, leading to aortobifemoral bypass grafting in 12 cases. The primary cumulative patency rate at 5 and 10 years was 83% and 68% respectively. Thromboendarterectomy of the common iliac artery is a safe procedure with few complications and good long-term results. It is an effective method of treating common iliac artery stenoses or occlusions.

Adolescent↗
PubMed1991

Unilateral iliofemoral occlusive disease: long-term results of the semi-closed endarterectomy with the ring-stripper.

Nowadays, fewer endarterectomies are performed for treatment of occlusive arterial disease; more often a bypass procedure is done. This study investigates whether the results of the semiclosed endarterectomy for unilateral iliofemoral occlusive disease indeed indicate a wider use of bypass procedures for such short obstructions. Ninety-four patients with an obstructed external iliac and common femoral artery, but with patent ipsilateral common iliac and contralateral iliac arteries, underwent 101 operations. Seven of these patients were operated on at a later stage for occlusive disease on the contralateral side. Ninety-three endarterectomies were performed, and an iliofemoral bypass graft was inserted eight times because an endarterectomy was not feasible. Sixty-two operations were performed for disabling claudication, and 39 operations were performed for limb-threatening ischemia. Eighty-five percent of the patients who underwent an endarterectomy for disabling claudication became asymptomatic. Eighty percent of the patients who underwent an endarterectomy for limb-threatening ischemia became asymptomatic or improved to claudication. After endarterectomy no deaths, false aneurysms, or infections occurred. The patency rates at 1, 5, and 10 years were 94%, 83%, and 65%, respectively. We conclude that the semiclosed endarterectomy with the ringstripper of a unilateral obstruction of one external iliac and common femoral artery can be performed with a low morbidity and without deaths and gives good long-term results.

Adult↗
PubMed1990

Femoropopliteal arterial fibrodysplasia.

Fibrodysplasia is a rare and unusual cause of obstruction of the superficial femoral or popliteal artery. Three young patients with intermittent claudication due to occlusion of the femoropopliteal artery are described. Histological examination showed destruction of the elastic and muscle fibres of the media. In one patient secondary fibrosis of the intima was seen. The adventitia showed an increase in elastin fibres in all cases. The lesions described can be respectively classified as perimedial fibroplasia, as medial dissection and as intimal fibroplasia. This is the first description of a patient with histopathologically proven perimedial fibroplasia and medial dissection of the femoropoliteal artery and the second case of intimal fibroplasia.

Adolescent↗
PubMed1983

The effect of prostaglandin E1 in patients undergoing clinical cardiopulmonary bypass.

The effect of prostaglandin E1 (PGE1) on protection of platelets during cardiopulmonary bypass (CPB) was evaluated in 9 patients, who were compared with an identical control group of 10 patients undergoing coronary artery bypass grafting. To evaluate the hemodynamic side-effects, PGE1 (0.05 micrograms/kg/min) was infused prior to CPB, resulting in a 26% drop in mean systemic arterial pressure. With this dose, no inhibition of the adenosine diphosphate-induced aggregation could be measured in the pulmonary artery sample. During CPB, the same infusion dose resulted in a severe drop in systemic arterial pressure below 50 mm Hg in 7 of the 9 patients. In 5 of these patients, volume load and phenylephrine infusion could not compensate for the pressure drop, and PGE1 had to be reduced to 0.02 micrograms/kg/min. Platelet aggregation was reduced significantly in the PGE1-treated group compared with the control group, but not completely inhibited during CPB. However, in the postbypass period no platelet preservation was seen in the PGE1 group. In both groups, platelet number and function were equally low. No differences were measured in blood loss or blood transfusion requirements. Except for hypotension, no side-effects of the PGE1 treatment were seen. It is concluded that the hypotension caused by minimal doses of PGE1 during CPB precluded using higher doses, which might have had a greater effect on platelet inhibition. These hypotensive side-effects should be reduced or eliminated before PGE1 can be expected to have the same protective effect on platelet damage that has been demonstrated in animal experiments.

Alprostadil↗
PubMed1983

Two membrane oxygenators and a bubbler: a clinical comparison.

We compared the hemocompatibility of the Polystan bubble oxygenator and the Travenol TMO and SciMed spiral-coil membrane oxygenators in 43 patients undergoing aortic valve replacement. In a subgroup of 27 patients, we collected hematological data and correlated platelet behavior with hemostasis. We found no differences in blood loss or blood (product) requirements among the groups. Platelet and erythrocyte damage was less in the membrane oxygenator groups than in the bubble oxygenator group. Differences in adenosine diphosphate-induced platelet aggregation were equivalent. Drops in this function concurred with intensified cardiotomy suction and administration of protamine. Leukocytosis after bypass was most marked in the SciMed group. Duration of bypass correlated with blood loss and blood requirements in the operating theater. Platelet counts shortly after bypass correlated negatively with duration of bypass and blood loss in the intensive care unit. Platelet function correlated with none of the factors just mentioned. We conclude that platelets and erythrocytes are preserved better by the membrane oxygenator than by the bubbler. The TMO system causes more erythrocyte damage than the SciMed oxygenator, probably due to TMO's dual-pump system. Clinical evidence for these improvements was not found, and this will be possible only when the other factors responsible for blood damage can be controlled.

Adult↗
PubMed1982

Clinical study of blood trauma during perfusion with membrane and bubble oxygenators.

This clinical study was designed to show differences in hemostasis after perfusion with membrane (MO) or bubble (BO) oxygenators in cardiopulmonary bypass. These differences, however, may be obscured by other damaging factors, such as cardiotomy suction, various perfusion durations, or different types of operations. Therefore, only patients undergoing coronary artery bypass grafting were studied. During such operations, rather equal perfusion durations can be expected and mainly apex vent suction is used. Data on postoperative blood loss and transfusions were collected from two groups: one comprising 49 patients perfused with the Travenol TMO membrane oxygenator (MO group) and the other composed of 25 patients with the Polystan VT 5000 bubble oxygenator (BO group). In 10 patients of each group, blood samples were taken at frequent intervals for blood cell counts, for the determination of platelet function, hematocrit, hemoglobin, and plasma hemoglobin, for several coagulation tests, and for the assessment of kidney and liver function. Significant differences between the two groups were found for postoperative blood loss and transfusions, both higher in the BO group. Platelet function was better maintained in the MO group until the moment of releasing the aortic cross-clamp, after which it decreased concurrently with a doubling of the amount of suction. After protamine administration, an additional drop of platelet function occurred and there was virtually no platelet function left in either groups; however, it recovered 90 minutes after bypass, mainly in the MO group. This study shows that hemostasis is better preserved with MO perfusion. Still further improvements may be achieved by preventing the damage of suction and by a correct protamine dose.

Blood Cell Count↗
PubMed1981

Hemodynamic side effects of prostaglandin E1 in patients before and during cardiopulmonary bypass.

Animal experiments have shown that the administration of prostaglandin E1 (PGE1) during cardiopulmonary bypass (CPB) reduces platelet damage and the tendency to bleeding disorders. Because PGE1 also has a strong vasodilating action, a clinical trial was started to evaluate its hemodynamic side-effects. PGE1 was studied during 3 different periods: 1. a 10-minute period before bypass, 2. a hemodynamically stable period during CPB, 3. during the whole period of CPB. 1. Before CPB, a consistent fall of mean arterial pressure (MAP) was observed (26 mmHg). 2. During the stable period of CPB, the blood pressure fall was dependent on the pre-existing systemic vascular resistance. 3. PGE1 infusion during the whole CPB period was, in general, badly tolerated. Increased perfusion flow was not sufficient to compensate for the resulting blood pressure drop. In most of the 13 cases vasopressors had to be given continuously. In 7 patients PGE1 had to be reduced, and in 4 patients the infusion had to be stopped altogether. Because of the marked vasodilator effects of PGE1 it appears impossible to give patients doses adequate to achieve platelet preservation during clinical CPB with safety.

Adult↗
PubMedDate not supplied

Inflammatory abdominal aortic aneurysms.

In a series of 517 operations for abdominal aortic aneurysm from 1971 to 1988 there were 45 cases (8.7%) with an inflammatory aneurysm with a typical thick glistening whitish fibrous layer. Almost two-third of the patients had rather severe chronic or acute progressive pain in the abdomen, the back or the flank. Unilateral (7) or bilateral (2) hydronephrosis due to ureteral compression occurred in 9 patients (20%). A diagnosis of inflammatory aneurysm was made preoperatively only in 10 patients. In 8 of the 9 patients with hydronephrosis ureterolysis was done, unilaterally (6) or bilaterally (2). After ureterolysis all had complete resolution of the hydronephrosis. Preoperative diagnostic methods are excretory urography, showing medial deviation, ultrasonography and CT-scanning of the abdominal aorta. All patients with an inflammatory aneurysm should undergo aortic replacement to prevent rupture and achieve pain relief. Ureterolysis in cases of hydronephrosis is strongly recommended and may be performed safely and with excellent results.

Abdominal Pain↗