PubMed Health⌕ Search

Biomedical subjects

J P Haxhe

Publications and source records attributed to J P Haxhe.

15 recordsLinked to original sources
PubMed2006

Carotid endarterectomy with internal carotid artery segmental resection, temporary shunt and vein patch angioplasty: early and mid-term results.

AIM: The authors report an alternative procedure to carotid endarterectomy with internal carotid artery (ICA) segmental resection and end-to-end anastomosis associated with temporary shunt and venous patch angioplasty. DESIGN: prospective cohort study. METHODS: Between May 1995 and December 2004, 192 patients underwent 200 primary CEAs for significant ICA stenosis. There were 131 men and 61 women with a mean age of 72.4+/-8.4 years. The indications for CEA were asymptomatic lesions in 51.5%, transient ischemic attack in 27.5% and stroke in 21%. RESULTS: The combined early morbidity and mortality rate was 2%. Two patients died, one due to fatal intracerebral hemorrhage and the second patient died of acute mesenteric ischemia. Neurological complications occurred in 2 patients, including 1 TIA and 1 nondisabling cerebrovascular accident. Non-neurological complications occurred in 26 patients (13.5%). Seventeen patients (8.8%) developed hypertension, 3 neck hematomas (1.5%) required surgical evacuation, 1 patient had reversible supraventricular arrhythmia (0.5%) and 1 patient had pneumonia (0.5%). Furthermore, 1 asymptomatic carotid occlusion was identified (0.5%) and 3 patients suffered permanent cranial nerve injury (1.5%). Mean follow-up was 45.7 months and there were 41 late deaths (21.8%). Survival rates at 1 and 5 years were 96.7+/-1.2% and 73.58+/-4.2%, respectively. CONCLUSIONS: CEA with ICA shortening and reanastomosis is a safe and reliable procedure without any increase in morbidity or mortality.

Aged↗
PubMed2005

Transilluminated powered phlebectomy. Mid-term clinical experience.

AIM: Transilluminated powered phlebectomy (TIPP) was first described in 1996 by Sptiz et al. and was designed to allow minimally invasive surgical treatment of varicose veins (VV). We report our updated experience with TIPP technique. METHODS: Between January 2001 and February 2004, 84 patients underwent treatment by TIPP technique for primary symptomatic VV. Saphenofemoral junction with complete stripping of the great saphenous vein was performed in all patients. Incompetent perforating veins was ligated and prominent VV were ablated with TIPP technique. RESULTS: Mean age of patients was 50.6 years (range 29-79 years) and most of patients were women (73%). The major varicose vein risk factors were standing position and parity. Heaviness (62%), pain (57%) and unsightly veins (30%) were the most common indications for surgery. The mean number of surgical incisions was 6 (range 3-10), the average operative time was 59 min (range 30-100 min) and the mean cosmetic score (out of 10) at 6 weeks was 8 (range 2-10). The mean pain score (out of 10) was at 2 days, 7 days and 6 weeks was 5, 3 and 0, respectively. All the complications were documented. CONCLUSIONS: The TIPP technique is safe without any adverse events, presents advantages and inconvenient which are discussed in this paper.

Adult↗
PubMed2002

[Spontaneous thrombosis of an iatrogenic pseudoaneurysm of the arterial brachiocephalic trunk following central venous catheterization].

Following the unsuccessful puncture of the right subclavian vein during central catheterism, a 80-year-old women developed a pseudoaneurysm on the external face of the brachiocephalic artery. Her symptomatology and haemodynamic status having remained steady, the patient was closely observed. The pseudoaneurysm itself thrombosed spontaneously and the foreseen endovascular procedure doesn't have been achieved. A review of the literature has been done concerning the venous catheterism complications and the pseudoaneurysm treatment.

Aged↗
PubMed2001

Thoracoscopic resection of pulmonary nodules after computed tomographic-guided coil labeling.

BACKGROUND: A limiting factor in performing video-assisted thoracic surgery for resection of peripheral solitary pulmonary nodules has been the recognition of the lesion visually. This study reports our clinical experience of injecting a small metallic marker under computed tomographic scan guidance before the operation, allowing localization of the lesion. METHODS: A series of 14 patients underwent video-assisted thoracic surgery for removal of 15 pulmonary nodules situated in the outer third of the lung. Before operation, a radiopaque microcoil was injected just behind the lesion and then used to locate, under fluoroscopy, the area to be resected during thoracoscopy. The technique was evaluated for accuracy, reliability, and ease of use. RESULTS: Microcoil labeling of peripheral pulmonary nodules allowed in every case a complete resection and a histologic identification of the lesion. It is more stable and accurate than methylene blue dye marking, and it is as easy to perform as computed tomographic scan-guided biopsy. The incidence of complication was small in spite of our inexperience with the technique. CONCLUSIONS: Our experience with microcoil injection shows that it provides consistent and highly accurate marking of pulmonary nodules for video-assisted thoracic surgery, allowing secure resection with a safe margin.

Adult↗
PubMed2001

Six hundred consecutive carotid endarterectomies with temporary shunt and vein patch angioplasty: early and long-term results.

PURPOSE: This retrospective study evaluates the long-term clinical outcome and the survival of 600 consecutive carotid endarterectomies performed with a temporary shunt. All arteriotomies were closed by vein patch angioplasty. MATERIALS AND METHODS: Between November 1989 and November 1998, 600 isolated carotid endarterectomies (CEA) were performed in 540 patients by a uniform surgical technique at the University Clinic of Mont-Godinne. An intraluminal shunt and patch closure were systematically used. The mean age was 68 yr (ranging from 41 to 91 yr), 400 patients were men. The risk factors included hypertension in 73%, smoking history in 60%, coronary artery disease in 51% and hyperlipidemia in 35%. The indications were asymptomatic stenosis in 47%, transient ischemic attack in 40%, vertebrobasilar symptoms in 7% and stroke in 6%. EARLY RESULTS: The combined 30-day stroke and death rate was 0.9%. There were four deaths. The stroke and TIAs rates were 0.2% and 1.5% respectively. The incidence of early carotid occlusion was 0.5%. Cranial or cervical nerve dysfunction was identified in 6.3%. LATE RESULTS: The median follow-up was 49 months with a range of 2-124 months. Cumulative survival rates at 5 and 10 yr were 92+/-1% and 89+/-2% respectively. Thirty-two patients died during long-term follow-up; the death was stroke-related in only three patients. CONCLUSION: Carotid endarterectomy using an intraluminal shunt and vein patch closure is a safe and effective procedure associated with low morbidity and mortality rates at short and long-term follow-up.

Adult↗
PubMed1996

Myocardial revascularization for severe left ventricular dysfunction. Factors influencing early and late survival.

The results of coronary bypass surgery have been assessed in 102 patients with severe left ventricular dysfunction who had a preoperative left ventricular ejection fraction of < or = 0.35 (mean (s.e.m.) 0.29 (0.01)). Independent risk factors influencing operative mortality were obesity (P = 0.0290) and the need for preoperative intra-aortic balloon counterpulsation (P = 0.0010). Cox regression analysis using as its end-point 'cardiac-related death' demonstrated three variables; the need for preoperative intra-aortic balloon counterpulsation (P < 0.001), advanced age (P = 0.011), and obesity (P = 0.36). In a subset of 43 patients who did not have these risk factors, the 4-year cardiac-related death rate was 95.1 (3.4)%. The operative mortality and long-term survival can be expected to be satisfactory in patients with severe left ventricular dysfunction, provided they have a viable myocardium rather than myocardial fibrosis.

Aged↗
PubMed1995

Unusual pitfall of use of retrograde cardioplegia.

The use of retrograde cardioplegia can lead to several complications, mainly related to injuries during the cannulation of the coronary sinus. We herein present a case report of injury to the right coronary artery related to kinking due to the pursestring on the right atrium.

Aged↗
PubMed1995

Functional evaluation of internal mammary artery bypass grafts in the early and late postoperative periods.

OBJECTIVES: We sought to determine whether internal mammary artery grafts adapt to an increase in myocardial flow demand and whether they restore maximal flow reserve. BACKGROUND: Although mammary grafts are now considered the graft of choice for coronary artery bypass surgery, there is still controversy about whether they can provide adequate flow at periods of peak myocardial demand. METHODS: Of 28 patients with a mammary graft anastomosed to the left anterior descending coronary artery, 15 were studied early (mean [+/- SD] 8 +/- 2 days) and 13 late (19 +/- 15 months) after operation by quantitative angiography and selective intravascular Doppler analysis at baseline, during pacing and after injection of papaverine and isosorbide dinitrate into the graft. Eleven patients with a normal left anterior descending artery served as control subjects. RESULTS: At baseline, mean graft diameter (2.39 +/- 0.41 vs. 2.42 +/- 0.45 mm) and bypass flow (38 +/- 22 vs. 30 +/- 12 ml/min) were similar in the early and late postoperative periods. Significant and similar vasodilation was observed in mammary grafts after administration of papaverine (+6 +/- 5% vs. +9 +/- 6%) and nitrates (+14 +/- 7% vs. +16 +/- 9%) both early and late after bypass surgery. Graft diameter increased during pacing late (+6 +/- 3%, p < 0.05) but not early after operation. Bypass flow increased similarly during pacing in both groups, but maximal flow reserve induced by papaverine was significantly lower in mammary grafts studied early (2.70 +/- 0.62) than those studied late (3.66 +/- 0.81, p < 0.01) and in normal coronary arteries (4.05 +/- 0.96, p < 0.001). CONCLUSIONS: An increase in myocardial blood flow induced by pacing resulted in vasodilation of mammary grafts in the late but not in the early postoperative period. Significant vasodilation of mammary grafts after papaverine and isosorbide dinitrate administration was observed both early and late after operation. However, bypass flow reserve after papaverine injection was significantly lower in the early postoperative period but normalized over time. This finding seems unrelated to the conduit; rather, it appears to be related to the periphery and could be the result of injury to the microvasculature during operation.

Blood Flow Velocity↗
PubMed1995

Peroperative hemodynamic study of left internal mammary artery grafts.

The present study was undertaken to analyse hemodynamic features of an arterial graft and to determine parameters which influence primarily flow and velocity. A total of 284 consecutive patients having isolated coronary bypass surgery underwent peroperative hemodynamic assessment by pulsed Doppler ultrasonics of a left internal mammary artery bypass graft implanted onto the left anterior descending artery. Internal mammary artery free flow was 109.2 +/- 3.7 ml/min and flow in the internal mammary artery measured after completion of the distal anastomosis was 70.9 +/- 2.7 ml/min. All values quoted are mean +/- standard error of the mean. Mean velocity was 21.2 +/- 0.6 cm/sec, internal diameter was 2.65 +/- 0.04 mm and pulsatility index was 2.24 +/- 0.12. Resistance was expressed as mmHg/(ml . min-1) and averaged 1.65 +/- 0.13 for total resistance, 0.87 +/- 0.05 for graft resistance, and 0.73 +/- 0.13 for coronary resistance. From a set of 35 variables, stepwise multiple regression analysis selected two parameters influencing independently flow in internal mammary artery (R2 = 0.8762): flow velocity (p < 10(-4)) and internal diameter (p < 10(-4)). Variables influencing velocity (R2 = 0.3071) were: pulsatility index, which is a dimensionless expression of peripheral resistance (p < 10(-4)), and free internal mammary artery flow (p = 0.0007). Furthermore, a significant correlation between internal diameter and total resistance was observed (R = -0.5363, p < 10(-4), Y = 1.676X-1.545), and the exponentially fitted regression line was characterized by a marked increase of resistance at diameters less than 2 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Operative risk assessment in coronary artery bypass surgery, 1990-1993: evaluation of perioperative variables.

Patient characteristics and the results of cardiac surgery change with time. To achieve the best possible treatment a continual analysis of results is necessary. The present study analyzes 1225 consecutive patients undergoing isolated aortocoronary bypass surgery for the four-year period ending September 1993. Average age was 63 years (range 32-86 years), 927 (75.7%) patients were male and 298 (24.3%) were female. Hospital mortality was 2.2% (17/787) for elective surgery, 6.3% (21/336) for urgent surgery, and 9.8% (8/82) for emergency surgery. Intraoperative variables increasing independently operative mortality as evidenced by multivariate analysis were the following: prolonged aortic cross-clamping time (p < 0.0001), absence of cold-blood cardioplegia (p = 0.0012), absence of bilateral use of internal mammary artery (p = 0.0035). Likewise, intraoperative variables influencing major adverse outcome (operative mortality and/or need for intra-aortic balloon pulsation) were the following: prolonged aortic cross-clamping time (p < 0.0001), absence of cold-blood cardioplegia (p = 0.0360). In conclusion, global ischemic time was the dominant variable in predicting operative outcome. Furthermore, a protective effect of cold blood cardioplegia and bilateral internal mammary artery grafting was evidenced.

Anesthesia, General↗
PubMed1994

Intraoperative assessment of coronary artery bypass grafts using a pulsed Doppler flowmeter.

A pulsed Doppler flowmeter was used in a series of 352 consecutive patients undergoing isolated coronary artery bypass grafting. Doppler flow measurements were available on 909 single terminolateral bypass grafts (327 internal mammary arteries and 582 saphenous veins) and 58 sequential bypass grafts anastomosed to combinations of arteries. Flow (mL/min) categorized as a function of the recipient artery was distributed as follows: left anterior descending coronary artery, 69.9 +/- 2.5; right coronary artery, 68.0 +/- 5.0; diagonals, 61.0 +/- 4.1; obtuse marginals, 55.9 +/- 2.2; and posterior descending coronary artery, 53.3 +/- 3.0 (p < 0.001). Graft outflow obstruction resulting from torsion of the graft pedicle or anastomotic stricture was identified in 7 patients (2%). After graft revision, flow increased from 9 +/- 4 mL/min to 69 +/- 13 mL/min (p = 0.023), and velocity rose from 4.6 +/- 1.1 cm/s to 18.1 +/- 2.4 cm/s (p = 0.009). In conclusion, the system was adequate for operative use and allowed identification and correction of technical errors.

Adult↗
PubMed1994

Intraoperative electromagnetic flowmeter measurements in coronary artery bypass grafts.

This study attempts to relate flow findings in internal mammary (IMA) and saphenous vein coronary artery bypass grafts to postoperative outcome. From 262 patients undergoing coronary artery bypass grafting, 601 electromagnetic flow measurements were obtained in IMA and saphenous vein grafts, and free graft flow was measured in 227 IMAs prior to grafting. Retrograde flushing of the IMA with diluted papaverine hydrochloride resulted in a marked increase in IMA free flow (124 +/- 4 mL/min versus 66 +/- 5 mL/min; p < 0.001). However, IMA free flow did not correlate with electromagnetic flow measurements after grafting to the left anterior descending coronary artery. The use of IMAs with free flows lower than 50 mL/min did not affect clinical outcome. Flow measured in saphenous vein grafts (66 +/- 9 mL/min) with an electromagnetic flowmeter was significantly greater (p < 0.001) than that in the IMA grafted on the left anterior descending coronary artery (36 +/- 3 mL/min) under comparable hemodynamic conditions. For the purpose of data analysis, patients were separated into three groups based on increasing incidence of complications: levels 0, 1, and 2. Patients with an uneventful outcome had a mean graft flow at chest closure of 51 +/- 3 mL/min versus 51 +/- 4 mL/min for patients in complication level 1 and 45 +/- 11 mL/min for patients in complication level 2 (p = not significant). Free flow measured in a vasodilated IMA was a poor predictor of flow into a grafted IMA and did not affect clinical outcome. We were unable to validate any flow limit to use of the IMA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Doppler flow measurement in coronary artery bypass grafts and early postoperative clinical outcome.

The present investigation attempts to correlate flow measurements made intraoperatively in coronary bypass grafts with clinical outcome. A total of 352 consecutive patients undergoing isolated coronary artery surgery underwent hemodynamic assessment of their bypass grafts (328 internal thoracic artery and 582 saphenous vein grafts) at the end of cardiopulmonary bypass (CPB) by using a 8 MHz pulsed Doppler ultrasound flowmeter. The total patient population was divided into three groups of distinct outcome (A: normal, 228 patients; B: complicated, 106 patients; C: poor, 18 patients) on the basis of a combination of the following parameters: difficult weaning from bypass, use of inotropic drugs, reduced left-ventricular stroke work index, myocardial infarction, intraaortic balloon counterpulsation, and death of cardiac origin. Univariate analysis has shown clinical outcome to be influenced by preoperative clinical condition and not by flow in bypass grafts (average flow per graft [ml/min] was 60 +/- 2 [mean +/- SEM] in group A, 58 +/- 3 in group B and 43 +/- 6 in group C: NS by analysis of variance). Multivariate analysis (Fisher linear discriminant analysis) selected only the two following factors leading to normal (group A) or adverse (groups B and C) outcome: unstable angina (p = 0.026) and duration of additional CPB after unclamping the aorta (p < 10(-5). To conclude, clinical outcome was not influenced by flow as measured in well-functioning bypass grafts by pulsed Doppler technique.

Blood Flow Velocity↗