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Biomedical subjects

J R Allenberg

Publications and source records attributed to J R Allenberg.

At least 73 records · Page 4Linked to original sources
PubMed1994

The value of preoperative lytic therapy in limb-threatening acute ischemia from popliteal artery aneurysm.

In a retrospective study, we analyzed our experiences in 24 patients with acute ischemia from popliteal artery aneurysms over a period of 27 years and evaluated the value of a preoperative lytic therapy as an adjunct to surgical revascularization, compared to surgery alone. Preoperative urokinase therapy revealed a satisfactory improvement of the runoff in all cases. Follow-up angiography showed complete lysis in 6 and incomplete lysis in 3 of 9 patients. In contrast, in patients treated by surgery alone, postoperative angiography showed residual clots in all cases. The overall amputation rate was 25% (6/24) in 24 popliteal aneurysms with acute ischemia, including four patients with primary amputation for irreversible gangrene. Bypass grafting alone resulted in an early amputation rate of 9% (1/11) and occlusive complications of 45% (5/11) compared to no limb loss and no bypass complication in patients who underwent combined surgery and preoperative lysis (0/9). Our results underline the value of preoperative lytic therapy as an important factor in the management of acute ischemia in popliteal artery aneurysms.

Acute Disease↗
PubMed1994

Revision of the proximal aortic anastomosis after aortic bifurcation surgery.

The implantation of an aortic bifurcation graft (ABG) for treatment of occlusive (OD) and aneurysmal (AD) aortoiliac disease is a standard technique with good long-term results and a relatively low incidence of complications. In a retrospective review of our patients from 1964 to 1993 only 36/1520 patients were identified who required reoperation at the proximal aortic anastomosis after ABG. Indications were graft occlusion (15/36) and graft stenoses (2/36), refractory to graft thrombectomy, proximal aortic anastomotic aneurysms (11/36) or graft infection (8/36). Graft occlusion or stenosis most frequently led to aortic reoperation in the OD-group (53.5%), recurrent aneurysmal disease (37.5%) and graft infection (37.5%) were the dominant indications in the AD-group. Mean time interval to reoperation was shorter in cases of graft infection (35 +/- 33 months) as compared with graft stenosis (66 +/- 58 months), graft occlusion (86 +/- 49 months) or aortic anastomotic aneurysms (152 +/- 90 months). Of the reoperations, 92% were done electively, 8% as emergency procedures. The perioperative course was uneventful in 67% of patients. Overall mortality rate after elective revisional surgery was 3% but reached 66% in emergencies. Postoperative morbidity and mortality was related to preoperative morbidity and the urgency of surgery, not with the mode of aortic intervention nor indication.

Anastomosis, Surgical↗
PubMed1994

[Transluminal stent prosthesis in aneurysm of the abdominal aorta. Initial experiences with a new procedure].

We report our initial experience with percutaneous treatment of aortic aneurysms in three patients by stent grafts. A newly developed balloon-expandable Palmaz stent in combination with predilated PTFE was used. In two patients a tube-type reconstruction was performed and in the third patient an aorto-bi-iliac reconstruction. Total exclusion of the aneurysm was achieved in one patient. The other two patients had an acceptably minimal amount of residual perfusion, which slightly decreased during the follow-up period of 6 months. One iliac rupture occurred that was immediately treated by insertion of another stent graft. This study confirms the feasibility of such a concept. Further investigation is warranted.

Aged↗
PubMed1993

The isolated posttraumatic aneurysm of the brachiocephalic artery after blunt thoracic contusion.

Most supra-aortic aneurysms are localized in the extracranial carotid and subclavian artery. Aneurysms of the brachiocephalic artery (BCA) represent a rather rare finding. Chronic arteriosclerotic changes are responsible for the majority of cases. Posttraumatic BCA damage is only occasionally encountered, complete vascular dissection by perforating injuries being the dominant causative mechanism. Although isolated BCA trauma after blunt thoracic contusion is rare, brachiocephalic injury in association with aortic lesions seems to be the second most common site of vascular injury after the aorta. Cases of isolated blunt BCA trauma documented in the literature to date usually involved a complete avulsion of the artery from the aortic arch or complete rupture near the aortic origin. We present an isolated case of posttraumatic BCA aneurysm in a woman involved in a car accident who suffered blunt chest trauma with a subtotal, near circumferential vessel wall dissection of only the intima and media. Clinical features, diagnostic procedure, surgical treatment, and trauma mechanisms of postcontusional BCA lesions are described and discussed in reference to the literature.

Accidents, Traffic↗
PubMed1993

Management of primary aortic graft infection by extra-anatomic bypass reconstruction.

In this retrospective study, 21 patients requiring treatment for primary infection of an aortic prosthesis between 1981 and 1991 were identified from a prospective register. Ten of the 21 patients had had additional peripheral reconstructive vascular surgery before the diagnosis of aortic graft infection. The median interval between aortic graft insertion and diagnosis of graft infection was 16 months (range 1-84). Infected grafts were removed and an extra-anatomic bypass constructed in all patients. All but three patients had axillodistal reconstruction. Six patients had simultaneous operations, whilst the other 15 patients had a staged procedure with extra-anatomic reconstruction preceding graft removal. Two patients died before discharge from the hospital (9.5%). No patient required extremity amputation in the perioperative period. By life-table analysis patient survival (including perioperative deaths) was 80% at 1 year, 55% at 3 years and 40% at 5 years. Primary patency was 62% at 1 year, 51% at 3 years and 40% at 5 years. Limb salvage rate was 89% at 1 year, 63% at 3 years and 63% at 5 years. The median length of follow-up was 24 months. Extra-anatomic reconstruction in patients with aortic graft infection can be performed with low perioperative mortality. Limb salvage rates following extra-anatomic reconstruction are determined not only by the mode of reconstruction, but also by the primary disease.

Aged↗
PubMed1992

Renal artery aneurysm: surgical indications and results.

The clinical course of 23 patients with 28 renal artery aneurysms (RAAs) is reported. The RAAs were recorded over a period of 10 years. Thirty-five per cent of the RAAs (eight of 23 patients) were detected during the investigation of hypertension, whereas 26% (six of 23 patients) were discovered incidentally while imaging atherosclerotic arterial disease in the aorto-iliac region by angiography. Twenty-two aneurysms were treated surgically and primary nephrectomy was necessary in one case. The surgical technique used was excision of the aneurysm with bypass grafting in 13 cases (seven Dacron, five vein, one arterial bypass), a running suture following aneurysm excision in four cases and an end-to-end anastomosis in two cases. The results (for a period of 1-10 years) were excellent in all but three cases: two early graft occlusions (vein interposition) and one late occlusion (Dacron bypass) in the course of a re-operation which had become necessary because of a ruptured aneurysm of the gastro-epiploic artery after 3 months. Three of 23 patients were treated by embolisation of four intraparenchymal aneurysms. The follow-up of a non-treated saccular aneurysm showed a total thrombosis of the aneurysm within 4 years and fixed renal hypertension developed later in this patient. We suggest surgical repair of an RAA regardless of its size and the clinical symptoms, in order to prevent microembolism into the renal parenchyma and to avoid the development of fixed renal hypertension. Intrarenal aneurysms can be treated by embolisation to stop severe haematuria thus preserving the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Differential diagnosis of angiodysplasias using angiography and CT with special reference to the MR tomographic aspects].

The basic prerequisite for a rational therapy of angiodysplasia is differentiated diagnostics, especially the differentiation between arteriovenous malformations, haemangiomas, and venous malformations. Angiography reveals the arterialisation, arteriovenous fistulas, CT infiltrations of bone and soft-tissue. MRT demonstrates completely the extent of haemangiomas because of its bright signal intensity in the T2-weighted images. Hence, differentiation of malignant vessel tumours and malformations with rapid blood flow is possible, because the signal intensity is much lower in MRT. The three supplementary methods allow a correct diagnosis of angiodysplasia.

Angiodysplasia↗
PubMed1991

Pedal reconstructions for limb salvage.

If only one pedal artery is patent the vascular surgeon has to decide between primary amputation and a bypass. Between 1980 and 1990, 460 femoro-distal bypasses were performed in our clinic and 8% (39 cases) of these received a pedal reconstruction. At discharge from the hospital 85% of these grafts were patent. The primary goal of treatment, to maintain life and salvage the limb on the basis of a functioning bypass, was obtained in 82% of patients. After 1 year the secondary patency of our pedal reconstructions was 68%. Taking the mortality of amputations into account, vascular surgery to the foot arteries is preferable to amputation, whenever possible.

Aged↗
PubMed1991

Magnetic-resonance tomography of an inflammatory aneurysm.

An inflammatory aneurysm is defined as an abacterial special type of atherosclerotic aneurysm. The macroscopic characteristics are: a porcellaneous appearance, excessive thickening of the aortic wall, and perianeurysmal adhesions. Chronic inflammatory infiltrations, which are localized in the adventitia, can be found via microscopy. With computed tomography the thickening of the aneurysmal wall can be demonstrated best. The appearance of an inflammatory aneurysm in magnetic-resonance tomography is described in one patient.

Aged↗
PubMed1991

Renovascular hypertension: predicting surgical cure with exercise renography.

Renal artery stenosis with resultant renovascular hypertension has attracted clinical attention because the disease is potentially curable and because numerous diagnostic and therapeutic modalities compete for clinical acceptance. An exercise-mediated disturbance of renal hippurate transport was recently described, and has been implicated as having a role in nephrogenic fixed hypertension. To predict the final course of renovascular hypertension before operation we carried out a prospective study with the goal of verifying the predictive value of exercise hippurate scintigraphy. The study was to test the hypothesis that patients with disturbance of renal hippurate transport (pathologic renogram) induced by exercise would have stabilized hypertension and would continue to be hypertensive after operation. Thirty-one patients with hypertension who had unilateral or bilateral renovascular stenosis documented on angiography were referred to rest and exercise hippurate scintigrams before operation. The results of the examinations at rest served as standard and were compared with the exercise scintigrams. In 19 of the 31 (61%) patients a disturbance of transrenal hippurate transport evolved during exercise, whereas 12 (39%) patients failed to respond to exercise with altered hippurate kinetics. Twenty-six patients went on to renovascular operations; five had percutaneous transluminal angioplasty. Revascularization results differed markedly when the blood pressure response of patients with positive results on exercise (abnormal) and patients with negative results on exercise (normal) were compared. Ten of 12 patients with hypertension who had normal exercise renograms were cured. In comparison, blood pressure values were little influenced by therapy in patients with an abnormal response, where 17 of 19 patients continued to have hypertensive disease after therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1991

[Renal artery aneurysms].

Between 1980 and 1990, 21 patients with 26 renal artery aneurysms (0.4-16.5 cm in diameter) were diagnosed and treated at the Surgical Center, University of Heidelberg. Surgical reconstructive methods were applied to treat extrarenal and interventional embolization to treat intrarenal aneurysms. The most effective diagnostic method is selective intraarterial angiography. The etiology, age distribution, localization and clinical aspects are discussed. Four bleeding intrarenal aneurysms were embolized with full preservation of renal function (one solitary kidney). After surgical reconstruction of the aneurysmatic vessel, 80% of the hypertensive patients turned normotensive. Follow-up of a nontreated sacciform aneurysm showed total thrombosis within 4 years. In the same period, fixed renal hypertension developed in the patient because of recurrent microembolism in the renal parenchyma. Therefore, we suggest immediate treatment of a renal aneurysm to prevent the development of renal hypertension.

Adult↗
PubMed1990

Bilateral congenital aplasia of the deep femoral arteries.

A patient with bilateral congenital aplasia of the deep femoral arteries is described. The condition was accompanied by aneurysms of the popliteal arteries. Besides the academic interest of such an anatomical rarity, the abnormality is of clinical importance insofar as acute ischemia of the extremity may occur in the presence of superficial femoral artery occlusion.

Adult↗
PubMed1990

The popliteal artery entrapment syndrome: presentation, morphology and surgical treatment of 13 cases.

The morphology, clinical parameters and treatment of the popliteal artery entrapment syndrome (PAES) are presented on the basis of 13 of our own cases and from the literature. PAES is based on a segmental vascular compression due to an anatomical anomaly of the popliteal region and a new classification is presented distinguishing three variants according to the different anatomical conditions. PAES is mostly found in young sportsmen with well-developed muscles. Clinical symptoms are acute or chronic, and the diagnosis is made by physical examination, angiography and Doppler ultrasound, both in neutral position and in plantar flexion. Although thromboendarterectomy in some cases leads to good results, the preferred surgical therapy is decompression of the entrapped artery and reconstruction of the arterial pathway by vein graft interposition. The results were excellent in nine of 13 cases. In two patients, a recurrent thrombosis necessitated a femoro-crural bypass and in two others the entrapment was only diagnosed during reoperation for aneurysms of the venous graft.

Adult↗
PubMed1990

[Diagnosis and differential diagnosis of hepatic artery aneurysms].

Four cases of intra- and extrahepatic aneurysms of the hepatic artery are discussed concerning the etiology, symptoms, therapy and complication rate. The diagnostic approach and problems in differential diagnosis are specified. Localization of the aneurysm and especially the relationship of the collateral circulation of the hepatic bed are essential to plan the therapy and are based on angiography. Interventional therapeutic techniques are favored for intrahepatic localization. Reconstructive or ablative surgery is indicated to treat the extrahepatic aneurysm.

Aneurysm↗