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Biomedical subjects

K Hüttl

Publications and source records attributed to K Hüttl.

18 recordsLinked to original sources
PubMed2005

Changes in the plasma concentration of soluble thrombomodulin in patients with severe carotid artery stenosis after eversion endarterectomy.

OBJECTIVE AND DESIGN: The purpose of the study was to investigate the putative role of soluble thrombomodulin (sTM) in severe carotid artery stenosis. MATERIALS AND METHODS: We prospectively studied 64 patients who were undergoing carotid endarterectomy (2001-2003). Plasma sTM concentration was determined in each patient before surgery and at 14 months postsurgery. -308 TNF-alpha promoter polymorphism was also determined. RESULTS: Strong negative correlation was found between the preoperative duplex scan values and the plasma sTM concentrations (R = -0.418, p = 0.0006). Patients with 308 A TNF-alpha genotype had significantly lower (p = 0.0415) preoperative sTM values than their counterparts with no such polymorphism. Soluble TM concentrations measured in plasma samples taken at the end of the postsurgical follow-up period of 14 months duration were significantly higher compared to the preoperative values (p < 0.0001). CONCLUSIONS: Our present findings indicate that sTM may be adsorbed to the atherosclerotic plaques or inflamed endothelium in carotid arteries. The pathological significance of this adsorption remains to be determined.

Adsorption↗
PubMed2002

Endovascular treatment of peripheral artery disease with expanded PTFE-covered nitinol stents: interim analysis from a prospective controlled study.

PURPOSE: Current covered peripheral stent designs have significant drawbacks in terms of stent delivery characteristics and flexibility. The aim of this study was to analyze the technical performance, safety and initial clinical efficacy of expanded polytetrafluoroethylene (PTFE)-covered nitinol stents for arteriosclerotic peripheral artery disease. METHODS: Eighty-two patients underwent implantation of PTFE-covered nitinol stents for iliac and/or femoral obstructions. The study was conducted prospectively in seven European centers and one Canadian center. Patients were controlled clinically and by duplex ultrasound follow-up. Data up to discharge were collected in 79 patients. Seventy-four patients have thus far received 1 month follow-up and 32 patients, 6 month follow-up examinations. RESULTS: The average lesion length measured 47 mm for the common and external iliac arteries and 50 mm for the femoral arteries. The mean severity of the stenoses was reduced from 94% to 4% in the iliac arteries and from 98% to 7% in the femoral arteries after stent placement and dilatation. One device deviation (inadvertent stent misplacement) and one puncture-related severe adverse event with formation of a pseudoaneurysm occurred. There were occlusions of the stent in five patients. No infections were noticed. CONCLUSION: The interim analysis of this trial using PTFE-covered nitinol stents indicates that a strategy using primary implantation of this stent type is technically feasible, has an acceptable safety profile and is effective from a short-term perspective.

Alloys↗
PubMed2001

[Management of carotid injuries].

The occurrence of carotid arterial injuries is relatively infrequent but have serious outcome. At the Department of Cardiovascular Surgery we have performed surgical interventions in 16 instances (7 penetrating and 9 blunt trauma patients) due to carotid injuries. Preoperatively all these patients developed neurological deficits and in the postoperative period 7 patients became asymptomatic. We lost two patients owing to stroke. Vascular injuries are generally characterized by hemorrhage and ischemia in the area supplied. In addition to the symptoms of hemorrhagic shock, penetrating vascular injuries may lead to embolism from the injured intimal surface, thrombus formation and subsequent occlusion may occur. In other instances pulsating hematomas can be formed and with combined arterial and venous trauma A-V fistula can develop. In blunt trauma patients stretching or compression of the vessel may cause intimal rupture with subsequent formation of subintimal hematoma, dissection and later pseudoaneurysm. The disruption of the atherosclerotic plaque or the accumulation on the injured intimal surface may serve as source of embolism and thrombosis. In symptomatic patients the urgent performance of the surgical correction of the carotid arterial injuries is mandatory, nevertheless in asymptomatic patients and in chronic cases the prevention of the late complications is also justified as soon as possible.

Adolescent↗
PubMed2001

[Percutaneous angioplasty of the innominate artery in 89 patients: experience of 19 years].

PURPOSE: To assess retrospectively the success of percutaneous transluminal angioplasty (PTA) in treating innominate artery stenoses and occlusion in a large series of patients with long-term follow-up results. METHODS: In symptomatic patients with high degree (> 60%) stenosis, innominate artery PTA was performed. Long-term follow-up was undertaken by blood pressure measurements on both arms as well as subclavian, right common carotid and right vertebral duplex scan. RESULTS: Between 1981 and 1999, primary success rate of 89 innominate artery PTA (84 stenoses, 5 occlusions) was 96.4%. Complications included 1 left occipital lobe infarction (1.5%), 2 puncture-site thrombosis (2.9%), and 4 TIA (5.8%). Two patients with restenosis were successfully treated with rePTA. Cumulative primary patency was 98 +/- 2% at 6 months, 93 +/- 4% at 16 to 117 months, secondary patency was 100% at 6 months, 98 +/- 2% at 12 to 117 months; 61% of the patients became symptomless, 32% improved, 7% showed no improvement. CONCLUSION: Angioplasty of the innominate artery has been proven to be safe and effective on a large series of patients. For innominate artery stenosis and short occlusion, PTA should be the first treatment of choice.

Adult↗
PubMed2001

[Simultaneous carotid and coronary operations: experience and results of 11 years (1990-2000)].

Between 1990-2000 163 coronary + carotid procedures were performed. The mean age was 4 years higher than it was at patients underwent isolated CABG (63.4 y vs 59.8 y). Clinically proven obliterative artery diseases in other anatomical regions were also present in more than 60% of patients. The half of the procedures were performed under emergency and urgent circumstances. The cardiac status and the coronary morphology were found to be unstable in half of the patients. The "Euroscore" risk evaluation model was used for risk scoring. The mean score value was as high as 6.26. According to this the estimated surgical lethality could have been as high as 11.2%. The real surgical lethality value was far under this estimated level (7.36%). The 1, 5, 10 year survival rate were as high as 89%, 82%, 68% (Kaplan-Meier). The majority of the patients was in NYHA I-II at the end of the follow-up period. The majority of the early and late deaths were found to be myocardial in origin. The estimated surgical risk of the simultaneous procedures could be reduce by accepting of the severe surgical indications existing at this surgical field and with the availability of an experienced operating team.

Carotid Stenosis↗
PubMed2001

[Primary percutaneous coronary angioplasty in acute myocardial infarction. Measures of quality control for the work of the hemodynamics laboratory].

The results of primary percutane coronary angioplasty in acute myocardial infarction were studied and compared to international standards. We tried to develop new quality indicators for objective comparison. Seventy nine patients with acute myocardial infarction were included in the study, 47 of them from the pre-stent, and 32 from the stent era. The primary success rate was 91.5 and 81 per cent, respectively. Six months event free period was achieved in 74 and in 69 per cent. The mortality reduced from 10.6 per cent to 3.1 per cent. No emergency by-pass operation was needed in the stent group.

Adult↗
PubMed2001

[Surgical considerations in type-B aortic dissection].

Inspite of remarkable progress in both diagnostic and therapeutic development in treating aortic dissections this continues to be one of the most severe vascular catastrophies complicated by high mortality. While aortic dissections Type A are to treat surgically in our days, in majority of patients with Type B dissections hypotensive treatment is the method of choice providing better chance for survival preventing effectively aneurysm formation and rupture at the site of intimal tear. However in certain cases Type B dissection produces either isthmic aneurysm formation, or with distal progression may afflict long segmental thoracic, thoracoabdominal or abdominal deterioration of the aorta and its side branches. The spinal, visceral, renal and lower limb ischemia threatens viability of these organs and hypotensive medication may enhance risk. Prompt evaluation and selection of these cases with proper surgical reconstruction help us to reduce mortality. At our department we have performed 33 thoracoabdominal endoaortectomies with meticulous reconstruction of renal and visceral orifices. The mortality rate in this subgroup of patients was 6%, meanwhile almost 70% in those, treated medically but had the severe distal branch involvement. Based on our experiences in selected patients with Type B aortic dissections we recommend this procedure in order to achieve improvement of results.

Adult↗
PubMed1998

Aneurysmal bone cyst: its pathogenesis based on angiographic, immunohistochemical and electron microscopic studies.

Based on angiographic, immunohistochemical as well as electron microscopic findings, authors outline a hypothesis for the etiopathogenesis of aneurysmal bone cysts. No changes were found at the arterial site in 16 studied aneurysmal bone cysts, with no signs of an arteriovenous shunt. In certain cases, however, dilated and tortous efferent veins became visible in the late venous phase. Due to the impedance of venous flow, the intracystic pressure increases and the small veins become dilated causing formation of aneurysmal slits. This is supported by the immunohistochemical finding that S-actin shows concentric arrangement around the aneurysmal cavities. Endothelial lining and basal membrane remnants were detectable in places, though the aneurysmal slits were devoid of continuous endothelial lining and basal membrane. We suggested that the aneurysmal bone cyst corresponds to a hemodynamic disturbance and is due to primary or secondary venous malformation of the bones.

Actins↗
PubMed1997

[Total proximal reconstruction of chronic aortic dissection in patients with Marfan syndrome].

Authors present two patients suffering from Marfan syndrome. Asymptomatically developed serious cardiovascular complications being characteristic of the syndrome itself were revealed at both cases. Type "A" aortic dissection was found at the first, and type "B" aortic dissection involving even the arch as well revealed at the other patient. They were operated on an elective base. Total proximal aortic reconstructions (aortic root-ascending aorta-arch) were performed under deep hypothermia using total circulatory arrest (35 and 87 min). Both patients are doing well without complaints 3-4 months following the surgical interventions. Control angiographic imagination has found normal anatomic conditions at one of the patients. Anastomosis stenosis at the borderline of the arch and descending aorta was revealed at the other case which should be necessary to operate at an later occasion.

Adult↗
PubMed1997

Proximal bleeding control obtained by a balloon catheter in the surgical repair of a left supraclavicular traumatic arteriovenous fistula.

Endovascular procedures offer various methods for the treatment of posttraumatic arteriovenous fistulas. We report the treatment of a posttraumatic arteriovenous fistula between the left subclavian artery and internal jugular vein combined with a large subclavian false aneurysm. To avoid left thoracotomy we attained control of arterial bleeding by means of a transfemorally introduced balloon catheter advanced into the left subclavian artery. We found that the combination of endovascular procedures with classical surgery can reduce the risks in the treatment of arteriovenous fistulas.

Aged↗
PubMed1997

Multimodality treatment of pancreatic pseudoaneurisms.

Vascular lesions of pancreatitis manifest in the form of haemorrhage into the pseudocyst (PC), the development of pseudoaneurisms (PA) or splenic lesions. Between 1987 and 1996 31 patients were found to develop vascular lesions either in the form of haemorrhage into a PC (12) or PA (19). Diagnosis of pancreatic PA was established preoperatively in 8 cases only. Gastrointestinal (GI) bleeding manifested in 12 patients, but only in 6 of them was the pancreatic origin of the bleeding considered. All patients were operated. For the management of the lesions resection of the pancreas (11 cases) or ligation of the bleeding vessel with external or internal drainage of the PC was performed (12 cases). Simple external drainage of a haemorrhaged PC in 3, and cystoduodenostomy or cystogastrostomy was performed in 5 cases respectively. Intraoperatively moderate bleeding gave some concern (7 cases), while post operatively pancreatic fistula developed in 9 patients drained externally. All stopped spontaneously. In two cases severe GI bleeding occurred post operatively. In both cases embolization of the bleeding vessels was performed successfully. No operative mortality occurred. The mean follow-up time was 40.6 months (5-106). Five patients died of unrelated causes, 3 patients underwent subsequent pancreatic operation, and 74.2% of the patients are doing well. Development of pancreatic PA was associated with a longer observation or conservative treatment period. Angiography should be considered whenever severe upper GI bleeding occurs in patients with known pancreatic disease and the source of bleeding is obscure. In selected cases selective embolization of the bleeding site may provide definitive treatment.

Aneurysm, False↗
PubMed1996

[Endocrinologic complications of neurofibromatosis type 1].

Neurofibromatosis type 1 is the most common autosomal dominant inheritable disease, which is often associated with secondary forms of hypertension and with tumors of neuroectodermal origin. The authors present the results of evaluation of 60 members of 3 families. Of the 60 family members, 13 subjects had symptoms of neurofibromatosis type 1 disease, of which 7 subjects were evaluated. The case histories of patients are discussed: (1) An incidentally discovered adrenal tumor was proved to be a pheochromocytoma. (2) Because of complaints similar to thyrotoxicosis, thyrostatic drugs were administered for years without effect and, finally, an adrenal phaeochromocytoma was diagnosed after the presence of neurofibromatosis was established. (3) Preeclamptic pregnancy of a young primigravida complicated with severe HELLP syndrome (hemolysis-elevated liver enzymes-low platelet count) led to thorough evaluation which revealed renal artery stenosis. In this patient, percutaneous renal artery angioplasty resulted in a complete cessation of hypertension. (4) Glucocortocoid replacement therapy in a patient with neurofibromatosis type 1 resulted in a complete normalization of both secondary adrenal insufficiency and a previously unexplained iron-refractor iron-deficient anemia. The case histories of the patients demonstrate a lack of in-depth knowledge of neurofibromatosis in clinical practice. A regular follow-up of neurofibromatosis patients is suggested in specialized health centers.

Adrenal Gland Neoplasms↗
PubMed1994

[Incidence of stenosis of the internal carotid artery among patients waiting for coronary surgery].

1273 patients awaiting for coronary surgery were screened towards coexisting internal carotid artery stenoses. Non-significant carotid stenosis was revealed in 7.3% of these patients. In 48 patients (3.8%) the revealed stenoses were found to be hemodynamically significant. The coexistence of significant carotid stenoses with coronary artery disease was especially high at elderly patients. Among male patients over 70 years of age the occurrence of high grade carotid stenosis was as high as 10%. The 75% of significant stenoses was found to be asymptomatic. These would not been revealed without the carotid screening. The goal of this study is drawing attention to the frequent coexistence of coronary artery disease with carotid artery stenoses.

Adult↗
PubMed1994

[Percutaneous transluminal angioplasty of the subclavian artery].

Over a period of 12 years, percutaneous transluminal angioplasty was used to dilate 227 subclavian obliterations (216 stenoses, 11 occlusions) in 208 patients. Immediate success rate was 96%. 152 dilated arteries long-term patency are known. The average follow-up time was 32 months (1-120 months). 14 restenosis occurred. In 7 of the 14 patients redilation were performed. Complication: 3 puncture site thrombosis, 1 haematoma, 4 transient confusion occurred. In 2 patients shoulder pain developed with unknown origin, and last for a few weeks. There were no irreversible neurologic deficit. Percutaneous transluminal angioplasty of subclavian artery stenoses should be the procedure of choice in symptomatic patients.

Adult↗
PubMed1993

[Importance of carotid artery studies prior to coronary surgery].

The incidence of cerebral complications following extracorporal cardiac operations is reported to be approximately 2%. One of the possible reasons behind these complications is the presence of significant carotid stenosis as coexistent disease to the cardiac illness requiring surgery. Because of the common etiology carotid stenosis coexists mainly with a coronary artery disease. The authors make known their own screening methods based on the correct exploration of medical history and on the proper physical examinations. Coexistent significant carotid stenosis was revealed in 3.6% of 1056 patients who underwent coronary surgery within the period of 41 months. In all of these cases prophylactic carotid endarterectomy was performed. In twenty cases within this group the carotid reconstructions were performed simultaneously with myocardium revascularization. Staged endprocedures were performed in the other 18 cases. There was no surgical mortality and only one patient suffered major stroke. The authors emphasize the importance of carotid screening among patients awaiting coronary surgery especially in patients who previously sustained cerebral ischemic attacks, the presence of carotid bruits or any other known localization of obliterate arterial disease and finally in all patients over 60 years of age.

Age Factors↗
PubMed1992

[Percutaneous transluminal angioplasty in atypical aortic coarctation in an adult patient].

In the reported case, coarctation of the aortic arch (Coa) was the cause of hypertonia. Coa diminishes the expected lifetime, and operative treatment is required. PTA is contradictory in the treatment of coarctation. In the reported case coarctation was located on the aortic arch, and because of the risk of the operation PTA was performed. The dilatation was successful, hypertension resolved, and there was no significant difference in the blood pressure on the extremities. 16 months after the dilatation the patient is symptomless. The result of this case indicates that PTA of the Coa of the aorta is feasible. More experience is needed to establish its role.

Adult↗
PubMed1990

[The diagnostic value of so-called "post-cholecystectomy bile duct dilatation"].

In 1706 gallstone operations the diameter of the common bile ducts was determined in 990 cases during telecholangiography using a so-called functional cholangiodiametry. The data of 213 postoperative determinations of the common bile duct diameters performed during the follow-up period did not support the existence of a postcholecystectomic compensatoric dilation of the common bile duct. Ultrasound and ERCP failed to find postoperative bile duct dilation in patients without complaints following cholecystectomy and in persons with complaints of extrabiliary origin. In conclusion we found that biliopancreatic and organic reasons (residual calculi, papillary stenosis, bile duct stenosis, chronic pancreatitis) can always be detected as the underlying cause of a significant bile duct dilation.

Cholangiography↗