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Biomedical subjects

L Kozloff

Publications and source records attributed to L Kozloff.

At least 19 recordsLinked to original sources
PubMed1987

Iliac arterial-enteric fistulas occurring after pelvic irradiation.

Fistulas from the iliac artery to the bowel constitute a condition that is often lethal. Excluding fistulas related to vascular grafts, a review of previously reported cases shows that they are most often due to atherosclerotic iliac aneurysms. Three unusual cases of this condition that occurred after high-dose pelvic irradiation for treatment of cancer are presented; in no case was recurrent tumor evident. These cases suggest that high-dose pelvic irradiation can predispose to the formation of iliac arterial-enteric fistulas, particularly if sepsis or inflammation develops. The definitive surgical management of these fistulas entails bowel resection, arterial ligation, and extra-anatomic bypass.

Adult↗
PubMed1985

Timing of carotid artery endarterectomy after stroke.

Carotid endarterectomy has been advocated to prevent further neurologic deterioration in patients who have had a stroke. Previous reports have shown that endarterectomy within 2 weeks of a stroke is associated with high morbidity and mortality rates presumably from hemorrhagic complications in the brain. Some recommend a 2- to 6-week waiting period after a stroke, but the safety of operation in the interval of time beyond 2 weeks has not been documented in the literature. The present study investigated the morbidity and mortality rates of 352 consecutive carotid endarterectomies. Three hundred three endarterectomies were performed on patients with symptoms other than stroke. Forty-nine endarterectomies were performed on patients with a deficit lasting more than 24 hours. Of these, 27 carotid endarterectomies were performed in an interval less than 5 weeks after initial stroke (early interval) and 22 operations were performed in a 5- to 20-week interval after stroke (late interval). Five strokes occurred in the 27 patients operated on within 5 weeks, an incidence of 18.5%; none of the patients operated on after 5 weeks exhibited worsening of their preoperative neurologic status. With the use of Fisher's exact test to compare these two intervals, the results were found to be significant (p less than 0.05). The cause of stroke in those operated on in the early interval was investigated by postoperative CT scans; in only one instance was there a hemorrhagic infarct of the ipsilateral hemisphere. The literature suggests that a variety of intracerebral vascular changes render the brain more susceptible to reinfarction soon after stroke. This study suggests an unstable situation in the 5-week interval following stroke that contraindicates carotid endarterectomy.

Adult↗
PubMed1984

Priority of revascularization in patients with graft enteric fistulas, infected arteries, or infected arterial prostheses.

Patients with arterial infections, infected arterial prostheses, or graft enteric erosions or fistulas have high amputation and mortality rates after treatment. An unresolved therapeutic question is whether remote ("extra-anatomic") bypass should precede or follow removal of the infected artery or prosthesis. None of the ten patients reported here who had a remote bypass inserted first developed distal limb ischemia or infection of the remote bypass. Literature review of patients with aortic prosthetic infections revealed a mortality of 71% (10/14) if infected graft removal preceded remote bypass and 26% (6/23) if remote bypass was first. Patients with graft enteric erosions or fistulas had a mortality of 53% (40/75) if graft removal was first and 17% (5/29) if remote bypass was first. Subsequent infection of the remote bypass was rare. Therefore, when possible, remote bypass with a prosthetic graft should precede removal of an infected artery, an infected arterial prosthesis, a graft enteric erosion, or a graft enteric fistula.

Aged↗
PubMed1980

Vascular trauma secondary to diagnostic and therapeutic procedures: cardiopulmonary bypass and intraaortic balloon assist.

Significant arterial trauma can result from femoral arterial cannulation for cardiopulmonary bypass or intraaortic balloon pumping. Threat of imminent loss of limb or suture line disruption requires prompt surgical intervention. Delayed appearance of claudication, characteristically at 1 to 2 weeks postoperatively, is highly suggestive of iatrogenic iliofemoral injury. Arterial reconstructive surgery was necessary in three of five such patients.

Adult↗
PubMed1980

Popliteal artery entrapment syndrome. Clinical, noninvasive and angiographic diagnosis.

The popliteal artery entrapment syndrome is increasingly recognized as a cause of arterial insufficiency in the leg. Diagnosis is based on a clinical history of claudication, which may be atypical, physical examination, noninvasive exercise testing and angiography. Patients with normal ankle pulses and resting ankle/brachial pressure indexes may require extensive exercise testing to document arterial insufficiency. Angiographic demonstration of medial deviation of the popliteal artery is diagnostic of the popliteal artery entrapment syndrome. Arteries that appear normal on routine angiography require biplane angiography with various provocative maneuvers to demonstrate induced arterial stenosis. Using this approach, three additional cases of popliteal artery entrapment syndrome were diagnosed preoperatively and successfully treated with surgery.

Adult↗
PubMed1980

Fallibility of postoperative Doppler ankle pressures in determining the adequacy of proximal arterial revascularization.

Twenty-three consecutive patients with limb-threatening ischemia underwent proximal arterial revascularization. In all patients Doppler ankle pressure was measured hourly in the postoperative period. In 16 limbs with patent superficial femoral arteries, the pressure index increased from 0.55 +/- 0.06 to 0.78 +/- 0.06 within the 1st hour postoperatively. Twenty limbs with occluded superficial femoral arteries, did not demonstrate a significant increase until 3 hours postoperatively (from 0.41 +/- 0.06 to 0.62 +/- 0.05). Immediate improvement in the Doppler pressure index is to be expected in patients with isolated aortoiliac disease who undergo successful arterial reconstruction. Failure to demonstrate such improvement is diagnostic of an intraoperative accident. Lack of immediate improvement in patients with combined aortoiliac and femoropopliteal disease should not be construed as evidence of intraoperative failure. With 3 to 4 hours, however, the ankle/arm pressure ratio should exceed the preoperative value. The failure to do so within that interval is strongly suggestive of inadequate revascularization, and in most cases immediate operative revision or the later addition of a distal bypass procedure will be necessary.

Adult↗
PubMed1980

An expedient shunt for the small internal carotid artery.

A simple and readily available device was used as a shunt during carotid endarterectomy in four cases in which difficulty in inserting a conventional shunt into the internal carotid artery was encountered. It was also used preferentially in one case of external carotid endarterectomy. No apparent injuries occurred in conjunction with its use, and in none of the four patients did neurologic complications develop. For those who wish to use a shunt in all cases of carotid endarterectomy, this device provides an expedient means of shunting in cases in which difficulty in inserting a conventional shunt is encountered.

Carotid Artery Thrombosis↗
PubMed1979

Popliteal vascular entrapment. Its increasing interest.

In the past 20 years since the first clinical management of a patient with a congenital anomaly associated with an abnormal medial head of the gastrocnemius muscle causing external compression on the popliteal artery, approximately 100 similar lesions have been documented in the world's literature. This has been a lesion of international interest, with only approximately 25% of the cases from hospitals in the United States. This present series of 14 lesions from Walter Reed Army Medical Center, Washington, DC, during a 12 1/2-year period beginning in September 1966 emphasizes the increasing interest in this lesion. The young athletic male in whom intermittent claudication develops with strenuous exercise or the middle-aged patient with a popliteal aneurysm should be evaluated for the possibility of popliteal vascular entrapment. Medial deviation of the popliteal artery seen angiographically is a classic finding, however, there might also be segmental occlusion of the midpopliteal artery. This series outlines various types of popliteal vascular entrapment and documents successful surgical management.

Adult↗
PubMed1979

Phleborheographic diagnosis of venous obstruction.

Between February 1977 and May 1978, phleborheograms were done on 328 extremities. Interpretable tracings were obtained in 322 (98.2%). Results were positive for 102 extremities, negative for 220 extremities, and equivocal or uninterpretable for six extremities. Phlebograms as well as phleborheograms were done in 64 extremities. Phlebograms were positive in 41 and negative in 23. The overall agreement between the interpretations of the phlebograms and phleborheograms was 95.3%. The phleborheogram was positive in each case in which the phlebogram was positive. In three cases with negative phlebograms the phleborheogram was positive. Thus, the sensitivity was 100%, and the specificity was 87%. Phelborheography is a useful ajunct to the diagnosis of venous obstruction. It has a high degree of sensitivity (100% in our experience). Clinical correlation is necessary to determine the most likely cause of venous obstruction in individual cases.

Evaluation Studies as Topic↗
PubMed1979

Ocular pneumoplethysmography: detection of carotid occlusive disease.

To determine the accuracy of ocular pneumoplethysmography (OPG-Gee) in detecting carotid arterial occlusive disease, 350 patients were tested by OPG-Gee. Sixty-three patients underwent angiography and the findings were correlated with the results of OPG-Gee tracings. Testing without carotid compression averaged three minutes and was easily performed by a physician or technician. There were no significant complications. Hypertension did not affect evaluation. There were two false-negative tests and no false-positive tests. Without carotid compression the overall accuracy for testing for significant arterial stenosis was 97%. When a carotid compression test was added, the two missed lesions were detected.

Carotid Artery Diseases↗
PubMed1979

Nondialysis uses for vascular access procedures.

Chemotherapeutic agents, blood products and hyperalimentation solutions have been administered and recurrent diabetic ketoacidosis has been treated via vascular access procedures in 13 patients during the period from 1972 through 1977. Bovine heterograft, saphenous vein graft and the direct arteriovenous fistulae have been successfully utilized in the construction of arteriovenous fistulae in patients requiring vascular access for nonhemodialysis purposes. Operative techniques and therapeutic usefulness are discussed.

Animals↗
PubMed1978

Doppler cerebrovascular examination, oculoplethysmography, and ocular pneumoplethysmography use in detection of carotid disease: a prospective clinical study.

To determine the comparative acccuracy of three noninvasive cerebrovascular testing systems, 72 patients underwent complete evaluation by Doppler cerebrovascular examination (DCE), oculoplethysmography (OPG-Kartchner), ocular pneumoplethysmography (OPG-Gee), and angiography. Considering 60% diameter stenosis or more by angiography as a true positive finding, the noninvasive tests of the 72 patients showed the following results: DCE, two false-positive, 17 false-negative, and 53 correct with an overall accuracy of 74%; OPG-Kartchner, six false-positive, four false-negative, and 62 correct with an overall accuracy of 86%; and OPG-Gee, no false-positive, two false-negative, and 70 correct with an overall accuracy of 97%. Independent of noninvasive test results, 57 symptomatic and three asymptomatic patients were selected for carotid endarterectomy. Of these 60 patients, 55 (92%) had positive preoperative OPG-Gee tracings. Noninvasive testing is a valuable carotid endarterectomy. Although considerable carotid ulceration may be undetected by noninvasive study, it was uncommon in this series.

Carotid Arteries↗
PubMed1978

Vascular trauma secondary to diagnostic and therapeutic procedures: laparoscopy.

Diagnostic and therapeutic laparoscopy are safe procedures that only rarely cause significant morbidity. However, major abdominal arterial and venous injury may occur, requiring prompt recognition and laparotomy. Direct compression will control major hemorrhage until resuscitation is complete. Vascular repair utilizing principles of proximal and distal control, good exposure, appropriate anticoagulation, and lateral suture technic should result in restoration of normal blood flow without significant sequelae.

Adult↗
PubMed1978

Femorofemoral grafts: the role of concomitant extended profundaplasty.

Twenty-one femorofemoral grafts were placed in high risk patients with symptomatic, unilateral, iliofemoral, arterial occlusive disease. There was 100 per cent immediate postoperative relief of ischemia or improvement in claudication. Three late below-knee amputations have been performed. All other living patients had healed extremities and were ambulatory at last follow-up. Cumulative graft patency determined by the life table method was 95 per cent at twenty-four months. The physiologic "steal" created by a femorofemoral bypass with donor limb and/or outflow stenosis must be considered to prevent clinical donor limb functional impairment. A gradient of 10 mm Hg or less between the radial artery mean pressure and the donor femoral artery ensured adequate donor artery flow without regard to angiographic a-pearance of the donor artery. The crucial technical problem in patients operated on for ischemia was reconstruction of adequate outflow. All but one patient required at least minimal profunda endarterectomy, and nine of seventeen (53 per cent) required concomitant extended profundaplasty procedures.

Age Factors↗
PubMed1978

Acute hemodynamic effects of lumbar sympathectomy.

Lumbar sympathectomy increases total limb blood flow after aortofemoral bypass in a high percentage of cases. This was true in eleven of fourteen extremities (78.6 per cent) in our series even though no specific selection criteria for entry into the study, other than the need for aortofemoral bypass, were used: that is, patients were entered into the study irrespective of preoperative ankle/arm pressure indexes or results of hyperemia testing. Overall, flow rates after sympathectomy was added to aortofemoral bypass were 1.55 times greater than after aortofemoral bypass alone. This degree of augmentation of flow may be important, particularly in cases of limited outflow.

Aged↗