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Biomedical subjects

L Lauterjung

Publications and source records attributed to L Lauterjung.

At least 19 recordsLinked to original sources
PubMed2006

Results of different operative procedures for patients with popliteal artery aneurysms.

BACKGROUND: Long term results of four different operative procedures for the treatment of popliteal artery aneurysms were investigated either performed by short venous or segmental alloplastic interpositions or long femoro-popliteal below the knee bypass using alloplastic grafts or autologous vein. PATIENTS AND METHODS: 47 patients treated for 50 popliteal aneurysms (mean diameter +/- SD: 3.5 +/- 1.1 cm) were analyzed (follow-up: 40.2 +/- 4.9 months). RESULTS: Primary patency rate was 78% and secondary patency rate was 86% at 5 years. Frequency of operative reinterventions was higher in patients treated for acute ischemia and in patients treated with alloplastic interpositions or alloplastic bypass (p = 0.026). Secondary patency rates were higher in patients treated with autologous venous interpositions or venous femoro-popliteal bypass (p = 0.022). Times of secondary vascular patency were significantly shorter for patients treated with short alloplastic interpositions in comparison to long alloplastic femoro-popliteal bypass procedures, short venous interpositions or long venous bypass operations (p = 0.018). CONCLUSIONS: For the treatment of patients with popliteal aneurysms autologous venous interposition is therefore recommended or as an alternative venous or alloplastic femoro-popliteal below the knee bypass.

Amputation, Surgical↗
PubMed2003

[Acute limb ischemia from the general surgeon's point of view. How much knowledge of vascular surgery is necessary?].

The diagnosis of acute peripheral ischemia can be obtained based on clinical presentation, inspection, and palpation of the affected extremity. Unfractionated heparin as a single shot is immediately given followed by continuous infusion when diagnosis is clinically evident and contraindications are excluded. Thromboembolectomy using a Fogarty catheter is immediately performed in patients with evidence of arterial embolization and signs of advanced ischemia (TASC IIb/III) followed by intraoperative angiography. Patients with evidence of arterial thrombosis require urgent angiography followed by thrombectomy and probably subsequent endovascular or surgical interventions and vascular reconstruction. For patients with moderate ischemia (TASC IIa), initial diagnostic angiography is recommended followed by primary thrombectomy with subsequent intraoperative angiography and immediate endovascular or operative treatment of remaining vascular problems. As an alternative therapeutic option initial catheter-guided local thrombolysis can be performed in selected patients with the intention of subsequent limb revascularization or unmasking relevant vessel alterations leading to specific endovascular or surgically performed vascular reconstruction. Possible development of muscle ischemia because of increased compartment pressure should be considered and fasciotomy performed when indicated. Primary amputation of the severely ischemic limb after initial thrombectomy might be recommended in patients with life-threatening organ failure related to muscle necrosis.

Acute Disease↗
PubMed2003

Graft patency and clinical outcome of femorodistal arterial reconstruction in diabetic and non-diabetic patients: results of a multicentre comparative analysis.

OBJECTIVE: in diabetic patients with critical limb ischaemia (CLI) an inferior success rate following infrainguinal bypass surgery is quite often suggested. The aim of this retrospective analysis was, therefore, to evaluate the graft patency and, particularly, the clinical outcome at 1 year in diabetic compared with non-diabetic patients. MATERIAL AND METHODS: two hundred and eleven patients (diabetics 94; non-diabetics 117) with femorodistal reconstruction for CLI were studied. Groups were comparable with regard to the Fontaine classification, the distribution of vascular risk factors, graft material, distal anastomosis site, and the angiographic runoff grading. RESULTS: diabetes did not adversely affect graft function. For diabetics and non-diabetics primary cumulative patency rate at 1 year was found to be 66 and 56%, respectively (p=0.10) and a virtually identical limb salvage rate of 85 and 83% was achieved (p=0.76). With regard to healing of ischaemic foot ulcers a trend against diabetics was noted with a healing rate of 81% compared to 96% in non-diabetics at 1 year (p=0.067); gangrenous foot lesions could be equally remedied in 94% and in 87% among patients with and without diabetes (p=0.44). The survival rate of diabetics, however, was significantly lower with 78% at 1 year compared with 95% in non-diabetic patients (p=0.0004). CONCLUSIONS: our preliminary results support the view that infrainguinal bypass grafting can be safely done even in diabetics. Despite increased mortality in this group, liberal indication for reconstructive vascular surgery seems to be justified by favourable patency rates and clinical outcome in selected patients.

Aged↗
PubMed2001

Silent cerebral infarction: risk factor for stroke complicating carotid endarterectomy.

"Silent" cerebral infarction is found in 20% to 30% of patients with significant internal carotid artery (ICA) disease. Our purpose was to determine whether such "silent" cerebral infarction in the operated carotid territory represents a risk factor for stroke during and immediately after carotid endarterectomy. Over 5 years we followed a cohort of 663 patients with symptomatic and asymptomatic ICA stenosis who were consecutively scheduled for surgery. The stenosis was more than 70% in patients with transient ischemic attacks and more than 95% in asymptomatic stenosis patients. All patients underwent preoperative computed tomography to determine the frequency, extent, and location of any "silent" cerebral infarction. Patients were grouped by the absence or presence of infarction in the operated carotid territory. Among the entire cohort, 20 patients had a major perioperative stroke (3.0%). All deaths were stroke-related. No intracranial bleeding occurred. Major stroke occurred in four (0.8%) patients without appropriate "silent" cerebral infarction, compared with 16 (8.8%) with an appropriate "silent" cerebral infarct (p < 0.001). After adjustment for confounding co-variables (e.g., gender, presence of preoperative symptoms, and age), "silent" cerebral infarction was found to be the only independent predictor of perioperative major stroke for symptomatic and asymptomatic stenosis (overall adjusted relative risk 11.5, 95% confidence interval 3.8-34.9, p < 0.0001). Patients with "silent" cerebral infarction seem to be at increased risk of perioperative stroke. Consequently, preoperative cerebral imaging is important for risk classification.

Aged↗
PubMed2001

Acute ischemia of the upper extremity: long-term results following thrombembolectomy with the Fogarty catheter.

OBJECTIVE: In 1962, the procedure of arterial thrombembolectomy with the Fogarty catheter was established. Numerous studies have been published studying thrombembolectomies of the lower extremities. Limited information, however, is available following thrombembolectomy of the upper extremity after arterial occlusion. The aim of the present study, therefore, was to determine long-term results (3-5 years after thrombembolectomy) following thrombembolectomy of the upper extremity with the Fogarty catheter in a large retrospective clinical study. DESIGN: In the present study, 251 patients were encountered. Over a period of 20 years, 283 thrombembolectomies with the Fogarty catheter were performed on the upper extremity at the surgical department of the University of Munich. MAIN OUTCOME MEASUREMENTS: The appearance of local and general complications in the postoperative phase, as well as long-term results, were evaluated. RESULTS: The results indicate that general complications - i.e., cardiac insufficiency, cerebral ischemia, etc. - occurred in 18 patients (7.2%). Local complications - i.e., wound infection, persistence of ischemia, or hematoma - were evident in 51 patients (20.3%). Re-occlusion following thrombembolectomy was found in 21 patients (8.8%). The affected extremity had to be amputated in five cases (2.0%), and 14 patients (5.6%) died during the postoperative phase. As a result of multimorbidity of the patients and average age at the time of surgery (73 years), 40% of the patients had died before the date of examination. Nonetheless, 111 patients of the 117 living patients showed no complaints or minor coldness and pain following heavy exercise. CONCLUSIONS: The results of the present study indicate that, in most cases, thrombembolectomy with the Fogarty catheter represents a successful surgical method for the acute treatment of arterial occlusion of the upper extremity.

Adult↗
PubMed1998

Ten-year results following elective surgery for abdominal aortic aneurysm.

OBJECTIVE: 10-year results after elective operation for infrarenal aortic aneurysm considering the influence of risk factors. EXPERIMENTAL DESIGN: Retrospective study with 5-12 year postoperative follow-up. SETTING: University hospital (Klinikum Grosshadern, Munich). PATIENTS: The long-term follow-up was based on 521 (95.6%) out of 545 consecutive patients operated upon electively for abdominal aortic aneurysm between 1978 and 1987. INTERVENTIONS: The infrarenal aneurysms were excluded by aortic tube grafts (314 patients, 59%) or bifurcation grafts (231 patients, 41%). MEASURES: The birthday, operation day and eventually the day of death in the hospital were documented in the charts. The patient's state or cause of death were elicited on the phone 5 to 12 years after the operation. Kaplan-Meier survival curves were calculated based on these data and compared to age-matched normal male populations. RESULTS: Hospital mortality was 6.4%. The cumulative rate of survival following elective surgery was 65% at 5 years and 41% at 10 years, the mean survival time being 95.1 months. Age, coronary artery disease and hypertension had a significant influence on the cumulative survival. Patients with aorto-coronary bypass had a better long-term outcome than those without bypass surgery. CONCLUSIONS: The excellent long-term results within a high-risk population support elective surgery of infrarenal aortic aneurysms. Results of new interventional techniques will have to be compared with this "golden standard" follow-up.

Aged↗
PubMed1998

[Inflammatory syndrome after endovascular implantation of an aortic stent--a comparative study].

Immunological changes as described in endovascular aortic aneurysm repair are not yet fully understood. In several studies this reaction (leukocytosis, fever, high CRP levels) is named as a "postimplantation syndrome". In our study we could show that in the first week after endovascular aortic aneurysm surgery complex immunological changes occur. But these changes do not quantitatively differ from those seen in open aortic aneurysm surgery. Fever (38 degrees C) was apparent in almost all patients. White blood cell count rose up to 10.6 (+/- 0.84) G/L during the first days. CRP, one of the acute phase proteins, was elevated with the maximum on postoperative day 2. Only the open operated patients had elevated alpha 1-antitrypsin levels from the second postoperative day on. IL-6 synthesis was increased in both groups, with an elevation in group B until day 8. The coagulation system was impaired, but was most evident in the open aortic aneurysm group. In this study we could show that both operative techniques had comparable immunological changes. During open aneurysm repair the large operative trauma seems to play a central role, whereas endothel activation might be crucial in endovascular operated patients.

Aged↗
PubMed1998

Alleles of the alpha-1-antitrypsin phenotype in patients with aortic aneurysms.

OBJECTIVE: To examine the possible significance of homo- or heterozygous alpha-1-antitrypsin deficiency in the pathogenesis of aortic aneurysms (AA). DESIGN: Prospective investigation. SETTING: University hospital. PATIENTS: 300 controls representing the general population in our region of Southern Germany and 126 patients with aneurysmectomy and graft insertion. METHODS: The alpha-1-antitrypsin phenotype was determined by employing isoelectric focusing. Each patient was also evaluated for hypertension, lipometabolic dysfunction, smoking, hyperuricemia, and diabetes mellitus. MAIN OUTCOME MEASURES: The frequency and distribution of alpha-1-antitrypsin phenotypes and risk factors. RESULTS: 115 of 126 patients presented with one or several of the conventional risk factors: hypertension (61.5%), lipometabolic dysfunction (36.9%), smoking (58.4%), hyperuricemia (13.8%), or diabetes mellitus (6.9%). The following frequencies of alpha-1-antitrypsin phenotypes were determined: PiMM (82.5%), PiMV (4.7%), PiML (1.5%), PiMS (7.1%), PiSS (0.7%), PiMZ (3.0%). Indeed, when compared to the general population (control group) the percentage of the normal PiMM phenotypes was lower in the group of patients with AA (p<0.001). However, in our study this significant difference was not primarily due to the presence of patients homozygous or heterozygous for deficiency alleles PiMS, PiSS and PiMZ (p=0.0523) as has been previously reported, but rather to the high prevalence of the variants PiMV (p<0.005). CONCLUSIONS: Our study suggests that not only Pi-deficiency alleles, previously identified as being associated with AA, but also that Pi variants may play a pivotal role in the pathogenesis of AA.

Adult↗
PubMed1997

[Is heterozygote alpha 1-antitrypsin deficiency a risk factor in the etiology of aortic aneurysm?].

A potential role of homozygous or heterozygous alpha-1-antitrypsin deficiency alleles Pi*Z or Pi*S in the pathogenesis of aortic aneurysms has been debated in recently published papers. Therefore, we have determined the alpha-1-antitrypsin phenotype in 103 patients with aortic aneurysms using isoelectric focusing. The vast majority of patients (92.2%) had one or more of the established risk factors: hypertension (65.0%), lipometabolic dysfunction (34.9%), smoking (65.0%), hyperuricemia (16.5%) or diabetes mellitus (8.7%). In our patients, the deficiency alleles Pi*Z and Pi*S were more frequent than in the general population of our region, but these differences did not reach statistical significance (PiMS 6.7 versus 3.4%, PiMZ 3.8 versus 2.5%, PiSS 0,9 versus 0.2%). Furthermore, the patients with heterozygous or homozygous antitrypsin deficiency had similar patterns of risk factors to those of the patients with normal phenotypes. In one patient we found a heterozygous PiMZ antitrypsin deficiency associated with Marfan's syndrome. These data do not support the results of recently published studies of fewer cases that suggest a higher prevalence of antitrypsin deficiency alleles in patients with aortic aneurysms. A heterozygous alpha-1-antitrypsin deficiency as a cause or predisposing factor for the development of aortic aneurysms appears to be of little or no importance.

Adult↗
PubMed1997

Hyperosmotic-hyperoncotic solutions during abdominal aortic aneurysm (AAA) resection.

A largely positive perioperative fluid balance during both elective and emergency abdominal aortic aneurysm repair (AAA) may put patients at risk of developing left ventricular failure and may thus contribute to morbidity. In the present paper we report on a prospective study using hyperosmotic-hyperonocotic solutions (HHS) infused during clamping of the aorta, for the prevention of declamping shock, and the associated reduction in perioperative fluid requirements. The major aim of this paper was to determine the efficacy of an HHS infusion when given over 20 minutes and to detect possible adverse effects of HHS. For perioperative fluid replacement 12 patients received crystalloid solutions with HHS [250 ml of 7.2% NaCl combined with either 6% Dextran (n = 3), 6% Hydroxyethylstarch (HES, n = 4) or 10% HES (n = 5)]. In 16 controls, crystalloids with 1000 ml of HES 10% were infused. Patients were invasively monitored and hemodynamic parameters frequently assessed during the operation, which were statistically analyzed in relation to the start of the fluid loading during clamping of the aorta. One patient showed an anaphylactoid reaction to HES, otherwise no side effects of HHS were observed during infusion (no hypotension, no pathological EKG changes). Plasma sodium and chloride concentration as well as osmolality rose resulting in an osmotic gradient and a desired intravascular volume expansion. Prior to declamping pulmonary capillary wedge pressure had increased to the desired value of > 13 mmHg and < 18 mmHg. Oxygen delivery was significantly elevated upon HHS and remained so post declamping, whereas no change was observed in controls. During clamping systemic vascular resistance was significantly decreased, but was unchanged in controls. The perioperative fluid balance of patients receiving HHS was 2471.0 +/- 948.6 ml, which was significantly less than + 3386.7 +/- 1247.9 ml of controls (P < 0.01). We suggest that HHS opens new perspectives in perioperative fluid management of both elective and emergency AAA repair, since hemodynamic parameters are improved and the overall fluid balance is less positive, thus decreasing the likelihood of edema formation. Moreover, the previously described positive microcirculatory effects of HHS may be particular beneficial in some high-risk patients.

Aged↗
PubMed1997

[Long-term results and costs of elective bypass operation of infrarenal aortic aneurysm].

During a 10-years-period from 1978-1987 n = 545 patients were operated upon for infrarenal aortic aneurysm. Hospital mortality was 6.4%. In 95.6% of the patients information concerning state and cause of death were achieved. Cumulative survival was 64.6% at 5 years and 41.0% at 10 years, the mean survival being 95.1 month. Preoperative risk factors like age, coronary artery disease and hypertension had a negative impact on the long-term results. The costs were calculated according to the "Gesundheitsstrukturgesetz" and on the mean in-hospital-stay of 16.4 days.

Aged↗
PubMed1997

Possible objectification of a critical maximum diameter for elective surgery in abdominal aortic aneurysms based on one- and three-dimensional ratios.

BACKGROUND: The purpose of this study was to evaluate the ratio of aneurysm size to aortic diameter (dm/ds) and newly defined volumetric parameters and to objectify by means of these parameters a critical maximum diameter (dm) as indicator for elective surgery of abdominal aortic aneurysms (AAA). METHODS: Based on contrast-enhanced CT scans one- and three-dimensional parameters were measured in 3 groups of n=58 patients selected for a) emergency surgery (n=13) in case of contained rupture and b) elective surgery (n=29) or c) non operative follow-up (n=16) if the AAA was bigger or smaller than 4.5 cm in dm. Ignoring these groups the statistically independent ratios dm/ds and thrombus to aneurysm volume (TV/AV) of all patients were retrospectively subjected to cluster and regression analyses in order to find out possible critical values confirming a dm-based decision. Thrombus (TV) and aneurysm volume (AV) correlated with increasing diameter. RESULTS: The ratio TV/AV predominantly increased from 0.42 to 0.65 in aneurysms 5 to 8 cm in diameter, reaching a maximum of 0.8 in AAA with contained rupture. A TV/AV of 0.45 and a dm/ds of 2.0 were found to be separators of two distinguished groups confirming a critical dm of about 5 cm. CONCLUSIONS: The newly defined volumetric ratio TV/AV and dm/ds may objectify the dm-based decision for elective surgery or follow-up treatment. Prospective studies have to evaluate this approach.

Aged↗
PubMed1996

Subclavian carotid transposition: an analysis of a clinical series and a review of the literature.

OBJECTIVE: To analyse the clinical results and long-term patency rates of 108 patients with subclavian carotid transposition (SCT) and compare the outcomes to other clinical series using the same technique, as well as to those reported for other surgical procedures and PTA in the treatment of proximal subclavian artery disease. METHODS: The hospital records of 108 patients with carotid subclavian transposition were retrospectively reviewed for preoperative symptoms, Doppler examination, arteriography, blood pressure differentials and postoperative complications. Long-term patency and symptoms were determined during a follow-up examination including a history, physical examination, blood pressure differentials, Doppler examinations and arteriography in selected cases. RESULTS: The indication for SCT were subclavian steal (78%), upper extremity ischaemia (59%), rest pain or acral necrosis (5%), vertigo (6%). There was no mortality, blood pressure differentials were equalised in all patients without any early reocclusions. The complication rate was 15% with a permanent morbidity of 3%. Eighty-four patients (77%) could be re-examined during follow-up. For them the overall patency after a mean observation period of 70 months (1-144 months) was 100%. CONCLUSIONS: Subclavian carotid transposition is an excellent method for the treatment of proximal subclavian occlusive disease because of its exceptional long-term patency and low morbidity.

Anastomosis, Surgical↗
PubMed1996

[Infrarenal aortic aneurysm--10 year follow-up after bypass operation with cost analysis].

Between 1978 and 1987, a total of 770 patients suffering from an infrarenal aortic aneurysm were operated upon electively (71.6%) or on an emergency basis (28.4%); mortality in hospital was 6.2% and 40% respectively. In 96.2% of the patients we received information concerning status and the cause of death. Overall survival following elective surgery was 64.6% at 5 years and 41% at 10 years, mean survival being 95.1 months. Following emergency surgery the survival rate was 38.7% and 24.1% at 5 and 10 years, mean survival being 57.3 months. Age, coronary artery disease and hypertension had a negative impact on the long-term results. The costs were calculated based on the mean length of hospital stay of 16.4 days for elective and 19.1 days after emergency surgery.

Adult↗
PubMed1996

[Thromboembolectomy with the Fogarty catheter in acute ischemia of the upper extremities].

Over a period of about 17 years 251 thrombembolectomies using the Fogartycatheter on the upper extremities were performed on 220 patients. In 9.5% of the cases reoperation and in 1.8% amputation were necessary; perioperative lethality was 5.5% and 19.5% developed local complications. Due to multimorbidity and the age of patients at the time of examination 46% had already died, while of the 101 surviving patients 94.1% showed good long-term results.

Acute Disease↗
PubMed1994

Iliac-subclavian-internal carotid artery bypass for cerebral ischemia due to multiple proximal supra-aortic vessel obstruction (aortic arch syndrome).

Severe cerebral ischemia was successfully treated in a patient with arteriosclerotic aortic arch syndrome by an iliac-subclavian-internal carotid artery bypass, using an extra-anatomic modified Dacron prosthesis externally coated with collagen. The procedure and material seem suitable for managing high-risk patients who have critically stenotic or occluded branches of the aortic arch and who would not tolerate anatomic, transthoracic repair.

Anastomosis, Surgical↗
PubMed1992

Pathophysiology of unilateral high-grade carotid artery stenosis: evaluation of intracranial haemodynamics by analysis of velocity waveforms from the middle cerebral artery.

1. Transcranial flow velocity waves were measured via Doppler sonography of the middle cerebral artery during hypo-, hyper- and normo-capnia. Applying the principle of vascular impedance, flow velocity waves were analysed in 30 young subjects, 37 elderly subjects and 18 patients with high-grade unilateral internal carotid artery disease. 2. There was evidence that the relative peak-to-peak velocity in the middle cerebral artery could serve as an index of peripheral wave reflection and cerebral resistance (CRi). The response of CRi to changes in arterial CO2 concentration (CRi reactivity) showed a clear age-dependency. However, the absolute side-to-side asymmetry of CRi reactivity (delta R) did not vary with age and could be used to define a normal range (0-4%CRi/vol.%CO2). 3. Selective angiography demonstrated no cerebral cross-flow through the anterior part of the circle of Willis in nine patients with carotid artery stenosis whose absolute delta R was above the normal range and whose CRi reactivity of the affected hemisphere was lower than that of the healthy opposite hemisphere. Conversely, another group of nine patients, whose ipsilateral CRi reactivity was higher than the contralateral CRi reactivity, demonstrated cross-flow through the anterior part of the circle of Willis. 4. delta R may be used to identify patients who have high-grade internal carotid artery stenosis and present with low cerebral vascular resistance owing to poor intracerebral collaterals.

Adult↗