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Biomedical subjects

M M Kartchner

Publications and source records attributed to M M Kartchner.

12 recordsLinked to original sources

Retroperitoneal unilateral ileofemoral thromboendarterectomy.

This clinical series of 145 operative procedures is presented to demonstrate that an aggressive approach in the management of ileofemoral arterial insufficiency utilizing a retroperitoneal approach for thromboendarterectomy is useful and appropriate. Considering the overall risk factors associated with this patient population, we have demonstrated that this method is well tolerated as supported by the low morbidity and mortality figures presented. The native vascular tree has been preserved, and excellent early and long-term revascularization goals have been obtained.

Adult

Wrapping of abdominal aortic aneurysms: a viable alternative.

Abdominal aortic aneurysm wrapping is an excellent procedure to use for poor-risk patients, calcified aneurysms, aneurysms extending above the renal arteries, and prophylaxis for small aneurysms. The procedure has a low operative mortality rate and a low long-term graft-related complication rate. It appears that aortic wrapping can be performed with a similar mortality and long-term survival rate as standard resection and grafting procedures, in spite of its application in generally poorer-risk patients. However, we do not believe that this procedure will replace aortic resection and grafting for most lumbar aortic aneurysms, but it should be considered for use in selected instances and should be in the armamentarium of all vascular surgeons.

Aged

A new method of preclotting fabric prostheses. A preliminary report.

A new method of preclotting arterial fabric prostheses is described. The preclotting process depends on infusion of blood into a polyethylene bag containing the prosthesis. Massage of the bag aids permeation of the graft, and a second infusion of blood over a 1 minute period seals the fraft completely. Rapid preclotting and asepsis are the unique features of this method.

Blood Coagulation

Stroke prevention.

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Cerebrovascular Disorders

Noninvasive evaluation and management of the "asymptomatic" carotid bruit.

Cervical bruits in patients who are asymptomatic or who have nonhemispheric neurological symptoms present a universal challenge. Of 4,000 patients evaluated noninvasively for carotid occlusive disease, 1,287 presented with "asymptomatic" bruits (697 had nonhemispheric neurological symptoms and 590 were clinically asymptomatic). Carotid phonoangiography (CPA), the visual analysis of carotid bruits, identifies bruits indicative of significant stenosis, documents progression, and differentiates bruits of carotid bifurcation and sub-bifurcation origin. Sub-bifurication bruits were diagnosed in 619, insignificant bifurcation bruits in 426, and significant carotid bruits in 242 patients by CPA. Oculoplethysmography (OPG) evaluates the hemodynamic significance of carotid bruits by comparative timing of simultaneously recorded ocular and ear lobe pulses. OPG detected 273 asymptomatic bruit patients with significant internal carotid flow reduction and indicated 5% of the bifurcation bruits were of external carotid origin. An accuracy of 89% in determining greater than 40% stenosis by OPG/CPA in 295 patients having arteriography increases to 97% when both OPG and CPA are positive. Six-month to 70-month clinical follow-up of the 1,287 patients documented 154 carotid endarterectomies and 38 strokes. Analysis of the strokes favors arteriography and operation only for those patients with appropriately positive or progressive OPG/CPA or with focal transient ischemic attacks (TIAs).

Auscultation

Oculoplethysmography: an adjunct to arteriography in the diagnosis of extracranial carotid occlusive disease.

A four and a half year study documents that oculoplethysmography, in conjunction with carotid phonoangiography, fulfills the criteria of an effective noninvasive adjunct to arteriography in the diagnosis of extracranial carotid occlusive disease. The risk and expense of unnecessary arteriographic studies can be reduced and accuracy of arteriographic technics and interpretations can be enhanced by routine application of oculoplethysmography.

Angiography

Thrombolysis of palmar and digital arterial thrombosis by intra-arterial Thrombolysin.

In nine patients, one with bilateral findings, impending gangrene of the hand due to thrombosis of the palmar arch or digital arteries did not respond to current surgical methods or to common nonsurgical measures and was treated by intra-arterial thrombolysin. The author's recommended diagnostic arteriography, direct surgical treatment, if indicated, and specific coagulation studies. Thrombolysin was given by perfusion at a rate of 100,000 U. per hour. Careful monitoring of the clotting process prevented any significant bleeding and excellent recovery occurred in eight hands and there was a good result in two.

Adult

Oculoplethysmography and carotid phonoangiography for the noninvasive detection of extracranial carotid occlusive disease.

Clinical applications of imaging techniques and noninvasive physiological vascular evaluations provide useful assistance in the detection and management of stroke-prone patients by minimizing unnecessary carotid arteriography and surgery. Two such evaluation techniques are oculoplethysmography (OPG) and carotid phonoangiography (CPA). Developed, used, and proved highly reliable at the Tucson (Arizona) Medical Center, the techniques have been documented in 12,000 tests on approximately 8500 patients. OPG simultaneously records the bilateral ocular pulses concomitantly with external carotid pulses. Delays in timing of these pulses reflect reduction of flow in the internal and/or external carotid arteries, respectively. CPA consists of electronic stethoscopic auscultation, direct visualization, and photographic recording of carotid bruits or blood flow sounds.

Arterial Occlusive Diseases