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Biomedical subjects

N Maeder

Publications and source records attributed to N Maeder.

8 recordsLinked to original sources
PubMed1999

[Carotid surgery for prophylaxis of ischemic stroke].

Every year more than 250,000 patients suffer from ischemic (80%) or hemorragic (20%) stroke. Some 40,000 of these strokes are induced by stenosis or occlusion of the extracranial carotid artery. Several randomized studies (NASCET, ECST, ACAS, etc.) have proved that operative removal of high-grade carotid stenoses is an effective method in the primary and secondary prophylaxis of ischemic stroke. Operative therapy is significantly better than medical therapy with thrombocyte aggregation inhibitors. The prerequisite for effective operative prophylaxis is a low perioperative stroke rate. Even though the prophylactic value of carotid thrombarterectomy (TEA) is obvious, only about 5% of all carotid-related strokes are prevented by this operation. Essential conditions for increased efficiency in carotid surgery are close cooperation with the neurologist and the internist, screening of patients with a high risk for ischemic stroke, sophisticated, mainly non-invasive diagnostics, and more operative capacity. Interventional methods (stent, PTA) have not yet been proved safe and effective. These methods should be employed only in special cases after interdisciplinary discussions or in randomized studies.

Cerebrovascular Disorders↗
PubMed1996

Pedal bypass for limb-threatening ischaemia: an 11-year review.

Fifty-six patients with limb-threatening ischaemia had pedal revascularization with either autologous vein (n = 39) or sequential composite graft with a 6-mm polytetrafluoroethylene prosthesis and autologous vein (n = 17); 75 per cent had gangrene and skin necrosis and 25 per cent had ischaemic rest pain alone. Twelve grafts occluded within the first week, and resulted in major amputation in eight patients after unsuccessful revision. Two patients required amputation for persistent ischaemia despite a patent bypass. One patient died from bowel perforation (2 per cent). In 47 (84 per cent) of the 56 patients limb and life were preserved. The primary patency rate after 1, 2 and 4 years was 65, 55 and 55 per cent respectively, the secondary patency rate was 71, 62 and 62 per cent, and cumulative limb salvage rates were 77, 71 and 66 per cent. Life-table survival rates during follow-up (median 25 (range 0-112) months) were 89, 78 and 52 per cent respectively after 1, 2 and 4 years. Thirteen of 21 patients who died during follow-up did not require major amputation. Pedal reconstruction with autologous vein provides limb salvage until death in nearly two-thirds of patients with critical limb ischaemia resulting from crural arterial occlusive disease.

Adult↗
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↗
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↗
PubMed1989

[Femoro-crural bypass--orthotopic].

From 1980 to 1988 248 femoro-distal bypass procedures were performed in anatomical position for limb salvage due to peripheral artery disease. Bypass material strongly influenced bypass patency rate. The analysis showed a highly significant difference between venous and prosthetic grafts over a period of 3 years (p less than 0.0001). Use of the composite jump craft technique increased patency rates after 3 years to 58%, which is close to that of vein bypasses (63%). Use of prosthetic bypass material alone achieved a patency rate of only 38%. It is concluded that technically more difficult procedures such as the composite jump graft technique are superior to prosthetic bypasses.

Arterial Occlusive Diseases↗