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Biomedical subjects

P Wigger

Publications and source records attributed to P Wigger.

8 recordsLinked to original sources
PubMed1998

[Surgical therapy of primary varicose veins].

The principle of varicose vein surgery still remains the interruption of all insufficient communications between the deep and the superficial venous system and removal of the varicosities. The basis for differentiated surgical treatment is accurate preoperative assessment. Careful dissection of the saphenofemoral junction through a suprainguinal incision, with division of all the branches and flush tie of the long saphenous vein combined with invaginated stripping of the long saphenous vein to just below the knee, appears to be the method of choice for good clinical results and a low incidence of damage to the saphenous nerve. Oesch recently introduced a new technique of perforate invaginate (PIN) stripping which gives even better cosmetic results. Regarding the short saphenous vein, preoperative localization of the exact level of the saphenopopliteal junction is of major importance in the prevention of recurrence. Simple evulsion or epifascial or subfascial ligation were the most common treatments for incompetent perforating veins for many years. In 1985 Hauer described endoscopic subfascial dissection of perforating veins (ESDP), which reduces delayed wound healing, especially in trophic skin changes. Deprivation of blood supply with a pneumatic tourniquet such as the Löfqvist roller cuff is necessary. The tributaries are removed by stab evulsion phlebectomy with specially designed hooks. This technique was originally introduced by Muller for ambulatory treatment of varicose veins. The incisions of 1-3 mm guarantee excellent cosmesis and minimal trauma. Adhesive tape is used to close the incisions. A number of alternative techniques such as cryosurgery, laser surgery, paratibial fasciotomy and the CHIVA technique (Conservative Treatment and Haemodynamics in Venous Insufficiency in Outpatient Departments) are briefly described. Complications of varicose vein surgery are rare. Minor complications are skin nerve injuries, haematomas, infections and lymphatic fistulas. Major complications such as injuries to the femoral vein or artery occur in less than 0.05%. But once it has occurred it is of paramount importance to recognize the injury at the time of initial surgery, to avoid limb loss. Provided the preoperative assessment is accurate and the principles of selective surgical treatment are followed, the surgeon is able to perform a curative operation with a low complication rate and excellent cosmetic results.

Humans↗
PubMed1996

Long-term results after open and semiclosed thrombendarterectomy for aortoiliac occlusive disease.

OBJECTIVES: This study reviews the long-term results of 514 aortoiliac thrombendarterectomies (TEA's). DESIGN: A prospective study in a major university hospital in Switzerland. SUBJECTS: 353 male and 62 female patients with aortoiliac occlusive disease. Operative indications: disabling claudication (n=334), rest pain (n=44), and gangrene (n=37). METHODS: Open and semiclosed TEA's were performed on 167 and 347 limbs, respectively. Follow-up was continuous and complete in 97.1 % of patients over a period of more than 15 years. RESULTS: The overall life-table patency rate at 5, 10, and 15 years postoperatively were 93.4 %, 90.4 %, and 84.2 %, respectively. Fifteen years postoperatively, the patency rate of 92.3 % after open TEA was significantly higher (p<0.04) than after semiclosed TEA (79.5 %). However, similar patency rates of 69.5 % and 69.8 % were observed 20 years postoperatively. Further significant prognostic factors on patency were: anatomic localization (p<0.004), preoperative stage of arterial occlusive disease (p<0.008), and gender (p<0.007). Patient's age did not influence the outcome in terms of patency. Hospital mortality rate was 1.2 %. Early obstruction occurred in 2.2 %, leading to subsequent early amputation of 1.4 % and reoperations in 1.2 %. The long-term actuarial survival rates of the patients were 55 %, 36 %, and 18 % after 10, 15, and 20 years postoperatively. CONCLUSION: Both open and semiclosed TEA give highly satisfactory long term results in aortoiliac occlusive disease with a low morbidity and low mortality.

Aortic Diseases↗
PubMed1995

Angioscopy guided in situ bypass versus angioscopy guided non reversed bypass for infrainguinal arterial reconstructions. A comparison of outcome.

In situ bypass grafting depends on an adequate ipsilateral greater saphenous vein. To profit from a tapered, valveless conduit in legs without an adequate greater saphenous vein, we routinely used the contralateral saphenous vein non reversed. In some reconstructions to the infrageniculate popliteal and the proximal anterior tibial artery we used the non reversed instead of the in situ technique because of the distance between the natural course of the saphenous vein and the recipient artery. This retrospective study compares the outcome of 48 in situ bypasses to the outcome of 66 non reversed bypasses. Endoluminal manipulations in all veins were visually controlled using an angioscope. The two groups of bypasses (in situ versus non reversed) did not differ concerning age, sex, risk factors, operative mortality, indication for surgery and distribution of the recipient arteries. There was a tendency for a lower wound complication rate in "in situ" compared to non reversed bypasses (10% versus 27%; p = 0.086). There were no differences in cumulative primary and primary assisted patency rates between the two groups after two years. We prefer the angioscopy guided in situ technique for reconstructions to infrageniculate arteries because of a low wound complication rate and excellent patency rates. In the absence of an adequate ipsilateral saphenous vein and in reconstructions to recipient arteries not presenting themselves for the in situ technique, similar results can be achieved with angioscopically prepared non reversed grafts.

Angioscopy↗
PubMed1994

[Cost saving after-care in infra-inguinal vascular reconstruction].

To assess the indications for routine colour flow duplex surveillance, 43 infrainguinal autogenous vein grafts were prospectively entered into a surveillance protocol. Screening consisted of measurements of ankle brachial indices (ABI) and colour flow duplex imaging of the entire graft length. All grafts at risk had a serial fall in resting ABI of more than 0.1. This study suggests that resting ABI measurements are a very sensitive and non-expensive primary screening procedure, provided that all grafts with ABI changes of more than 0.1 are further evaluated. About 60% of ABI-screened grafts needed further evaluation because of ABI changes of greater than 0.1, incompressibility of arteries or extension of the graft to the ankle or pedal arteries. Colour flow duplex scanning was very useful in excluding of identifying and localising graft problems and deciding on further invasive diagnostic and therapeutic procedures.

Aftercare↗
PubMed1992

[Abdominal aortic aneurysm. Risks and early postoperative course].

A review of the literature shows a very variable mortality, especially after emergency operations for abdominal aortic aneurysm (AAA) (14-70%). We therefore analyzed the mortality of our patients in different subgroups. The hospital data of 82 patients operated on for abdominal aortic aneurysm were analyzed retrospectively. 42 patients underwent emergency operations and 40 patients elective surgery. The mean age was 67.5 +/- 9.4 and 70.7 +/- 7.3 years respectively. The overall 30-day mortality in elective cases was 5% (2/40); elective patients under the age of 75 years had a mortality of 0%. 33% of the emergency cases died within 30 days. The mortality in various subgroups was as follows: "asymptomatic AAA" 5.4% (2/37), "symptomatic AAA" 10% (1/10), "retroperitoneal rupture" 34% (11/32) and "intraperitoneal rupture" 66.6% (2/3). Preoperatively 21/42 patients who underwent emergency surgery were in hypovolemic shock (systolic blood pressure < or = 90 mm Hg). The mortality of these patients was 52% (11/21) compared to 9.5% (2/21), (p < 0.01), in emergency patients without preoperative shock. The causes of death after emergency procedures were hypovolemic shock in 6, heart failure in 4, and multi-organ failure, respiratory insufficiency, unknown and pulmonary embolism in 1 each. 5/14 patients died in theatre. Two patients died after elective procedures: one 9 days postoperatively from myocardial infarction and the second 23 days after the operation from an unknown cause. Reoperation rate after elective and emergency procedures was 7.5% and 16.6% respectively. Mortality after reoperation was 40%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Treatment of pelvic venous spur (May-Thurner syndrome) with self-expanding metallic endoprostheses.

PURPOSE: The application of self-expanding metallic endoprostheses (stents) to treat symptomatic pelvic venous spurs as an alternative to surgery. METHODS: Wallstents with a diameter from 14 to 16 mm and one Cragg stent were placed in the left common iliac vein of eight patients (seven women, one man; mean age 42 years) with a symptomatic pelvic venous spur (left deep venous thrombosis or post-thrombotic leg swelling). Four patients had surgical thrombectomy prior to stent placement. RESULTS: Technical success with immediate reduction of left leg circumference was achieved in all eight patients. A primary patency rate of 100% was observed during an average follow-up of 3 years (range 10-121 months). There were no procedural or stent-related complications. CONCLUSION: The percutaneous transfemoral placement of self-expanding metallic stents is an effective minimally invasive alternative to surgery in the treatment of symptomatic pelvic venous spur.

Adult↗
PubMedDate not supplied

Subduction and collision processes in the Central Andes constrained by converted seismic phases.

The Central Andes are the Earth's highest mountain belt formed by ocean-continent collision. Most of this uplift is thought to have occurred in the past 20 Myr, owing mainly to thickening of the continental crust, dominated by tectonic shortening. Here we use P-to-S (compressional-to-shear) converted teleseismic waves observed on several temporary networks in the Central Andes to image the deep structure associated with these tectonic processes. We find that the Moho (the Mohorovicić discontinuity--generally thought to separate crust from mantle) ranges from a depth of 75 km under the Altiplano plateau to 50 km beneath the 4-km-high Puna plateau. This relatively thin crust below such a high-elevation region indicates that thinning of the lithospheric mantle may have contributed to the uplift of the Puna plateau. We have also imaged the subducted crust of the Nazca oceanic plate down to 120 km depth, where it becomes invisible to converted teleseismic waves, probably owing to completion of the gabbro-eclogite transformation; this is direct evidence for the presence of kinetically delayed metamorphic reactions in subducting plates. Most of the intermediate-depth seismicity in the subducting plate stops at 120 km depth as well, suggesting a relation with this transformation. We see an intracrustal low-velocity zone, 10-20 km thick, below the entire Altiplano and Puna plateaux, which we interpret as a zone of continuing metamorphism and partial melting that decouples upper-crustal imbrication from lower-crustal thickening.

Journal Article↗