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R F Kempczinski

Publications and source records attributed to R F Kempczinski.

72 records · Page 4Linked to original sources
PubMed1984

Extended autogenous profundaplasty and aortofemoral grafting: an alternative to synchronous distal bypass.

The success of aortofemoral reconstruction in patients with superficial femoral artery occlusion depends on the restoration of satisfactory inflow to the profunda femoris artery (PFA). When significant occlusive disease exists within this vessel, two options exist: femoral-distal bypass or reconstruction of the PFA. In 165 aortofemoral reconstructions for occlusive disease, 29 limbs (9%) underwent an extended autogenous profundaplasty. The cumulative 5-year patency rate of autogenous reconstructions was 86%, with a 72% limb salvage rate without distal bypass. Two limbs were amputated early for sepsis with patent grafts. One early and one late femoral-popliteal bypass was performed. Groin wound complications, primarily lymphoceles and wound edge necrosis, were numerous (38%). There were no graft infections. Relief of ischemic symptoms was achieved regardless of patency of the popliteal artery. Furthermore, noninvasive testing, clinical history, and angiography failed to accurately predict the results. In patients with advanced PFA disease undergoing aortofemoral grafting, the extended autogenous profundaplasty is a durable procedure with excellent relief of ischemic symptoms.

Aged↗
PubMed1983

A comparison of digital subtraction angiography and noninvasive testing in the diagnosis of cerebrovascular disease.

Among the 1,892 patients who underwent cerebrovascular digital subtraction angiography at our hospital over the past 18 months, there was a subgroup of 34 patients (65 carotid arteries) for whom noninvasive cerebrovascular test results and standard cerebral arteriograms were also available. These patients were reviewed retrospectively and the ability of both methods to detect hemodynamically significant lesions, defined as a greater than 50 percent reduction in the diameter of the carotid artery, was determined using the arteriograms as the "gold standard." Noninvasive cerebrovascular tests had a sensitivity of 81 percent, a specificity of 95 percent, a positive predictive value of 92 percent, a negative prediction value of 88 percent, and an overall accuracy of 89 percent. Digital subtraction angiography had a sensitivity of 84 percent, a specificity of 92 percent, a positive predictive value of 88 percent, a negative predictive value of 89 percent, and an overall accuracy of 89 percent. If the four cases of hemodynamically significant stenosis of the carotid siphon not detected by digital subtraction angiography had been considered as false-negatives, its sensitivity would have been reduced to 72 percent. In patients with hemispheric cerebral ischemia, we found noninvasive cerebrovascular tests neither necessary nor cost-effective. Digital subtraction angiography, on the other hand, often provided definitive diagnostic information in such patients if the intracranial circulation was well defined and the extracranial lesion corresponded to the patients' symptoms. Noninvasive cerebrovascular testing was the safest and most cost-effective technique for screening patients with asymptomatic bruits, atypical, nonhemispheric cerebral symptoms, and those who have undergone carotid endarterectomy. If the noninvasive cerebrovascular test result was positive or equivocal, digital subtraction angiography was performed to localize the responsible lesion and exclude carotid occlusion.

Adolescent↗
PubMed1982

The management of orthopedic patients with arterial insufficiency.

The identification and management of the orthopedic patient who has chronic arterial insufficiency is presented in four cases in which failure to appreciate marginal arterial supply led to major and costly complications. Every orthopedic surgeon treating elderly patients should be aware of these possibilities. After a through history and physical examination, patients with signs or symptoms of significant arterial compromise should be evaluated by means of Doppler segmental limb pressures. This evaluation should be performed prior to the institution of the indicated orthopedic treatment whenever possible. If the segmental ankle pressure is less than 50 mm Hg, or the ankle brachial pressure index is less than 0.3, the patient should undergo complete vascular evaluation and consideration for revascularization in order to preserve marginal arterial flow and tissue perfusion during and after the orthopedic procedure. Constrictive straps, bandages, or dressings should be scrupulously avoided, as well as decreasing tissue perfusion by unnecessarily elevating the already vascular compromised extremity. The development of pain or ulceration after lower extremity surgery mandates immediate consideration of arterial ischemia and the institution of appropriate diagnostic and therapeutic measures to improve circulation to the extremity.

Aged↗
PubMed1981

Aortofemoral bypass grafting: a reappraisal.

Aortic bypass grafting was performed in 100 consecutive patients with disabling manifestations of aortoiliac arterial occlusive disease. There were no operative deaths, graft infections, false aneurysms, or aortoduodenal fistulas. Of those patients whose superficial femoral arteries were patent, 95% had a good or excellent immediate functional result that was maintained in 89% on late follow-up. Of those whose superficial femoral arteries were occluded, 83% had a similar immediate result and 70% maintained this improvement. Graft limb patency was 89% after 36 months. Additional distal arterial reconstructions were ultimately required in 9% of all limbs, resulting in a good to excellent functional outcome for 93% of all our patients. We believe aortofemoral grafting remains the best method for the correction of aortoiliac occlusive disease.

Aorta↗
PubMed1980

The carotid-carotid bypass graft.

Occasional patients have multiple, branch artery occlusions of the aortic arch that preclude any of the standard extrathoracic bypass grafts. We recently treated such a patient with carotid-carotid bypass and found it to be remarkably simple and effective. This article describes the technical details of this procedure and suggests its future applications.

Arterial Occlusive Diseases↗
PubMed1980

Impotence after kidney transplantation.

Sexual performance was evaluated in 28 men, thirty to sixty years of age, with functioning renal allografts: 13 were potent (controls), 10 had moderate sexual dysfunction, 5 had marked sexual dysfunction. Penile blood pressures, serum hormone levels, plasma zinc levels, and penile venous angiography were evaluated in search of causes of impotence. Thirteen of 15 impotent transplant patients (87 per cent) had marked abnormalities in at least one of the four areas studied. Systematic search for etiologic factors may permit specific therapy for impotence, which occurred in 54 per cent of the 28 kidney transplant patients analyzed.

Adult↗
PubMed1980

Percutaneous transluminal angioplasty in the selected management of proximal arterial occlusive disease of the lower extremities: a preliminary report.

Percutaneous transluminal angioplasty was used in the treatment of 17 segmental, arterial stenoses in 12 patients. Successful dilatation was achieved in 88% of lesions with documented hemodynamic improvement of all successful cases. The technique has been applied as the sole treatment in certain cases of isolated iliac stenosis. It also has been used to improve arterial inflow prior to more distal reconstruction, as well as to treat localized disease progression in patients with previous arterial reconstruction. It must be considered a new adjunct in the management of patients with arterial occlusive disease.

Aged↗
PubMed1980

The significance of graft diameter.

To study the influence of diameter on graft patency, an 8 mm aortoiiliac Dacron graft was implanted in on leg of 25 dogs that had liac arteries 3 to 5 mm in diameter and a 5 mm graft was placed in the other leg. In six dogs both grafts clotted within 3 months, in 10 dogs both grafts remained patient until the dogs were killed between 7 and 66 months, and in nine dogs one graft became occluded before the other. In eight of these nine animals the 8 mm graft became occluded before the 5 mm graft; only in one dog did the 5 mm graft become occluded first. When the 10 dogs with two patient grafts were killed, the 8 mm graft was found to be lined with thick, organized fibrin, whereas the 5 mm graft had a thin, smooth, glistening lining. Histologic examination confirmed that healing was more complete in the 5 mm graft. In vivo blood flow measurements in the dogs were used to compare flow rates and graft resistance in 4, 6, 8, 10, and 12 mm grafts. A given sized graft carried the same flow capacity as larger grafts until the flow rate was reached when graft resistance developed. Once resistance appeared, the graft could still triple or quadruple its flow capacity but it could not deliver the same rate of flow under the same pressure head as larger grafts. In 4 mm grafts, resistance first appeared at approximately 150 cc/min and capacity was 450 cc. In 6 mm grafts, resistance developed at 400 cc/min and capacity exceeded 1,200 cc. In 8 and 10 mm grafts, resistance was first noted at 800 and 1.400 cc/min, respectively. These studies suggest that 6 mm diameter grafts can carry the 200 cc/min or less that is measured in the human superficial femoral artery at rest, as well as the four-to sixfold increase that accompanies vigorous exercise.

Animals↗
PubMed1979

Lower-extremity arterial emboli from ulcerating atherosclerotic plaques.

Ten cases of lower-extremity emboli originated from proximal, ulcerated atherosclerotic plaques. Two distinct clinical presentations were seen. Embolization of cholesterol-rich debris was usually widespread and lodged in terminal arteries, producing either focal digital ischemia or livedo reticularis of the extremity. By contrast, thrombi arising from mural erosions were larger and produced a picture indistinguishable from emboli of cardiac origin. Biplanar aortography was essential in making the correct diagnosis. Anticoagulation has not prevented recurrent embolization. Endarterectomy or graft replacement of the diseased arterial segment is the preferred method of treatment. Lumbar sympathectomy is a useful adjunct when persistent cutaneous ischemia is present.

Adult↗
PubMed1979

Physical characteristics of implanted polytetrafluoroethylene grafts: a preliminary report.

Despite the widespread clinical use of polytetrafluoroethylene (PTFE) grafts, few reports dealing with their physical properties have appeared in the literature. In the past 20 months, 17 such grafts have been implanted into 15 patients threatened with limb loss, with an 88% immediate graft patency. Postoperatively, all patients underwent periodic evaluations; arteriograms were obtained in four. The effect of knee flexion on graft function was also studied. All grafts were found capable of withstanding cuff pressures in excess of 300 mm Hg without occlusion. With 90 degrees flexion, the grafts kinked crossing the knee joint but a pressure gradient or decrease in pulsatile blood flow did not develop. This remarkable resistance to external compression should render these grafts especially valuable for extra-anatomic bypass.

Aged↗
PubMed1979

Role of the vascular diagnostic laboratory in the evaluation of male impotence.

Penile systolic pressures, penile volume waveforms, and postischemic reactive hyperemia were measured in 106 patients (38 potent and 68 impotent). With such testing the vascular laboratory can clearly identify those impotent patients in whom penile blood flow is normal and who would not benefit from direct arterial surgery. Unfortunately, abnormal results give no assurance that ischemia is responsible for a given patient's impotence and a multimodal approach is necessary to further evaluate such patients.

Adult↗
PubMed1979

A combined approach to the noninvasive diagnosis of carotid artery occlusive disease.

A combined approach utilizing ophthalmosonometry (OSM), carotid phonoangiography (CPA), and ocular pneumoplethysmography (OPG) was applied to 31 patients with symptoms of carotid artery occlusive disease. Arteriograms were subsequently obtained in 70 of these patients, thus allowing the accuracy of each technique to be assessed in 140 carotid arteries. Both Doppler OSM and OPG correctly identified all complete occlusions of the internal carotid artery. However, greater than 50% stenoses were detected by OSM in only 52% and by OPG in 87%. Thus the cumulative accuracy in detecting hemodynamically significant lesions was 76% for OSM and 93% for OPG. The addition of CPA to OPG raised the combined accuracy of the two techniques to 98% for significant carotid lesions. The development of a regression line criterion for the OPG, in combination with CPA, permitted identification of 100% of patients with bilateral carotid artery lesions. However 75% of patients with symptomatic, ulcerating plaques were missed by all three tests, thereby emphasizing the need for angiography in appropriately symptomatic patients. The principal usefulness of noninvasive testing in evaluating patients with carotid artery occlusive disease is for: (1) asymptomatic bruits, (2) atypical, nonhemispheric symptoms, or (3) following carotid endarterectomy.

Aged↗
PubMed1976

Vascular insufficiency secondary to ergotism.

A case of ergot-induced peripheral vascular insufficiency mimicking atherosclerosis is presented and the clinical symptoms with vascular laboratory evaluation and roentgenographic findings are discussed in detail. A review of the literature of the vascular complications of ergot alkaloids is presented. After considering the various therapeutic modalities employed, a conservative, but hopefully more rational, treatment for these lesions is recommended. Although uncommon, this problem always must be considered in the differential diagnosis of the young patient, especially female, who presents with visceral or peripheral arterial insufficiency.

Adult↗
PubMed1974

Giant sigmoid diverticula: a review.

Two patients with giant sigmoid diverticula are added to 13 cases reported in the literature and the clinical features of this rare complication of diverticulosis are reviewed. These lesions probably arise as pseudodiverticula of the sigmoid colon with herniation of the mucosa through the muscle wall. They become progressively inflated by colonic gas via a ball-valve type mechanism. They are best treated by resection of the diverticulum, in continuity with the involved sigmoid, and primary anastomosis.

Aged↗
PubMedDate not supplied

Semi-quantitative photoplethysmography in the diagnosis of lower extremity venous insufficiency.

A new standardization device has permitted calibration of the Photopulse Adaptor, thus, making venous photoplethysmography (PPG) a more accurate, semiquantitative technique. Using this device, we studied 10 normal volunteers and 151 extremities in 69 symptomatic patients We also developed a formula for calculating the slope of the venous recovery curve which took into consideration the degree of venous emptying as well as the duration of venous recovery. The PPG was "abnormal" if there was no measurable venous emptying despite effective calf contraction or if the calculated venous recovery rate (VRR) exceeded 2.0 mm/sec. VRR clearly separated normal extremities (1.28 mm/sec) from those in which venous reflux was present (3.34 mm/sec). If we had relied on measurement of venous recovery time (VRT) alone, 30% of hour normal volunteers and 52% of our symptomatic patients would have been misdiagnosed. We feel that these modifications have made PPG a more accurate technique less subject to the vagaries of arterial inflow, and thereby more valuable to the vascular surgeon in elucidating venous pathophysiology and following the results of his therapy.

Adolescent↗
PubMedDate not supplied

Segmental volume plethysmography in the diagnosis of lower extremity arterial occlusive disease.

Over a 24 month period, segmental limb systolic pressures (SLP), pulse volume recordings (PVR) and bi-planar arteriograms were obtained for 202 lower extremities. The SLPs proved unsatisfactory for the localization of arterial disease and are presently employed only to assess the extent of limb ischemia. Bases on simple, qualitative criteria, the thigh PVR was graded as "normal" or "abnormal" and correctly predicted the presence or absence of hemodynamically significant aortoiliac disease in 95% of limbs. It there was a greater than 25% increase in the amplitude of the calf PVR relative to he thigh, patency of the superficial femoral artery was correctly identified in 97% of lower extremities. The limited accuracy of SLP alone in differentiating iliac and femoral artery occlusive disease, especially when present in combination, emphasizes the necessity of including some type of waveform analysis in the routine evaluation of patients with lower extremity arterial insufficiency.

Aorta↗