Biomedical subjects
R L Kistner
Publications and source records attributed to R L Kistner.
Surgery in acute and chronic venous disease.
This report describes a favorable experience with 140 cases of surgical intervention in deep venous disease of the lower extremity, divided between acute and chronic problems. Of these, 107 were treated for acute phlebitis and 33 for deep venous insufficiency. Seventy-seven cases of acute iliofemoral phlebitis underwent thrombectomy. Preoperative venography was done in all, and postoperative venography was done in 57 patients. Of these, 75% had patent iliofemoral segments after a modified surgical approach. A positive correlation has been found between the degree of adherence of the iliofemoral clot and the postoperative patency rate--and this usually can be predicted from the preoperative venographic findings. Clinical follow-up averages 4 years and extends to 11 years. Ligation and division of the superficial femoral vein was done as the sole procedure in 30 patients with acute deep venous thrombosis (DVT) and in five with deep vein insufficiency. Its indications were guided by preoperative venography. It has been successful as a means to control emboli in selected cases. Long-term ill-effects have been minimal. In chronic severe venous insufficiency, expanded applications for surgery are presented. Ligation of incompetent veins, reconstruction of valves, and anastomosis of major segments of the femoral system are presented with preoperative and postoperative studies. Postoperative thrombosis has not been a problem. Specific procedures are presented to remedy chronic problems of the deep venous system.
Angiography as an aid in extra-enteric gastrointestinal bleeding due to visceral artery aneurysm.
Three unusual patients with visceral artery aneurysms involving the hepatic artery, inferior pancreaticoduodenal artery, and a mesenteric branch artery are presented. Each of these lesions is unusual and all were diagnosed preoperatively. Surgical intervention was planned on the basis of angiography. In two patients with hypovolemia a simple diagnostic approach employing emergency selective angiography was formulated and successfully used.
Importance of calf vein thrombophlebitis.
Fifty-four patients with phlebogram-proven deep vein thrombophlebitis limited to the tibial and popliteal veins were studied for evidence of pulmonary embolism, both symptomatic and silent. All but two patients were symptomatic of either phlebitis or embolism. Pulmonary embolism, as judged by lung scan defects with V-Q imbalance, changing serial scans, or positive pulmonary angiograms were found in 50%. Popliteal thrombi had an embolism incidence of 66%, whereas tibial thrombi had a 33% incidence. Emboli from the popliteal veins were more extensive than were tibial emboli. Forty-five percent of all emboli were silent. Bilateral phlebitis was accompanied by a 75% incidence of pulmonary embolism. Emboli from tibial veins were minor in five of nine instances, but three instances involved 20% or more of total lung volume and one involved over 40% of total lung volume. These results support the belief that popliteal thrombophlebitis merits anticoagulant therapy. They also suggest caution in the management of tibial vein phlebitis. Objective tests are recommended to monitor for pulmonary embolism and for propagation of the thrombus before deciding to withhold anticoagulants in tibial thrombophlebitis.
Surgical repair of the incompetent femoral vein valve.
Incompetent femoral vein valves are identified by reflux femoral phlebography in selected patients with postphlebitic syndrome. In addition to conventional stripping of varices and subfascial interruption of communicating veins, 14 patients with 17 involved extremities have undergone surgical repair of an incompetent valve in the superficial femoral veins. Pathologic condition of the valve consisted of elongation of the cusp edge. Repair was achieved by a series of tucking sutures shortening the cusp and restoring competence to the valve. Healing of ulcers and relief of swelling occurred in 90% of the patients. This rate was maintained up to seven years. These cases demonstrate the feasibility of surgery on the femoral vein valve. The relative importance of conventional stripping, subfascial communicating vein interruption, and femoral valve repair will have to be established by way of further clinical experience.
Incidence of pulmonary embolism in the course of thrombophlebitis of the lower extremities.
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Atherothrombotic emboli in the lower extremities.
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Therapeutic arteriovenous fistula in management of severe ischemia of the extremities.
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Advances in management of thromboembolic disease.
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Management of severe leg ischemia in the elderly patient.
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Evaluation of intra-abdominal disease of obscure cause. Analysis of arteriograms of 185 patients.
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Proceedings: Post-phlebitic syndrome. Cure by surgical repair of the incompetent femoral value.
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The present status of reconstructive venous surgery.
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Deep venous reconstruction (1968-1984).
This paper describes our overall experience with venous reconstructive surgery in the past 15 years. A thorough diagnostic evaluation of the patient with advanced chronic venous insufficiency is necessary to guide the surgeon in selecting a surgical approach that will address the specific problem in each patient. The diagnostic workup will separate those with insufficiency due to valve incompetence from those with deep vein obstruction as the basis for their problem. The operations vary from vein ligations to valve reconstruction or transplantation for valve incompetence and venous bypasses for obstructive problems. An aggressive surgical attitude in chronic venous disease makes it possible to restore selected patients to full activity with symptom-free extremities rather than teaching them to live within the confines of their disease state by nonsurgical management.
Pulmonary embolism in deep leg vein thrombosis.
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Retrospective study of hospitalized patients with chronic leg ulcers in Hawaii.
The authors describe 226 patients with chronic leg ulcers at a community hospital over a 14-year period. Most leg ulcers were ischemic or venous in origin and located below the ankle. Fifty-five percent of patients were diabetic and the majority of patients were hypertensive. The cases required prolonged hospitalization for systemic antibiotics and vascular surgery. Only 2.3% of patients required above the knee amputation, and 7% needed below-the-knee amputation.