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Biomedical subjects

R Takolander

Publications and source records attributed to R Takolander.

At least 19 recordsLinked to original sources
PubMed2005

A randomized prospective study of valvulotome efficacy in in situ reconstructions.

OBJECTIVES: To compare the efficacy of valvulotomes during in situ bypass surgery. DESIGN: A randomized prospective blinded study. MATERIALS AND METHODS: Thirty PAD patients scheduled for infrainguinal greater saphenous vein bypass were randomized to use of adjustable or fixed valvulotomes for valve destruction. Valvulotomy was performed after construction of the proximal anastomosis. The efficacy of valve destruction was determined by angioscopy after completion of the distal anastomosis by a separate blinded examiner. RESULTS: A total of 123 valves were evaluated, 61 after use of an adjustable and 62 with a fixed valvulotome. There was no difference ( p = .88) in number of retained valves between the two groups ( n = 16, 17, respectively). The majority of incompletely destroyed valves were found in the proximal parts of the graft (46%, 13 out of 28). The primary patency at 30 days was 100 and 79%, respectively, p = .09). CONCLUSIONS: No significant difference in efficacy between valvulotomes was found. Both types tend to miss a large proportion of proximal valves.

Aged↗
PubMed1999

Complications in carotid endarterectomy are predicted by qualifying symptoms and preoperative CT findings.

OBJECTIVES: To relate the 30-day perioperative rate of stroke or death in carotid endarterectomy (CEA) to preoperative qualifying symptoms and to the presence of cerebral infarction (CI) demonstrated on computed tomography (CT). DESIGN: Retrospective clinical study. MATERIAL AND METHODS: Two hundred and seventy-two consecutive CEAs for symptomatic stenosis in 262 patients were analysed. RESULTS: The total complication rate was 5.9%. Patients with retinal symptoms (n = 81) had no complications, TIA patients (n = 76) had 6.6% (p < 0.001). Patients qualifying with minor stroke (n = 113) had complications in 9.7% (N.S. compared to TIA patients). Patients qualifying with cortical symptoms had a significantly higher complication rate compared to those with retinal (8.4% vs. 0%, p = 0.004). The presence of a preoperative CT-verified infarction resulted in a higher risk for stroke or death (9.8% vs 2.8%, p = 0.008). Within the subgroup presenting with minor stroke, the presence of CI resulted in stroke or death in 13.9%. In patients without CI the corresponding figure was 2.4% (p = 0.017). CONCLUSION: The qualifying symptoms and the presence of CI visualized by CT influence the complication rate in CEA. When evaluating risk and comparing outcome, these parameters should be included in reporting standards.

Adult↗
PubMed1999

Sexual function in women suffering from aortoiliac occlusive disease.

OBJECTIVE: To describe the sexual function in women suffering aortoiliac occlusive disease (AIOD) and in an age-matched reference group. PATIENTS AND METHODS: Thirty-six women suffering from AIOD were included. Twenty were investigated before vascular intervention (untreated) and 16 different women after treatment (treated). Eighteen age-matched women served as a reference group. The patients answered a questionnaire including sexual, social and medical questions and a gynaecological examination was performed. RESULTS: Untreated patients with AIOD have a significantly impaired physical well-being compared to the other groups (p < 0.001). A negative effect of the vascular disease and its treatment on sexual life was experienced by 69% of treated compared to 40% affected among untreated (p = 0.05). Vulval sensibility was impaired in 44% of treated, 11% of untreated and 22% of reference patients. Defective anal sphincter function was found in 33% of treated, 17% of untreated and 6% in the reference group. Those differences were not statistically significant. CONCLUSIONS: Symptomatic AIOD in women is associated with a significantly impaired physical and sexual well-being. Though limited by size and methodology, the results indicate the possibility of iatrogenic nerve damage.

Adult↗
PubMed1998

Conservative treatment, stent grafting or open repair of abdominal aortic aneurysms.

The incidence of abdominal aortic aneurysm (AAA) is increasing in most parts of the world and the natural history is death from rupture unless the patient dies from another cause prior to rupture. The treatment of the aneurysm involves insertion of a vascular prosthesis sutured proximally to the non-dilated segment of the aorta and distally either to the neck below the aneurysm or on a convenient place in the iliac or femoral arteries. The endovascular technique has brought the possibility of inserting and securing this prosthesis in the aorta by use of stents which replace surgical suture and act as friction seals. This may in the future alter the indications for intervening against the AAA. In this short review the possibilities offered for treatment and how and when they should be used, are discussed.

Angioplasty, Balloon↗
PubMed1996

Postocclusive reactive hyperemia estimating peripheral vascular resistance: a noninvasive method to predict outcome of infrainguinal vascular reconstructions?

OBJECTIVE: The peripheral vascular resistance is an important factor determining the outcome of infrainguinal revascularizations. When measured intraoperatively, it correlates to graft patency, but to select patients to surgery a preoperative, preferably noninvasive, method is necessary. The aim of the present study is to test if parameters recorded during postocclusive reactive hyperemia can be used for that purpose. EXPERIMENTAL DESIGN: This prospective study compares patients with occluded grafts within 30 days postoperatively to patients with patent grafts. SETTING: University Hospital. PATIENTS: Thirty patients with critical ischemia scheduled for infrainguinal bypass surgery. MEASURES: Correlations between intraoperatively measured peripheral resistance and preoperatively recorded parameters of postocclusive reactive hyperemia. The ability of the values to predict outcome. RESULTS: Peripheral resistance correlated significantly to two parameters during postocclusive reactive hyperemia recorded after thigh occlusion, flux reappearance time (r=0.47, p=0.01) and time to peak flux (r=0.41, p=0.03). Intraoperative peripheral resistance predicted graft occlusion at 30 days with a 90% accuracy, while parameters obtained during reactive hyperemia, only tended to predict adverse outcome. CONCLUSIONS: Several parameters during reactive hyperemia show weak correlation to intraoperatively measured peripheral resistance, but none was able to accurately predict graft failure. Further studies are needed to evaluate its capability for patient selection.

Aged↗
PubMed1995

The "ad hoc" estimation of outflow does not predict patency of infrainguinal reconstructions.

OBJECTIVES: This prospective study was performed to evaluate the clinical implication of the adhoc estimation (also called SVS score) of outflow on patency of infrainguinal in situ femoropopliteal or -distal bypasses. METHODS: The bypasses were followed with Duplex scanning at 1, 3, 6, and 12 months after surgery. Fifty-three bypasses were recruited for the study, 20 of which were performed in 17 diabetics. In 47% the adhoc scoring was < or = 4.5 and in 53% it was between 5 and 10 (1 corresponds to an excellent outflow and 10 to a blind segment). RESULTS: Within the first 30 days eight occlusions occurred, all of which were surgically corrected. The adhoc score for these bypasses was 4.2 vs. 4.9 (NS) for those who did not occlude. During follow-up, revisions were performed in 21 cases (40%) with 30 interventions. At the end of 1 year, 68% of the bypasses were patent (80% among diabetics and 64% among non-diabetics, NS). Patency at 1 year was not influenced by the adhoc classification. CONCLUSION: The estimation of outflow from angiography seems to be of no value in predicting graft patency in infrainguinal grafting.

Adult↗
PubMed1994

The effect of erythropoietin treatment on arteriovenous haemodialysis fistula/graft: a prospective study with colour flow Doppler ultrasonography.

To determine the effect of erythropoietin (EPO) on patency the haemodynamics and morphology in haemodialysis fistula/graft were prospectively assessed using ultrasonographic two-dimensional imaging and colour flow Doppler together with pulsed Doppler, prior to and during partial correction of anaemia with EPO. Nineteen radiocephalic fistula and 11 loop grafts in 30 patients on routine maintenance haemodialysis were investigated prior to EPO treatment. A significant stenosis defined as a localised 100% increase in flow velocity was found in the arterial inflow in seven (23%) patients, in the loop graft in seven (64% of loop grafts) patients, and in the venous segments in 23 (77%) patients. Fourteen patients were rescanned after more than 200 days of EPO therapy. There was a significant increase in haemoglobin (84 +/- 14 g/l to 104 +/- 18 g/l) and haematocrit (24 +/- 4 to 31 +/- 5%) during this time. One arterial, four loop grafts and two venous stenoses appeared or increased in severity, and one venous return flow segment had occluded. Blood flow according to ultrasonography was unchanged. Of the 16 patients lost to follow-up, three underwent surgical intervention (clinical failure rate 0.20 access/year). EPO therapy may contribute to minor changes in access haemodynamics but does not seem to be detrimental to patency.

Adult↗
PubMed1994

Calcitonin gene-related peptide attenuates experimental ischemic renal failure in a rat model of reversible renal ischemic insult.

Calcitonin gene-related peptide (CGRP) has been shown to decrease vascular resistance and increase renal blood flow. To study the effects of CGRP in acute renal failure (ARF) of moderate degree, we used a rat model of bilateral temporary renal artery occlusion (RAO) inducing ARF with spontaneous recovery within 1 week, resembling a clinical situation. Three groups were studied: CGRP 10 (CGRP10) and 25 (CGRP25) pmol.kg-1.min-1 and vehicle alone (control), respectively, infused from 10 min before until 2 h after declamping. Serum urea levels reached a peak after 24 h at 13.0 +/- 1.3, 8.1 +/- 1.1, and 8.5 +/- 1.0 mmol.L-1 in the control, CGRP10, and CGRP25 group, respectively. They were significantly lower postischemia in the two CGRP-treated groups than in the control group. Mean arterial pressure (MAP) decreased to 90%, 80%, and 60% of baseline MAP in the control, CGRP10, and CGRP25 group, respectively. Histologically there was no significant difference between the three groups. Our data indicate that CGRP preserves renal function in experimental ARF despite reductions in MAP. We conclude that further investigations of the renal effects of CGRP are needed in order to clarify whether CGRP might be used clinically to maintain or improve renal function in ARF.

Acute Kidney Injury↗
PubMed1994

Venous shunting as a complication to penile revascularization--a case report.

As a serious complication to arterial penile revascularisation arterio-venous shunting was observed in a 60 years old male. The patient suffered bilateral obstruction of his pudendal arteries. Following revascularization using the left inferior epigastric artery he obtained good pulsation in the penis but no return of sexual function. Instead his general condition deteriorated. A follow-up angiogram revealed shunting of the contrast from the epigastric artery, via the penis, to the venous system. Venous ligation was carried out. The patient's general condition returned to normal status and he can now obtain rigid erections. Reconstructive arterial surgery for erectile dysfunction should never be carried out unless venous leak has been ruled out as a complicating factor.

Follow-Up Studies↗
PubMed1993

Natural history of patients with unoperated atherosclerotic carotid artery disease--results from a retrospective study.

The natural history of carotid artery disease was studied in a retrospective study of 609 angiograms performed during 1969-1979 on patients who had subsequently not been operated on. The indication for angiography differed, but was aimed at clarifying suspected cerebrovascular events. 578 patients could be followed-up after a median time of 10.4 years (0-22). The median survival time after angiography was 9.7 years for the 355 men and 12.8 years for the 223 women (p = 0.0099). Internal carotid stenosis of > 50% was seen in 9.0% (bilaterally in 2.2%), a stenosis > 75% in 4.5% (bilaterally in 0.9%) and occlusion in 9% (bilaterally in 0.7%). Ulceration was present in 10.7% (bilaterally in 1.6%). 26.5% of the patients had a cerebrovascular event during follow-up, of which 31.4% had transient ischaemic attack or amaurosis fugax. Survival was not influenced by the degree of stenosis, but presence of arteriosclerotic carotid artery disease significantly reduced the median survival time from 11 to 3 years. The main cause of death for men was myocardial infarction (27.7%) and for women a cerebrovascular event (27.8%), a significant difference. From this study, in selected patients it can be concluded that the annual frequency of cerebrovascular events was low, approaching frequencies reported in asymptomatic patients. The cause of death differed between men and women, with more cardiac deaths among men and more cerebrovascular deaths among women.

Carotid Artery Diseases↗
PubMed1993

Does low-dose acetylsalicylic acid prevent stroke after carotid surgery? A double-blind, placebo-controlled randomized trial.

BACKGROUND AND PURPOSE: The aim of this randomized double-blind, placebo-controlled trial was to evaluate whether neurological deficits could be prevented with low-dose acetylsalicylic acid (ASA) as an adjunct to carotid endarterectomy. METHODS: A total of 232 patients were randomized to two groups, 75 mg/d ASA starting preoperatively and continued for 6 months (n = 117) or placebo (identical tablets) (n = 115). The patients were followed up regularly for 1 year. RESULTS: The groups were well matched regarding laboratory data and indication for operation. The number of patients with intraoperative or postoperative stroke without complete recovery within 1 week were 0 and 2 at 30 days and 6 months, respectively, in the ASA group, compared with 7 and 11 in the placebo group (P = .01). Including all neurological events within 6 months, this was found in 15 patients in the ASA group compared with 24 in the placebo group (P = .12). Mortality was 0.8% and 3.4% at 30 days and 6 months, respectively, in the ASA group. In the placebo group, the corresponding figures were 4.3% and 6.0%, respectively (P = .12). The intraoperative bleeding did not differ between the groups nor did the number of reoperations due to bleeding or other complications related to pharmacology. CONCLUSIONS: This study indicates that low-dose ASA (75 mg/d) reduces the number of postoperative strokes without complete recovery within 1 week. Overall neurological events are insignificantly reduced, as also mortality. The use of low-dose ASA (75 mg) seems safe and effective in reducing cerebrovascular events after carotid endarterectomy.

Adult↗
PubMed1991

Changes in middle cerebral artery flow velocity and pulsatility index after carotid endarterectomy.

Transcranial Doppler sonography (TCD) was used in 33 patients undergoing carotid endarterectomy (CEA). Mean flow velocity (MCA MV) and the pulsatility index in the middle cerebral artery (MCA PI) were measured pre- and on six occasions postoperatively. The MCA MV was reduced by anaesthesia but was increased postoperatively (+43%, p less than 0.001) compared to the preoperative value and was still increased at late follow-up after several months. The MCA PI, which was lower preoperatively than normally reported in this age group, was not changed by anaesthesia but then rose and remained elevated, i.e. within normal limits 72 h postoperatively (+30%, p less than 0.01) as well as at late follow-up. No significant changes in MCA MV or MCA PI were noted on the contralateral side. The results from this study support earlier findings from invasive studies showing that CEA results in an increased flow in the middle cerebral artery on the operated side and an increased MCA PI suggests an increased resistance on the operated side. The findings are compatible with an increased cerebral blood flow during the first days after CEA and with the operated side supplying a greater part of the cerebral blood flow even several months after surgery.

Aged↗
PubMed1991

Edema after lower limb arterial reconstruction. Influence of background factors, surgical technique and potentially prophylactic methods.

The pathogenesis of lower leg edema regularly following a distal arterial reconstruction is unclear and generally no treatment is used. In 85 patients background factors such as diabetes, age, sex and side of operation were analysed and found not to influence the degree of edema. A significantly less pronounced edema was found when a prosthetic graft was used as compared to a vein graft as well as if the distal anastomosis was located above as compared to below the knee. Both these findings might be explained by differences in incisions. In a pilot series the prophylactic effect of various pharmacological regimens was studied and in another 22 patients leg elevation was prescribed. None of the drugs (furosemide, mannitol, terbutaline and corticosteroids) appeared to prevent the development of edema. Within the leg elevation group there was, like in patients without special treatment, less swelling if the distal anastomosis was performed above the knee and if a prosthetic graft was used. In these cases leg elevation seemed to prevent swelling with significantly less edema than corresponding patients treated without leg elevation.

Aged↗
PubMed1990

Compartment syndrome after prolonged surgery with leg supports.

Compartment syndrome has been reported in a few cases after prolonged surgery with patients in leg supports. A recent case in our hospital (57-year-old man undergoing cystourethrectomy because of cancer) made us interested in the problem. This case together with six from the literature are analysed. Moreover, the first 11 cases operated on with a pelvic pouch and ileoanal anastomosis at our department were reviewed. They had been in the leg support position for a median duration of 6.4 (5.8-8) h. In four of them leg pain and swelling developed within 12 h. Three showed regression within a few days, one after a week. In one patient with swelling compartment pressure was measured with a transducer tipped catheter. Intermittently the pressure was up to 50 mm Hg. There was an obvious decrease in pressure on knee bending. Also, in a patient without swelling large pressure variations were seen but not to critical levels.

Adult↗