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Biomedical subjects

R W Hallin

Publications and source records attributed to R W Hallin.

13 recordsLinked to original sources
PubMed1993

Femoral MR angiography versus conventional angiography: preliminary results.

PURPOSE: To develop a bilateral femoral magnetic resonance (MR) angiographic examination that would include the aortic bifurcation to the ankle. MATERIALS AND METHODS: Thirty-seven patients underwent conventional angiography and the bilateral femoral MR angiographic examination. Two-dimensional time-of-flight angiography was used for all studies. RESULTS: The femoral MR angiogram could have replaced the conventional angiogram in 57% of patients (21 of 37). In 43% of patients (16 of 37), the femoral MR angiogram could not have replaced the conventional angiogram. Reasons for diagnostic failure with femoral MR angiography included artifact from vascular clips (n = 8) or prosthetic joints (n = 3), overlooked distal aortic stenosis (n = 1), and suboptimal definition of vessels (usually trifurcation vessels) owing to various causes (n = 8). Seven of the patients in this group had bypass grafts. CONCLUSION: Some of the current limitations of femoral MR angiography could be avoided by supplemental duplex sonography around prostheses and vascular clips. The other limitations will require advances in MR imaging techniques.

Aged↗
PubMed1987

Ten year experience with the negatively charged glutaraldehyde-tanned vascular graft in peripheral vascular surgery. Initial multicenter trial.

The negatively charged glutaraldehyde-tanned vascular graft was developed to determine the utility of grafts of biologic origin to provide satisfactory revascularization for ischemic limbs with advanced arteriosclerotic peripheral vascular disease. The bovine carotid artery was modified under a number of conditions using a large number of variables and evaluated in the carotid artery and aorta of dogs. Eventually ficin-digested carboxylated glutaraldehyde-tanned grafts were selected as being most antithrombotic and most resistant to aneurysm formation. Under an Investigational Device Exemption with the Food and Drug Administration, 146 grafts were evaluated in 108 patients with patency approaching 67 percent for all grafts at 5 years and 59 percent at 9 years plus. Total aneurysm formation has been 4 percent (six grafts) occurring only in hypertensive patients. The graft is now undergoing clinical use and evaluation worldwide.

Adult↗
PubMed1984

Intraarterial streptokinase infusion for acute popliteal and tibial artery occlusion.

Eight consecutive patients with acute thrombotic or embolic occlusion of the popliteal or tibial artery were treated with low-dose intraarterial streptokinase followed by arterial reconstructive surgery where appropriate. Three patients had acute thrombosis of a popliteal aneurysm with limb-threatening ischemia. All three were relieved of their acute ischemia by streptokinase infusion accompanied by lysis of clots in the popliteal artery outflow tract. Each patient then underwent elective popliteal aneurysm bypass. Four patients had acute embolic popliteal or tibial artery occlusion. Each was relieved of ischemic symptoms. One required surgery to remove residual clot. One patient with thrombosis of the tibioperoneal trunk did not have a decrease in symptoms with streptokinase infusion, but did experience sufficient outflow tract thrombolysis to permit construction of a tibial bypass with resultant restoration of normal circulation. Low-dose intraarterial streptokinase may be the treatment of choice for selected patients who present with thrombosis of a popliteal aneurysm with tibial vessel involvement or with embolic popliteal or tibial artery occlusion.

Acute Disease↗
PubMed1983

In situ saphenous vein bypass grafting. Experience in 34 extremities over a 2 year period.

Over a 2 year period, 34 limbs were revascularized in 33 patients. The in situ saphenous vein technique was used. Improved instrumentation and patency rates have encouraged the use of this method. Eighteen patients were insulin-dependent diabetics. The indication for operation was limb salvage in 25 limbs (73 percent). No vein was considered too small to use. The origin of 25 of the grafts were femoral and 9, popliteal. The termination of 15 of the grafts were popliteal, 11 tibial or peroneal, and 8 pedal. Of 12 limbs considered to be the most difficult to treat due to diabetes and accompanying poor runoff, 4 had a patent pedal arch. Initial graft patency was achieved in 94 percent of the limbs. Overall graft patency was 73 percent; femoropopliteal patency was 86 percent; and combined femoral, tibial, peroneal, and pedal patency was 64 percent. Learning the in situ bypass technique is tedious. The low thrombogenicity of the graft provides a temptation to extend operative indications. Use of the saphenous vein in situ can result in superior revascularization of the leg.

Actuarial Analysis↗
PubMed1976

The Sparks' mandril graft. A seven year follow-up of mandril grafts placed by Charles H. Sparks and his associates.

A clinical follow-up study of the Sparks' mandril graft used for lower extremity revascularization between 1968 and 1973 is presented. Of seventy-three mandril grafts placed, sixty were used to revascularize lower extremities in fifty-four patients. Results show 100 per cent patency in the ilioiliac and ilio-femoral sites, 26 per cent patency in the femoropopliteal sites, and 0 per cent patency in the femorotibial and axillofemoral grafts. Complications include poor maturation of the graft, early thrombosis, postoperative hemorrhage, and aneurysm.

Adolescent↗
PubMed1976

Femoropopliteal versus femorotibial bypass grafting for lower extremity revascularization.

Thirty-nine femoropopliteal revascularization procedures were compared with 35 femorotibial revascularization and one brachioradial revascularization over a follow-up period of six months to six years. Preoperative study, operative technique, results and complications are described. Living patency is compared with closure rates. The living patency rates are 49 per cent and 51 per bent for the femoropopliteal and femorotibial group. The complication rate was higher in the femorotibial group by four times (37% compared to 10%). Four reoperations were done because of progression of the patient's disease in the femorotibial group. Femorotibial revascularization is at least as effective as femoropopliteal revascularization, and produces a comparable live patency record, but with a higher incidence of postoperative complications.

Adult↗
PubMed1975

Complications with the mandril-grown (Sparks) dacron arterial graft.

Mandril-grown dacron grafts were successful (22-35 months patency in the iliofemoral position. Because of the tendency of the mandril-grown dacron graft to become aneurysmal (4 of 17 grafts), its use is probably contraindicated in the hypertensive patient. Overall patency is 41 per cent (7 of 17 grafts) at three years. Patency below the inguinal ligament is 18 per cent (2 of 11 grafts) at 29 months. A minimum waiting period of six weeks is required. No infections occurred in this seeries.

Adult↗
PubMedDate not supplied

Endovascular stents covered with pre-expanded polytetrafluoroethylene for treatment of iliac artery aneurysms and fistulas.

PURPOSE: This report describes the early clinical experience with use of a transluminally placed endovascular graft (TPEG) covered with pre-expanded polytetrafluoroethylene (PTFE) to treat iliac artery aneurysms and fistulas. MATERIALS AND METHODS: Eight patients with iliac artery aneurysms (n = 7) and common iliac artery to common iliac vein fistula (n = 1) were treated with TPEGs. The iliac artery aneurysms were either common iliac (n = 6) or hypogastric (n = 1). All of the patients had significant comorbid diseases. The TPEG devices were made with pre-expanded PTFE sutured to Palmaz stents and delivered through 10- or 12-F sheaths. RESULTS: The aneurysms were successfully excluded in six of seven patients and the one iliac artery-to-vein fistula was successfully occluded. There were no immediate procedural complications related to the TPEG devices. Follow-up was limited (mean, 12 months), but no stenoses or occlusions of the TPEG devices were detected. The one failure was probably due to the marked tortuousity of the iliac artery, which prevented an adequate seal. CONCLUSION: In the authors' early clinical experience, the use of TPEG devices with pre-expanded PTFE successfully treated iliac artery aneurysms and an iliac artery-to-vein fistula. Although the results are encouraging, longer follow-up is necessary to better evaluate this type of treatment.

Aged↗