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Biomedical subjects

R W Oblath

Publications and source records attributed to R W Oblath.

25 records · Page 2Linked to original sources
PubMed1984

Large-vessel arterial occlusive disease in symptomatic upper extremity.

Subclavian and axillary artery occlusive disease resulted in sufficient upper extremity symptoms to necessitate 30 vascular reconstructions in 28 patients over the past ten years. Female patients predominated, with a ratio of 2.5:1. The average age of the patients was 61 years. The incidence of diabetes mellitus was low (7%). Sixteen of 18 proximal subclavian lesions were on the left side, while more distal lesions were equally distributed on the left and right. Extrathoracic bypasses were used in all cases. Dacron grafts were used in 16 of 17 carotid-subclavian bypasses. Autogenous vein grafts were used in 11 of 13 bypasses to the axillary or brachial artery. Concomitant cervicodorsal sympathectomy was done in only four patients. The in-hospital graft patency rate was 93% and the long-term graft patency rate at one year and beyond was 88%.

Adult↗
PubMed1984

Successful long-term limb salvage using cephalic vein bypass grafts.

Successful long-term limb salvage using cephalic vein bypass grafts was attained in 70 limbs of 67 patients over the past 11 years. The saphenous vein was absent in 76% and inadequate in 24% of the cases. Revascularization for limb salvage was carried out in 83%. Ninety per cent of the grafts were extended to the infrageniculate level while 56% were to a tibial vessel. Patency rates at 1, 3, and 5 years were 85%, 72%, and 68%, respectively. Limb salvage rate was 85% at 5 years and thereafter. There were no operative deaths or upper extremity morbidity. The 5-year survival rate was 50%. The results obtained with cephalic vein were comparable to those reported using saphenous vein but superior to those reported for nonautogenous bypass grafts.

Adult↗
PubMed1984

Patency of femoropopliteal and femorotibial grafts after outflow revascularization (jump grafts) to bypass distal disease.

Repair of failing femorodistal bypass grafts with secondary distal "jump" grafts was performed 34 times in 33 patients. Indication for operation was limb salvage for all distal jump grafts and for 85% of the initial femorodistal bypass grafts. Autogenous vein bypass grafts were used in 28 of 33 initial femorodistal grafts (85%) and in 29 of 34 secondary jump grafts (85%). Sixteen of the 33 initial grafts in jeopardy extended to the infrapopliteal level (48%) and 19 of the jump grafts terminated in foot or ankle arteries (56%). The 12 jump grafts performed in the first 2 months of the initial graft were associated with high rates (9%) of graft thrombosis and amputation. Early loss of viability of initial grafts probably resulted from technical and judgment errors or underestimation of distal disease. Progression of distal disease produced late failure after 1 year of implantation of the initial grafts. The 1-year patency rate of the initial femorodistal grafts was 63% but only 32% of these grafted limbs were viable and were not at risk of amputation. Distal jump grafts produced a 49% improvement in limb viability (to an 81% limb salvage rate) and an 11% increase in the initial graft patency rate (to 74%) at 1 year.

Adult↗
PubMed1978

Extra-anatomic bypass of the abdominal aorta: management of postoperative thrombosis.

Extra-anatomic bypass of the abdominal aorta was performed in 25 patients too ill to undergo abdominal operation (Group I) and in 22 patients with graft sepsis or hemorrhage (Group II). The graft patency rate determined by life table analysis in Group I patients was 83.5% at one year and 60% at two years. The graft patency rate for Group II patients of 47% at one year was significantly lower than the patency rate for Group I patients (p <.01). Thrombectomy was attempted in 11 of the 18 grafts that occluded postoperatively. Patency was re-established by this method in nine grafts (82%), failures resulted in amputation. Recurrent occlusion of three thrombectomized grafts was treated by multiple thrombectomies with cumulative patencies up to 44.5 months. Thrombectomy was not attempted in seven occluded grafts. Two graft occlusions resulted in amputation of extremities. Contralateral axillofemoral grafts were performed in three of the patients, ipsilateral axillofemoral graft in one patient, and aortobifemoral graft in one patient. Thrombectomy is the treatment of choice for occluded extra-anatomic bypass grafts. It can be performed easily under local anesthesia. If unsuccessful, contralateral axillofemoral or femoro-femoral grafts are indicated to re-establish blood flow.

Aged↗
PubMed1978

Human umbilical veins and autogenous veins as canine arterial bypass grafts.

Glutaraldehyde treated human umbilical veins (Dardik Biograft) were used to bypass short segments of the femoral artery in 15 dogs and were compared to autogenous jugular veins placed in the contralateral femoral artery of each animal. All 15 autogenous jugular veins remained patent for the four month period of observation whereas thrombosis occurred in seven of 15 umbilical vein grafts. This patency rate of 53% was significantly lower than that observed for autogenous jugular veins (p less than 0.01). Neointimal Fibrous Hyperplasia (NFH) a the proximal anastomosis was responsible for six of the seven umbilical vein graft occlusions. Of the eight patent umbilical veins, five had varying degrees of proximal anastomotic stenosis secondary to NFH. Histological examination of each graft revealed significant fibroblastic proliferation and collagen deposition within the lumen of stenosed and thrombosed grafts. Although human umbilical veins have distinct advantages over other prosthetics, such as availability and flexibility, the incidence of experimental neointimal fibrous hyperplasia causing anastomotic stenosis and thrombosis is prohibitively high.

Animals↗