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Biomedical subjects

S Weimann

Publications and source records attributed to S Weimann.

At least 19 recordsLinked to original sources
PubMed1992

Graft replacement of post-traumatic thoracic aortic aneurysm: results without bypass or shunting.

From 1986 to 1991 13 cases of post-traumatic thoracic aneurysm were treated at our department. All patients had apparent thoracic injury at the time of trauma, and their mean age was 35 years. The mean time between trauma and operation was 3 years and six patients were asymptomatic. In all patients the diagnosis was made by computed tomography and angiography and all post-traumatic thoracic aneurysms were located at the aortic isthmus. No spinal cord protection by bypass or shunting was used during surgery and the clamp-and-repair method with a mean clamping time of 38 min was used in all 13 patients. No renal or neurological complications were observed postoperatively and there were no hospital deaths. The data of 202 patients who had been operated upon for post-traumatic thoracic aneurysms since 1981 have been reviewed with regard to the relationship between spinal cord protection and the incidence of postoperative paraplegia. Different methods of spinal cord protection were used in 121 patients resulting in paraplegia rate of 1.6%. In 81 patients the clamp-and-repair method was used and no case of paraplegia was observed in this group.

Adult↗
PubMed1991

[Increasing value of the duplex scan in preoperative diagnosis of the carotid artery--is preoperative carotid angiography still sensible?].

In effort to eliminate morbidity and costs, associated with arteriographic investigation, we increasingly perform Duplex Scan of the extracranial carotid artery prior to endarterectomy. 451 carotid reconstructions between 1986 and April 1991 were evaluated retrospectively. The percentage of patients undergoing carotid endarterectomy without angiography has increased from 21.1% to 92.8%. Angiography was associated with a combined neurologic morbidity rate of 3.0%. Perioperative outcome of patients and stratification by indication did not show any significant differences for both groups undergoing Duplex Scan alone and/or angiography. Diagnostic Carotid angiography should only be used selectively in patients showing distal internal carotid plaque, recurrent stenosis, symptomatic carotid occlusion or aortic arch disease.

Aged↗
PubMed1990

Isolated iliac artery aneurysms.

Clinical and diagnostic data were collected from 22 men with iliac artery aneurysms treated surgically over a period of 22 years. Their ages ranged from 47 to 80 years (mean 64.0). Eight patients had multiple aneurysms. Thirty isolated iliac artery aneurysms were detected, 20 aneurysms (66.6%) located on the right and 10 (33.3%) on the left side. Twenty-six aneurysms were found in the common iliac artery (86.6%). Fifteen patients were symptomatic (68.2%); rupture occurred in five patients (22.7%), three of whom were initially asymptomatic. Thirteen of 17 patients whose aneurysms did not rupture had a palpable mass (76.4%), and three had bruits in the area of the aneurysm. All 22 patients were subjected to operative procedures. Seventeen patients operated upon electively survived, whereas only three patients who were operated upon after rupture survived. Graft interposition was the most common procedure. All 20 patients who survived after the operation were followed. Two died of myocardial infarction three and five years later, one of cancer six years later, and one of an unknown cause eight years after operation. Iliac artery aneurysms are extremely rare; their diagnosis is very difficult. The mortality rate is two times higher than in aortic aneurysms, once the diagnosis has been established. Therefore elective resection and arterial reconstruction are recommended.

Aged↗
PubMed1989

[Extrathoracic versus transthoracic methods of surgical correction of stenoses and occlusions of the aortic arch branches: a comparison].

125 reconstructions performed during the years 1968 to 1988 were analysed retrospectively. 81 surgical procedures were extrathoracic (64.8%) and 44 transthoracic (35.2%). The symptoms of the aortic arch branch lesions included subclavian steal syndrome in 67 (53.6%), transient cerebral ischemia in 16 (12.8%), residua of cerebral infarction in 5 (4.0%), monocular ischemic attacks in 16 (12.8%) and ischemic arm symptoms in 27 (21.6%) patients. Surgical repair was achieved by subclavian-carotid transposition in 44 (35.2%), carotid-subclavian bypass in 23 (18.4%), carotid-subclavian transposition in 2 (1.6%), endarterectomy of the subclavian artery in 5 (4.0%), carotid-carotid bypass in 3 (2.4%), subclavian-subclavian bypass in 4 (3.2%), aorto-subclavian bypass in 9 (7.2%), endarterectomy of the left subclavian artery in 18 (14.4%) and reconstruction of the innominate artery in 17 (13.6%) patients. 124 patients had complete remission of symptoms or at least showed marked improvement postoperatively. The overall patency rate of the extra- and transthoracic procedures in 85% at an average follow-up of 115 months. The patency rate in the extrathoracic group is 82% and not significantly lower than in the transthoracic group with a patency rate of 89%.

Adult↗
PubMed1989

[Non-invasive morphologic and functional assessment of arteriovenous fistula in dialysis patients with duplex sonography].

In 61 patients with end-stage renal disease the results of 89 consecutive Duplex examinations of the arteriovenous fistulas used for haemodialysis were evaluated. The examinations were performed because of various problems concerning the vascular access or before the first puncture. Using 7.5 and 10.0 MHz probes (pulsed Doppler 3.0 and 4.5 MHz) the morphology and the function of the fistulas were evaluated. In 35 cases the results were normal, in a further 27 cases minor anomalies were seen without influencing the function. Complete thrombosis was observed in 7, partial thrombosis and severe stenosis in 4 cases each. Large aneurysms were documented in 6 examinations and in the remaining 6 the fistulas had not matured sufficiently within 4 weeks. The ultrasound results correlated well with consecutive angiography or surgery. The mean flow in normal fistulas was 514 +/- 223 ml/min. It was higher in PTFE shunts (614 +/- 242 ml/min) than in Cimino-Brescia fistulas (464 +/- 199 ml/min). Complications were observed more often in the PTFE group (63.9% vs. 58.5%). We think that Duplex sonography offers an accurate, non-invasive way to evaluate the morphology and the function of arteriovenous fistulas of patients on haemodialysis. This should therefore be performed as the first imaging method whenever problems concerning the fistula occur.

Adult↗
PubMed1988

Carotid occlusion caused by seat belt trauma.

Surgical reconstruction should be considered in patients showing episodes of transient cerebral ischaemia or progressive neurological deterioration secondary to carotid arterial injuries proved by arteriography. Even complete thrombosis of the internal carotid artery may be managed successfully, if thrombectomy and intimal repair are undertaken within some hours after the onset of neurological symptoms. Unger reported a mortality rate of 21% following carotid arterial trauma, 34% of the patients improved if they underwent surgical repair, whereas only 14% of the patients improved if they had ligation or were not treated surgically. Statistical data have shown that both shock and coma are bad prognostic omens and patients presenting with these signs have less than a 50% chance leaving the hospital alive and well, even if they receive optimum emergency management. Although coma has been suggested as a contraindication to carotid repair, review of the literature has shown the data to be too limited to warrant such a conclusion.

Carotid Artery Injuries↗
PubMed1987

Endoscopic aspects of aortointestinal fistula.

The etiology, diagnostic difficulties and treatment of five cases of aortointestinal fistulas are presented. In all of them, endoscopy played a major diagnostic role. Early diagnosis is essential for elective surgery since reconstruction in the massive bleeding stage has a mortality of up to 80%.

Adult↗
PubMed1987

Traumatic renal artery occlusion: is late reconstruction advisable?

We report a case of traumatic renal artery occlusion treated successfully by reconstruction several years after the injury. Hypertension resulted in diagnostic investigation by means of excretory urography, computerized tomography, angiography and perfusion scintigraphy. Treatment consisted of a thin-walled polytetrafluoroethylene (Gore-Tex) bypass between the aorta and left renal artery near the hilus. When the patient was discharged from the hospital the creatinine level was normal and blood pressure was 180/90.

Adult↗
PubMed1987

Direct subclavian-carotid anastomosis for the subclavian steal syndrome.

Between 1984 and 1986, 38 patients--25 males and 13 females--underwent treatment for proximal subclavian arteriosclerotic lesions. All of these patients presented with symptoms of the subclavian steal syndrome and 13 (34.2%) had additional claudication of the arm. Preoperative angiography showed distal filling of the subclavian artery via retrograde flow in the vertebral artery. 31 patients (81.5%) had total occlusion of the proximal subclavian artery and 7 (18.5%) presented with severe stenosis. 34 of these lesions were on the left (89.5%) and 4 on the right side (10.5%). Complete cerebral angiography was performed in each patient with emphasis on visualisation of the carotid bifurcation and selective opacification of the aortic arch vessels if indicated. Doppler ultrasound flow measurement in the vertebral artery yielded the basic data which were then used for comparative postoperative evaluation. The operation was performed under general anaesthesia and heparinisation. A shunt was not required while performing the direct end-to-side anastomosis between the transected subclavian and the common carotid artery. Arteriosclerotic plaques in the distal stump of the transected subclavian artery and occasionally the origin of the vertebral artery were dealt with by simple eversion endarterectomy. There was no operative mortality; the postoperative complication rate was 13.1% including palsy of the recurrent nerve in 3 patients, a lymphatic cyst of the neck in one patient and bleeding requiring re-exploration in another. Occlusion of the reconstructed artery or neurologic deficit did not occur. Post operatively all patients were treated with platelet inhibitors. The average follow-up period was 13 months, when the reconstructed arteries were found to be patent in 37 patients (97.4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Primary arteriovenous fistula between the common iliac vessels secondary to aneurysmal disease.

Arteriovenous fistulas between the common iliac vessels are rare; at the present time, only 56 cases have been reported. Forty-seven (83.9%) of these fistulas were secondary to either trauma or surgery for herniated intervertebral disks and nine (16.1%) were caused by aneurysmal disease. Physical examination is very difficult because only 30% of the patients with iliac artery aneurysms have palpable masses before rupture; approximately 60% of the patients already have ruptures at the time of diagnosis. Therefore a high degree of suspicion is necessary and early use of angiography is commendable. Surgical intervention consists of closure of the fistula, resection or ligation of the aneurysm, and restoration of vascular continuity. The survival rate after elective resection is 93%, whereas the operative mortality rate in patients operated on for ruptured iliac artery aneurysms is 52%.

Aged↗
PubMed1986

[Aneurysm of the popliteal vein as the source of a lung embolism].

A case of pulmonary embolism secondary to a clinically unsuspected aneurysm of the popliteal vein is presented. The importance of venography in establishing the source of pulmonary emboli is stressed in comparison to other diagnostic investigations such as ultrasonography, computed tomography or pletysmography. The aneurysm was suitable for local venous reconstruction. Previously reported cases are reviewed, etiology, diagnosis and treatment of this uncommon condition are discussed.

Aneurysm↗
PubMed1986

[Sonographic diagnosis of an aneurysm of the superior mesenteric artery].

This is a report on a patient with a mycotic aneurysm of the superior mesenteric artery proved by histology. Because of a marked intolerance of contrast media we abstained from angiography. It is shown that real-time sonography gives a definite diagnosis, if the multiple vascular structures of the upper abdomen are precisely identified.

Aneurysm, Infected↗
PubMed1978

[Operative therapy of the pilonidal sinus; 115 controlled patients (author's transl)].

The operative results of 115 patients with pilonidal sinus are described. The patients were controlled in 1977, 2 to 11 years after surgery. Only small, non-infected pilonidal sinuses should be radically excised followed by primary suture and Redon-drainage. For extended sinuses and for recurrences the best results are obtained when the wound is left open or marsupialisation is applied. Pilonidal sinus-abscesses should be incised. This simple procedure resulted in primary healing in 23% of our patients.

Adolescent↗