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Biomedical subjects

T M Buckenham

Publications and source records attributed to T M Buckenham.

At least 19 recordsLinked to original sources
PubMed1999

Carbon dioxide angiography of the lower limbs: initial experience with an automated carbon dioxide injector.

Carbon dioxide (CO2) has been used as an arterial contrast agent since 1971. The development of digital subtraction angiography and an automated CO2 injector has increased the practicability and safety of using CO2 routinely. Sixty-three patients had lower limb and/or renal arteriograms performed over a 6-month period using CO2 in comparison with iodinated contrast medium. The majority (mean 74%, range 53-86%) of non-selective studies were diagnostic to the level of the popliteal artery, and 84% of selective lower limb studies were diagnostic. No serious complications occurred. The contrast and spatial resolution of CO2 digital subtraction arteriography (CO2DSA) was not consistently as good as iodinated contrast medium in peripheral lower limb or renal studies. However, due to the absence of allergic reactions and lack of nephrotoxicity, CO2 is a diagnostic alternative to iodinated contrast medium in selected patients.

Aged↗
PubMed1999

The use of the angio-seal haemostatic puncture closure device in high risk patients.

The use of the Angio-Seal haemostatic puncture closure device in 45 patients considered to be at increased risk of puncture site complications is described. Successful device deployment occurred in 44 of 50 arteries (88%). Two major complications were associated with, but not necessarily caused by, the Angio-Seal device. Four minor complications were observed. In a subset of 23 patients well enough to mobilize early after their procedure, 17 did so at an average of 2.6 h as opposed to the routine 12-18 h for patients after a procedure involving a 6-8F sheath. Once the initial learning curve has been overcome, the Angio-Seal device is a simple and successful method of achieving arterial haemostasis following catheterization and is associated with a low risk of complications. At present we would recommend its use for high risk patients only, as manual compression is effective in the majority of routine cases.

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PubMed1999

Peripheral thrombolysis for acute-onset claudication. Thrombolysis Study Group.

BACKGROUND: The aim of this study was to determine the outcome of patients who presented with sudden onset of incapacitating claudication of less than 2 weeks' duration and who were treated with peripheral arterial thrombolysis. METHODS: The database of the Thrombolysis Study Group was searched retrospectively for patients who received thrombolysis for acute-onset claudication. Some 108 patients (65 men, median age 69 (range 29-94) years) were treated with intra-arterial tissue plasminogen activator at 14 hospitals. The median duration of symptoms was 72 h (range from 2 h to 2 weeks). There were 52 graft and 56 native vessel arterial occlusions. RESULTS: The immediate outcome of thrombolysis for native vessel arterial occlusion was thrombus clearance in 50 patients (89 per cent) and failed lysis in six (11 per cent). Thirty-six patients (64 per cent) had a secondary radiological or surgical procedure carried out after lysis. After 30 days four patients (7 per cent) had a major amputation, eight (14 per cent) had died, 38 (68 per cent) were symptom free and seven (12 per cent) continued to have claudication. Three patients (5 per cent) suffered a major haemorrhage. The immediate outcome of thrombolysis for graft occlusion was thrombus clearance in 48 patients (92 per cent) and failed lysis in four (8 per cent); 27 patients (52 per cent) had a secondary procedure. After 30 days four patients (8 per cent) had a major amputation, seven (13 per cent) had died, 32 (62 per cent) were symptom free and nine (17 per cent) had persistent claudication. Three patients (6 per cent) suffered a major haemorrhage. CONCLUSION: Patients who presented with acute onset of incapacitating claudication had an outcome similar to that after thrombolysis for critical ischaemia. It is recommended that patients who present in this way should be observed and treated with thrombolysis only if they progress to critical ischaemia. Presented to the Association of Surgeons of Great Britain and Ireland, Edinburgh, UK, May 1998, and published in abstract form as Br J Surg 1998; 85(Suppl 1): 24

Adult↗
PubMed1999

The endovascular management of blue finger syndrome.

OBJECTIVES: To review our experience of the endovascular management of upper limb embolisation secondary to an ipsilateral proximal arterial lesion. DESIGN: A retrospective study. MATERIALS AND METHODS: Over 3 years, 17 patients presented with blue fingers secondary to an ipsilateral proximal vascular lesion. These have been managed using transluminal angioplasty (14) and arterial stenting (five), combined with embolectomy (two) and anticoagulation (three)/anti-platelet therapy (14). RESULTS: All the patients were treated successfully. There have been no further symptomatic embolic episodes originating from any of the treated lesions, and no surgical amputations. Complications were associated with the use of brachial arteriotomy for vascular access. CONCLUSIONS: Endovascular techniques are safe and effective in the management of upper limb embolic phenomena associated with an ipsilateral proximal focal vascular lesion.

Adult↗
PubMed1999

The association between laser Doppler reactive hyperaemia curves and the distribution of peripheral arterial disease.

OBJECTIVES: To determine whether postocclusive laser Doppler fluxmetry (LDF) curves can be related to the arteriographic distribution of disease. DESIGN: Prospective study. MATERIALS: Sixty-nine patients with symptomatic peripheral ischaemia and 15 healthy subjects. METHODS: Laser Doppler fluxmetry (LDF) was monitored on the dorsum of the symptomatic foot following 2 min of arterial occlusion at the ankle. During reperfusion three patterns of LDF were identified (types I-III). All patients subsequently underwent arteriography which was reported independent of LDF results. The distribution of disease, particularly patency of below-knee vessels, was related to the type of LDF curve observed during reactive hyperaemia. RESULTS: Type I curves were observed in all healthy subjects and 75% of patients with a single arterial lesion. Type II curves were found in 78% of patients with multiple lesions above the knee. The presence of either a type I or II curve was associated with a continuous vessel from knee to ankle (positive predictive value 83%, p < 0.01), whilst type III curve was associated with discontinuous infrapopliteal run-off (positive predictive value 86%, p < 0.01). CONCLUSIONS: This pilot study suggests that post-occlusive LDF curves may identify the distribution of arterial disease and may be useful in the non-invasive management of peripheral ischaemia.

Chi-Square Distribution↗
PubMed1999

Sequential retroperitoneal venous hemorrhage and embolism of an angio-seal puncture closure device complicating iliac artery angioplasty.

PURPOSE: To present a case of iatrogenic puncture closure device embolization complicating surgery for retroperitoneal hemorrhage (RPH) secondary to angioplasty-induced common iliac vein trauma. METHODS AND RESULTS: A 78-year-old woman with rest pain underwent successful kissing balloon dilation of her aortoiliac bifurcation for a calcified ostial stenosis of the left common iliac artery. Hemostatic puncture closure devices (Angio-Seal) were used to secure both femoral punctures. A right-sided retroperitoneal hematoma developed, and during surgical exploration of the right groin, the Angio-Seal device was removed. The only bleeding site found was the external iliac artery puncture and it was repaired. She again became hypovolemic 18 hours later and was returned to surgery, where bilateral groin explorations and laparotomy by the vascular surgical team found a tear in the left common iliac vein. After repair, the patient was stable for 48 hours when the left leg became critically ischemic. Angiography detected a new high-grade stenosis in the left profunda femoris artery; embolectomy retrieved a footplate from the left puncture closure device. The patient died 11 days later from multiorgan failure. CONCLUSIONS: RPH should be considered early as an occult cause of hypovolemic shock developing soon after even technically straightforward iliac angioplasty. Interventionists should be aware that using the Angio-Seal device risks acute limb ischemia if footplate embolization occurs.

Aged↗
PubMed1999

Using CO2-enhanced arteriography to investigate acute gastrointestinal hemorrhage.

OBJECTIVE: The objective of the study was to compare the efficacy of CO2-enhanced arteriography with that of arteriography enhanced with standard iodinated contrast material in the detection of gastrointestinal hemorrhage. CONCLUSION: For acute gastrointestinal hemorrhage, we did not find an advantage to using CO2 to show active bleeding. In fact, CO2 was inferior to iodinated contrast material in revealing nonbleeding vascular anomalies.

Acute Disease↗
PubMed1999

A review of alternative approaches in the management of iatrogenic femoral pseudoaneurysms.

The management of iatrogenic pseudoaneurysms (IPAs) demands close co-operation between radiologist, vascular surgeon and plastic surgeon. Ideally, each patient should be reviewed employing a team approach. Many IPAs require only observation; those with a volume greater than 6 cm3 will require treatment as spontaneous thrombosis is uncommon. Radiological treatment options include ultrasound guided compression repair (UGCR), embolisation, and covered stenting. Occasionally, these are unsuccessful or contra-indicated, and the vascular surgical approach is discussed in detail. Finally, the role of the plastic surgeon in dealing with skin ischaemia is detailed.

Aneurysm, False↗
PubMed1998

Update on endovascular management of arterial occlusive disease.

Although balloon angioplasty is the most widely used technique for treating peripheral vascular disease, developments in endovascular therapies have extended methods of percutaneous vascular intervention. Lasers have been used to recanalize occluded arteries. Mechanical devices can remove obstructions and metallic stents can be placed to keep a vessel open with good long-term patency.

Angiography, Digital Subtraction↗
PubMed1997

The predictive value of laser Doppler fluxmetry and transcutaneous oximetry for clinical outcome in patients undergoing revascularisation for severe leg ischaemia.

OBJECTIVES: To investigate the predictive value of laser Doppler fluxmetry and transcutaneous oximetry in 41 patients undergoing technically successful revascularisation for severe leg ischaemia. DESIGN: Toe and ankle systolic arterial pressures, transcutaneous oxygen tension (tcpO2), and stressed laser Doppler fluxmetry at the foot (time to peak laser Doppler flux following 2 min arterial occlusion, tp LDF, and the response of LDF to raising the leg 40 cm, the elevated:supine LDF ratio) were measured before revascularisation. Six months later these measurements were compared in those patients who were clinically improved, and those who still had symptoms of severe ischaemia or had lost their limb. SETTING: Vascular Laboratory, St. George's Hospital, London SW17, U.K. RESULTS: Six months following revascularisation 30 (73%) of the 41 patients had partial or complete symptomatic relief. Six (15%) had undergone major amputation and five (12%) still had symptoms of severe ischaemia. Before intervention toe and ankle systolic pressures were similar in the 30 who were improved and the 11 who had lost, or were still at risk of losing, their leg. Pre-revascularisation tcpO2 was significantly lower (18.3 mm Hg vs 33.5 mm Hg; p < 0.05) and tp LDF significantly longer (140 s vs 92 s; P < 0.05) in the 11 patients who were not clinically improved at 6 months. Whilst pre-revascularisation toe and ankle pressures below 30 mm Hg and 50 mm Hg respectively identified only 55% of those patients who were not improved 6 months later, a tp LDF in excess of 100 s identified 82% (p < 0.05) and was noted in five of the six amputees. CONCLUSION: Microcirculatory assessments performed in patients with limb-threatening ischaemia are likely to be more deranged in those patients who suffer clinical failure or amputation despite an apparently successful revascularisation procedure.

Amputation, Surgical↗
PubMed1997

The relationship between the delayed improvement in ankle-brachial pressure index and changes in limb volume following balloon angioplasty for leg ischaemia.

OBJECTIVES: To investigate the association between changes in the ankle-brachial pressure index (ABPI) and simultaneous changes in calf volume following percutaneous transluminal angioplasty (PTA) for chronic leg ischaemia. MATERIALS: A total of 37 consecutive patients undergoing PTA for chronic leg ischaemia. METHODS: Bilateral calf volume, as calculated from girth measurements, and ABPI were determined before PTA, and repeated 24 h and 1 week following the procedure. Changes in the calf volume of the treated leg, both absolute and relative to changes of the non-treated leg, were then related to simultaneous changes in ABPI. RESULTS: Twenty-four hours following PTA, the calf volumes of both legs were decreased, although the ratio of the treated: untreated leg had increased by 2.4% (CI + 1.1-3.7, p < 0.01). After 1 week there was no difference in calf volume. These patterns were observed both in the 21 patients who had ABPI improvement of 0.15 or more 1 week following PTA, and in the 16 whose ABPI was unchanged. In the former group ABPI improved by a further 0.13 between 24 h and 1 week following PTA (p < 0.05), but there was no relationship between this delayed ABPI increase and simultaneous changes in calf volume. CONCLUSIONS: We did not detect any significant calf swelling following PTA. Furthermore, changes in ABPI were not related to changes in calf volume.

Angioplasty, Balloon↗
PubMed1997

The nature and importance of changes in toe-brachial pressure indices following percutaneous transluminal angioplasty for leg ischaemia.

OBJECTIVES: To document changes in toe-brachial pressure indices (TBPI) during the 6 months following percutaneous transluminal angioplasty (PTA) and relate these changes to restenosis. Furthermore, to ascertain the effect of administering a vasodilator, glyceryl trinitrate (GTN), immediately following PTA. DESIGN: Eighty-three technically successful PTA procedures were studied. Fifty-six were for intermittent claudication, 14 for ischaemic rest pain, and 13 for non-healing ulcers. Immediately following balloon dilatation an intra-arterial bolus of either 150 micrograms GTN, with or without a 10 mg GTN patch for 24 h, or a saline placebo was administered. TBPI were measured before and for 6 h after PTA and then at 24 h, 1 week, 1 month and 6 months. At this time, patency at the PTA site was determined by arteriography. RESULTS: There was continuing TBPI improvement over 1 month in patients given saline following PTA. In patients given GTN, peak TBPI was achieved by 1 week, and corresponded with the TBPI observed immediately following GTN administration. Restenosis occurred in 27 (33%) patients, and was significantly more frequent following the procedures for rest pain or ulceration, or where a TBPI increase of more than 0.15 by 1 week was observed. CONCLUSIONS: Haemodynamic changes following PTA continue for at least 1 month, can be modified by GTN administration, and are predictive of subsequent restenosis. Measuring the TBPI increase during the first week following PTA underestimates total improvement, and may give false reassurance with respect to recurrent disease.

Aged↗
PubMed1997

Prospective randomized trial of high-dose bolus versus low-dose tissue plasminogen activator infusion in the management of acute limb ischaemia. Thrombolysis Study Group.

INTRODUCTION: Accelerated thrombolysis with high-dose bolus tissue plasminogen activator (tPA) may enable patients with more severe acute leg ischaemia to be treated without recourse to surgery. This study was a randomized comparison of two thrombolytic regimens. METHODS: One hundred patients with acute leg ischaemia of less than 30 days' duration were randomized to receive either high-dose bolus tPA (three doses of 5 mg over 30 min, then 3.5 mg/h for up to 4 h, then 0.5-1.0 mg/h) or conventional low-dose tPA (0.5-1.0 mg/h). The groups were well matched for age, cardiovascular risk factors, duration and severity of ischaemia, site, cause and length of arterial occlusion. RESULTS: The median duration of infusion in the high-dose group was 4.0 (range 0.25-46) h compared with 20 (range 2-46) h for low-dose infusion (P < 0.0001). Successful thrombolysis was achieved in 45 of 49 high-dose and 39 of 44 low-dose infusions but significantly more adjunctive procedures were required following high-dose bolus infusion (26 versus 16 patients) (P = 0.002). Thirty days after treatment was commenced, limb salvage was achieved in 39 of 49 patients in the high-dose group compared with 37 of 44 who had a low-dose infusion of tPA. Six and two patients respectively required amputation. Four patients in the high-dose group and five in the low-dose group died. Three patients in each group suffered a major haemorrhage and one in the low-dose group had a stroke. CONCLUSION: High-dose bolus therapy significantly accelerated thrombolysis with tPA without compromising outcome. Some 50 per cent of patients were treated within 4 h enabling thrombolysis to be used as primary therapy for patients with acute critical ischaemia.

Acute Disease↗
PubMed1996

Transbrachial arteriography: indications and complications.

PURPOSE: to retrospectively evaluate brachial artery puncture at the antecubital fossa with regard to the indications for and complications arising from the procedure. PATIENTS AND METHODS: Sixty-two cumulative brachial artery punctures in fifty-three patients over a 5-year-period were retrospectively studies. RESULTS: In the majority of cases the brachial approach was utilised in order to avoid groin puncture in patients with absent femoral pulses or recent graft surgery. Occasionally it was performed as a more direct method of assessing upper limb arterial anatomy. Catheter sizes ranged from 3F to 8F. Fifty-one (82%) of the procedures were diagnostic and 11 (18%) were interventional. Glyceryl trinitrate was routinely administered. The overall incidence of complications was low (8%) and included haematoma and arterial spasm. None required surgical intervention and all resolved without permanent sequelae. CONCLUSION: Brachial artery puncture at the antecubital fossa is a suitable site of access for both diagnostic and interventional procedures. Potential limitations are the long distance from puncture site to that of intervention and damage to the brachial artery can result in upper limb ischaemia. Percutaneous brachial artery puncture at the antecubital fossa is, however, a low-risk alternative to either intravenous digital subtraction angiography or axillary artery puncture in patients in whom the femoral approach is contraindicated.

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