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Thomas Schachner

Publications and source records attributed to Thomas Schachner.

At least 19 recordsLinked to original sources
PubMed2006

In vivo (animal) models of vein graft disease.

Despite the very important use of arterial bypass conduits, vein grafts remain one cornerstone in coronary surgery. Newer studies show a saphenous vein graft patency of about 60% at 10 years postoperatively. This article reviews the in vivo (animal) models of vein graft disease. According to the different models, the findings on pathology of graft thrombosis, neointimal hyperplasia, and vein graft atherosclerosis are summarized. Therapeutic strategies to prevent vein graft disease (including external stenting, pharmacotherapy, and gene therapy) are reviewed.

Animals↗
PubMed2006

Risk factors of postoperative nephropathy in patients undergoing innovative CABG and intraoperative graft angiography.

INTRODUCTION: Intraoperative graft angiography is considered gold standard in quality control of innovative CABG techniques. Iodixanol, an iso-osmolar, non-ionic contrast agent has been safely applied in patients with impaired renal function. We aimed to quantify postoperative nephropathy in CABG patients undergoing intraoperative angiography and to define associated risk factors. METHODS: One hundred and thirty-five patients, aged 61 years (range: 43-83), underwent intraoperative angiography following CABG (36 robotically assisted CABG via sternotomy, 41 OPCAB and MIDCAB, 51 AHTECAB, 7 BHTECAB). In all patients iodixanol (Visipaque) was used, median amount: 150 ml (range: 20-500). Nephropathy was defined as an increase in serum creatinine concentration >or= 0.5 mg/dl compared with preoperative values. RESULTS: Nephropathy occured in 19/135 (14%) patients, and was correlated with the following variables: preoperative serum creatinine (p = 0.015, r = 0.208), age (p = 0.008, r = 0.229), postoperative peak troponin T levels (p < 0.001, r = 0.545), postoperative CK-MB peak levels (p = 0.028, r = 0.189), and presence of peripheral vascular disease (p = 0.011). No correlation was found for the contrast agent amount, diabetes mellitus, hypertension, preoperative urea level, cardiopulmonary bypass time, aortic cross clamp time, postoperative CK peak levels. Multivariate analysis showed that postoperative peak troponin T levels (p < 0.001), preoperative serum creatinine (p = 0.031), and patient age (p = 0.043) were independently associated with a postoperative increase of serum creatinine. In all 19 patients with postoperative nephropathy serum creatinine levels returned to preoperative levels. CONCLUSION: Patients with older age and elevated serum creatinine levels undergoing innovative CABG and intraoperative angiography were at increased risk of postoperative nephropathy. However, no correlation was found between the amount of contrast agent (iodixanol) applied and the nephropathy rate and none of the nephropathy cases persisted.

Adult↗
PubMed2006

Multislice computed tomography for detection of patients with aortic valve stenosis and quantification of severity.

OBJECTIVES: The purpose of this study was to evaluate whether multislice computed tomography (MSCT) provides a reliable, noninvasive imaging modality for identification of patients with degenerative aortic valve stenosis (AS) by quantifying the aortic valve area (AVA) in comparison to the accepted diagnostic standard transthoracic echocardiography (TTE). BACKGROUND: Management of patients with degenerative AS is based on the severity of disease. The severity of AS in clinical practice is assessed by TTE and classified as mild, moderate, or severe according to the AVA. METHODS: Forty-six patients were examined with contrast-enhanced, electrocardiogram-gated, 16-row MSCT for the evaluation of the diagnostic accuracy. In 30 patients, quantification of the AVA with MSCT was compared to TTE using the continuity equation with Doppler velocity-time integral for calculation of the AVA. RESULTS: Sensitivity of MSCT for the identification of patients with degenerative AS was 100%, and the specificity was 93.7%. Thirty of 46 patients had AS determined by TTE. Quantification of AVA by MSCT (mean AVA = 0.94 cm2) in patients with AS showed a good correlation to TTE (r = 0.89; p < 0.001). Bland-Altman plot illustrated good intermodality agreement between the two methods (limits of agreement, 0.20; 0.29). CONCLUSIONS: Multislice computed tomography may provide an accurate, noninvasive imaging technique for detection of patients with AS and quantification of AVA.

Aged↗
PubMed2006

Robotically assisted totally endoscopic atrial septal defect repair: insights from operative times, learning curves, and clinical outcome.

BACKGROUND: Remote access perfusion and robotics have enabled totally endoscopic closure of atrial septal defect and patent foramen ovale. The aim of this study was to address learning curve issues of totally endoscopic atrial septal defect repair on the basis of a single-center experience and to investigate whether long cardiopulmonary bypass and aortic occlusion times influence intraoperative and postoperative outcomes. METHODS: Seventeen patients (median age, 35 years; range, 16 to 55 years) underwent totally endoscopic atrial septal defect repair using remote access perfusion and robotic technology (da Vinci telemanipulation system). Learning curves were assessed by means of regression analysis with logarithmic curve fit. The effect of operative variables on clinical outcome was analyzed by linear regression using the Spearman's rho coefficient. RESULTS: No operative mortality or serious surgical complications were observed. No residual shunt was detected at intraoperative or postoperative echocardiography. Significant learning curves were noted for total operative time: y(min) = 406 - 49 ln(x) (r2 = 0.725; p = 0.002); cardiopulmonary bypass time: y(min) = 225 - 42 ln(x) (r2 = 0.699; p = 0.003); and aortic occlusion time: y(min) = 117 - 25 ln(x) (r2 = 0.517; p = 0.04), x = number of procedures. Median ventilation time, intensive care unit stay, and hospital length of stay were 7 hours (range, 2 to 19 hours), 26 hours (range, 15 to 120 hours), and 8 days (range, 5 to 14 days), respectively. No correlation was detected between cardiopulmonary bypass time and intubation time (r2 = 0.283; p = 0.326), intensive care unit stay (r2 = -0.138; p = 0.639), or total length of stay (r2 = 0.013; p = 0.962). CONCLUSIONS: Totally endoscopic atrial septal defect repair can be performed safely, and learning curves for operative times are steep. Longer cardiopulmonary bypass times had no negative impact on intraoperative and postoperative outcome.

Adolescent↗
PubMed2006

Pharmacologic inhibition of vein graft neointimal hyperplasia.

Although arterial conduits are widely used and have improved the long-term results of coronary artery bypass grafting, vein grafts remain important additional conduits in coronary surgery. Newer studies show a saphenous vein graft patency of 60% or more at 10 years postoperatively. The pathology of vein graft disease consists of thrombosis, neointimal hyperplasia, and vein graft atherosclerosis, which limit graft longevity. Therapeutic strategies to prevent vein graft disease include external stenting, pharmacotherapy, and gene therapy. The potential benefits of a pharmacologic approach are as follows: (1) Drugs with a broad clinical experience can be used; (2) side effects of systemic application can be minimized by local therapy; and (3) no vascular injury, such as pressurizing the vein for a viral transfection approach, is necessary. The different sites for pharmacotherapy in vein graft disease are reviewed in this article.

Animals↗
PubMed2006

Combined transplantation of skeletal myoblasts and angiopoietic progenitor cells reduces infarct size and apoptosis and improves cardiac function in chronic ischemic heart failure.

OBJECTIVES: Cellular cardiomyoplasty using skeletal myoblasts or angiopoietic progenitor cells offers a promising approach for the treatment of ischemic heart failure. Although several studies have shown encouraging results in acute myocardial infarction, the efficacy of cell therapy using skeletal myoblasts and angiopoietic progenitor cells in chronic ischemic heart disease remains undetermined. METHODS: Ischemic heart failure was induced by left anterior descending coronary artery ligation in nude rats: (1) Culture medium, (2) homologous skeletal myoblasts (SM), (3) human AC-133+ cells (SC), and (4) both skeletal myoblasts and AC-133+ cells (Comb) were injected in the infarct (SM) and peri-infarct area (SC) 4 weeks after infarction. Assessment of myocardial function included echocardiography 4 weeks after cell delivery. Histology was based on quantification of myocardial fibrosis, apoptosis, and capillary density. RESULTS: Left ventricular dilatation was attenuated and ejection fraction improved significantly after cell transplantation (SM: 59.4% +/- 8.8%, SC: 60.3% +/- 6.6%, Comb: 68.2% +/- 5.6% vs control: 41.5% +/- 7.4%, P = .0013). Quantification of scar tissue showed a significant reduction of infarct area in cell-treated animals (SM: 22.3% +/- 9.1%, SC: 19.8% +/- 7.6%, Comb: 13.2% +/- 5.8% vs controls: 36.5% +/- 8.2%, P = .008). Improvement of myocardial function was associated with reduced apoptotic index (SM: 3.2% +/- 0.9%, SC: 3.1% +/- 0.6%, Comb: 1.8% +/- 0.8% vs controls: 10.3% +/- 1.6%, P = .0002) and increased vascular density (SM: 5.2 +/- 1.2, SC: 8.3 +/- 1.8, Comb: 12.3 +/- 2.3, controls: 1.9 +/- 0.3, all capillary vessels/high-power field, P = .007) in animals after cellular cardiomyoplasty. CONCLUSIONS: Combined transplantation of skeletal myoblasts and angiopoietic progenitor cells results in ventricular function improvement, reduction of scar size and myocardial apoptosis, and increased neoangiogenesis in chronic ischemia. Clinical studies are warranted to prove this new therapeutic concept.

Animals↗
PubMed2006

Evaluation of ascending aortic atherosclerosis with 16-multidetector computed tomography is useful before total endoscopic coronary bypass surgery.

BACKGROUND: The purpose of this study was to investigate the assessment of ascending aortic atherosclerosis with 16-multidetector computed tomography (16-MDCT) angiography prior to total endoscopic coronary artery bypass (TECAB) surgery. METHODS: Forty-five patients were examined with electrocardiogram-gated, 16-MDCT angiography. The presence of atherosclerosis at the ascending aorta was graduated as severe (>50% of circumference) or as mild (<50% of circumference). Ascending aortic plaque composition was evaluated based on CT densities expressed as Hounsfield units (HU). TECABs using the Da Vinci telemanipulator were performed either on the arrested heart (n = 39) with an intra-aortic cardiopulmonary bypass (CPB) perfusion device or on the beating heart (n = 6) in patients with severe atherosclerosis. RESULTS: The presence of mild atherosclerosis at the ascending aorta (11/39) was associated with intra-aortic CPB perfusion device-related difficulties such as intra-aortic balloon migration (BM) or balloon rupture (P = .007) in arrested heart TECABs. The CT density of atherosclerotic plaque in patients with BM was mean 58 HU +/- 51 standard deviation (SD), suggesting noncalcifying plaque. In patients without BM, CT density of plaque was mean 526 HU +/- 306 SD corresponding to calcifying plaque (P < .001). Balloon rupture occurred in 2 patients who had calcifying plaque at the ascending aorta. CONCLUSION: Evaluation of ascending aortic atherosclerosis with 16-MDCT angiography is useful prior to TECAB surgery. Even mild atherosclerosis of the ascending aorta is associated with intraoperative difficulties regarding the remote-access perfusion system that is used for arrested heart TECAB surgery.

Aorta↗
PubMed2006

Perivascular treatment with azathioprine reduces neointimal hyperplasia in experimental vein grafts.

BACKGROUND: Azathioprine is an immunosuppressive and anti-inflammatory drug, and it has been shown to induce apoptosis in human T-lymphocytes. We investigated whether local treatment with azathioprine can inhibit neointimal hyperplasia in experimental vein grafts. METHODS: C57BL/6J mice underwent interposition of the inferior vena cava from isogenic donor mice into the common carotid artery using a cuff technique. In the treatment group azathioprine was perivascularly applied. The control group did not receive local treatment. Vein grafts were harvested at 1 and 2 weeks postoperatively and underwent morphometric analysis as well as immunohistochemical analysis for apoptosis (TUNEL). RESULTS: In grafted veins without treatment (controls), neointimal thickness was 10 microm (range, 6-29 microm), and 12 microm (range, 8-40 microm) at 1 and 2 weeks postoperatively, respectively. In azathioprine-treated grafts, the neointimal thickness was 2 microm (range, 1-5 microm) and 4 microm (range, 3-11 microm) at 1 and 2 weeks postoperatively, respectively. This reduction of neointimal thickness was significant at 1 week (P = .001) and 2 weeks (P = .016) postoperatively. Azathioprine-treated vein grafts showed an increased rate of apoptosis in the vascular wall as compared with controls (593 [range, 26-783] versus 45 [range, 0-106] apoptotic cells/mm(2) at 1 week, P = .063; and 656 [range, 327-1270] versus 19 [range, 0-79] apoptotic cells/mm(2) at 2 weeks, P = .016). CONCLUSION: We conclude that treatment of experimental vein grafts with azathioprine is associated with a reduction of neointimal hyperplasia and an increased apoptosis rate in the vascular wall. These results suggest that azathioprine may be useful for the prevention of vein graft disease after coronary artery bypass grafting.

Animals↗
PubMed2006

Diagnostic performance of MDCT for detecting aortic valve regurgitation.

OBJECTIVE: This study evaluates whether ECG-gated 16-MDCT coronary angiography provides a reliable imaging technique for detecting aortic regurgitation (AR). SUBJECTS AND METHODS: We examined 71 patients prospectively with 16-MDCT angiography using retrospective ECG gating during the mid-to-end diastolic phase. A visible central valvular leakage area was considered as a diagnostic criterion for AR. The central valvular leakage area was quantified in patients with positive transthoracic echocardiography (TTE). We compared 16-MDCT to Doppler TTE, the accepted diagnostic standard based on semiquantitative regurgitation jet analysis (grade 0-3+ for mild, moderate, and severe). RESULTS: The overall sensitivity of 16-MDCT for the identification of patients with AR was 81%. The specificity was 91%, the negative predictive value was 70%, and the positive predictive value was 95%. Of the 71 patients, 48 had AR determined by TTE, and 16-MDCT correctly detected AR in 39 of those 48 patients. The sensitivity of 16-MDCT for the detection of patients with moderate and severe AR (grade > or = 1.5+) was 95%, and the specificity was 96% (20 of 21 patients). The sensitivity of 16-MDCT for identification of patients with mild AR (grade < or = 1+) was 70%, and the specificity was 92% (19 of 27 patients). Quantification of the central valvular leakage area was not possible in 50% of cases with AR by TTE because of valve calcifications. CONCLUSION: Sixteen-MDCT coronary angiography provides an accurate, noninvasive imaging technique to detect moderate and severe aortic regurgitation (grade > or = 1.5+). However, severe valve calcifications and mild AR limit its results.

Adult↗
PubMed2005

Intramyocardial microdepot injection increases the efficacy of skeletal myoblast transplantation.

OBJECTIVE: Recent progress in the field of cellular cardiomyoplasty has opened new prospects for the treatment of ischemic heart disease and currently moves from bench to bedside. The aim of the present study was to develop a novel cell delivery technique, reducing target tissue damage and improving cell dispersion and engraftment. METHODS: In 30 male Fischer F344 rats an infarction of the left ventricle was generated by ligation of the left anterior descendent artery. Seven days after infarction, either 15 microdepots of 10 microl myoblast cell suspension (microdepot group) or culture medium (control group) were injected into the infarcted region using an automatic pressure injection device, or three depots of 50 microl myoblast cell suspension (macrodepot group) were injected using the standard surgical technique. Echocardiography was performed in all rats before and 6 weeks after cell injection. In all groups the perioperative mortality was below 20%. Six weeks after cell transplantation, a significant improvement of ejection fraction was seen in both myoblast treated groups compared to controls (macrodepot, microdepot, control; 53.7+/-11.9, 70.7+/-2.0, 39.1+/-6.4; P=0.026, P<0.001). The microdepot group showed a more decent improvement than the macrodepot group (70.7+/-2.0 vs. 53.7+/-11.9, P=0.013). In both treated groups, grafted myoblasts differentiated into multinucleated myotubes within host myocardium, however, the engraftment pattern was different and angiogenesis was enhanced in the microdepot group. CONCLUSIONS: Intramyocardial multisite pressure injection allows the safe and reliable transplantation of several myoblast microdepots into an infarcted myocardium and improves the efficacy of myoblast transplantation compared to the standard technique.

Animals↗
PubMed2005

Robotic totally endoscopic coronary artery bypass and catheter based coronary intervention in one operative session.

A 56-year-old male patient underwent robotically assisted totally endoscopic left internal mammary artery (LIMA) to left anterior descending artery (LAD) grafting. After protamine administration complete heart block developed in the patient. On intraoperative angiography the LIMA to LAD graft was perfectly patent but an acute occlusion of the right coronary artery (RCA) was noted. We performed an immediate on table percutaneous coronary angioplasty and stent placement to the RCA. The heart regained sinus rhythm and the wall motion abnormalities on the back wall of the heart resolved. No clinical symptoms indicating ongoing myocardial ischemia were noted postoperatively. This case demonstrates that a hybrid procedure of robotic totally endoscopic coronary artery bypass grafting and catheter based coronary intervention is feasible in one simultaneous session.

Angioplasty↗
PubMed2005

Rapamycin treatment is associated with an increased apoptosis rate in experimental vein grafts.

OBJECTIVE: Rapamycin is an immunosuppressive agent with marked antiproliferative properties and is effective in reducing in stent restenosis and vein graft neointimal hyperplasia. Apoptosis is one mechanism counterbalancing cellular proliferation. We therefore investigated the role of apoptosis in rapamycin treated vein grafts in a mouse model. METHODS: C57BL6J mice underwent interposition of the inferior vena cava from isogenic donor mice into the common carotid artery using a cuff technique. In the treatment group 200 microg of rapamycin were applied locally in pluronic gel. The control group did not receive local treatment. Vein grafts were harvested at 4 weeks postoperatively and underwent morphometric analysis as well as immunohistochemical analysis for apoptosis (TUNEL). RESULTS: In grafted veins without treatment (controls) neointimal thickness was 50 (12-58) microm at 4 weeks postoperatively. In 200 microg rapamycin treated grafts the neointimal thickness was 17 (5-55) microm. Rapamycin treated vein grafts showed a significantly increased rate of apoptosis in the adventitia as compared with controls (P=0.032). In the neointima the apoptosis rate was lower in both groups with no significant difference between rapamycin treated grafts and controls. CONCLUSION: We conclude that treatment of experimental vein grafts with rapamycin is associated with an increased apoptosis rate in the vascular wall and a trend towards reduction of neointimal hyperplasia. These results suggest that apoptosis may be a beneficial antiproliferative component for the treatment of vein graft disease.

Animals↗
PubMed2005

Technical problems and complications of axillary artery cannulation.

OBJECTIVE: Cardiopulmonary bypass via the axillary artery is frequently used especially in aortic dissections. With an increased use of this technique problems were recognized too. We describe the technical problems and complications associated with axillary artery cannulation. METHODS: Sixty-five patients underwent cannulation of the axillary artery. The indication for operation was acute aortic dissection type A in 57%, chronic aortic dissection in 8%, aortic aneurysm in 18%, pseudoaneurysm in 3%, and others in 14%. RESULTS: Technical problems and complications occurred in 14%, and in 11% the perfusion had to be switched to either femoral (n=5) or aortic cannulation (n=2). Arterial damage or dissection of the axillary artery or the aorta occurred in 0% of the sidegraft technique, whereas they were found in 9% with direct cannulation (P=n.s.). Cannulation problems or insufficient CPB flow due to a narrow vessel occurred in 0% of the sidegraft technique, whereas they were found in 4% with direct cannulation (P=n.s.). Malperfusion in aortic dissections occurred in 20% of the sidegraft technique, whereas they were found in 0% with direct cannulation (P=0.016). No postoperative complications related to axillary cannulation which were evaluated by clinical examination, such as brachial plexus injury, axillary artery thrombosis or local wound infection were observed. CONCLUSIONS: Although axillary artery cannulation is an attractive alternative to femoral cannulation there needs to be an alertness for technical problems. Different complications occur with either direct cannulation or the sidegraft technique and at present it remains the surgeons preference which technique for axillary artery cannulation is used.

Adult↗
PubMed2005

The influence of ascending aortic atherosclerosis on the long-term survival after CABG.

OBJECTIVE: Ascending aortic atherosclerosis is a risk factor for perioperative morbidity and mortality in coronary surgery. It was the aim of our study to determine the role of atherosclerosis of the ascending aorta and other factors for the survival rate during long-term follow-up after CABG. METHODS: From 500 out of 580 CABG patients (aged 67 (33-85) years, 77% male), who underwent intraoperative epiaortic ultrasound for assessment of ascending aortic wall thickness, a complete follow up regarding long-term survival was achieved. The median follow-up time was 55 (1-78) months. RESULTS: 53/500 (11%) patients died within the follow-up period, and the cumulative survival rate was 95, 90, and 84% after 1, 3, and 5 years, respectively (including hospital deaths). A significantly lower long-term survival was present in patients with: an age of 70 years or more (P<0.001), COPD (P=0.005), preoperative elevated serum creatinine of >1.2mg/dl (P=0.007), preoperative LVEF <40% (P=0.033), ascending aortic wall thickness of 4mm or more (P=0.001), carotid artery disease (P<0.001), peripheral vascular disease (P<0.001), and acute operation (P=0.009). Multivariate analysis revealed carotid artery disease, LVEF <40%, peripheral vascular disease, and advanced age to be independent risk factors. CONCLUSION: Patients with ascending aortic atherosclerosis are at risk for a decreased long-term survival after CABG. Besides, preoperative elevated serum creatinine, COPD, carotid artery disease, LVEF <40%, peripheral vascular disease, and advanced age are risk factors for a decreased long-term survival after CABG.

Adult↗
PubMed2005

Risk factors for late stroke after coronary artery bypass grafting.

BACKGROUND: Postoperative stroke is a severe complication immediately after coronary artery bypass grafting, and it significantly deteriorates the postoperative quality of life if it occurs in the long term. It was the aim of our study to determine factors associated with the occurrence of new strokes during long-term follow-up after coronary artery bypass grafting. METHODS: From 387 of 500 patients undergoing coronary artery bypass grafting (age, 67 years [33-84 years]; 76% male) who had intraoperative epiaortic ultrasonography for assessment of ascending aortic wall thickness, a complete follow-up regarding postoperative stroke was achieved. The median follow-up time was 52 months (9-74 months). RESULTS: A stroke occurred in 26 (7%) of 387 patients, and the cumulative freedom from stroke was 99%, 95%, and 89% after 1, 3, and 5 years, respectively. A significantly lower freedom from stroke was present in patients with an age of 70 years or more (P = .007), preoperative unstable angina (P = .031), chronic obstructive pulmonary disease (P = .009), carotid artery disease (P < .001), preoperative history of neurologic events (P < .001), and a maximum ascending aortic wall thickness of 4 mm or more (P = .010). Multivariate analysis revealed preoperative history of neurologic events (P = .021) to be an independent risk factor. CONCLUSION: Patients with ascending aortic atherosclerosis, older age (> or =70 years), preoperative unstable angina, chronic obstructive pulmonary disease, and carotid artery disease are at risk for late postoperative stroke after coronary artery bypass grafting. A history of neurologic events is of special predictive importance.

Adult↗
PubMed2005

How to handle remote access perfusion for endoscopic cardiac surgery.

INTRODUCTION: Remote access is a prerequisite for endoscopic cardiac surgery on the arrested heart. Despite careful patient selection, technical problems and complications occur with the use of this sophisticated technique, and we aim to describe these problems and suggest solutions. PATIENTS AND METHODS: From 2001 to 2004 remote access cardiopulmonary bypass (CPB) was installed in 70 patients, aged 55 (16-70) years. The operations performed were AHTECAB in 44, ASD repair via minithoracotomy in 10, totally endoscopic ASD repair in 11, and minimally invasive mitral valve operation in 5 cases. CPB time was 134 (72-342) minutes and aortic endoocclusion time was 70 (35,223) minutes. RESULTS: In 3 cases the guide wire had to be detected in the aortic root fluoroscopically because it could not be detected in the aortic root on TEE. Initial balloon migration requiring repositioning occurred in 30 cases. After achieving a stable balloon position and incision of the atrium/coronary artery balloon migration occurred in 2 cases, which could be overcome by a quick repositioning maneuver. In 1 patient no stable position of the balloon could be achieved and conversion to median sternotomy was necessary. Balloon rupture occurred in 2 cases. In one case, rupture of the balloon occurred before the endoscopic LIMA-to-LAD anastomosis was started. The cannula could be successfully replaced and the TECAB procedure finished without complications. In the second case, the balloon ruptured after finishing the LIMA-to-LAD anastomosis and no replacement of the cannula was necessary. Inadequate CPB flow was found in 1 case, and sufficient flows were achieved by an additional 15 F arterial cannula which was placed in the contralateral groin. We had no major surgical complication related to the use of the remote access perfusion device, such as aortic dissection, leg ischemia reperfusion injury, or neurological injury and no hospital death. Wound infection of the groin occurred in 1 patient, which resolved after surgical revision. Ten patients suffered temporarily from lymphatic secretion of the groin. CONCLUSION: Remote access is technically challenging, but most difficulties can be overcome if regular application by a dedicated team is guaranteed. Remote access perfusion can be performed with an acceptable risk if exclusion criteria are carefully observed.

Adolescent↗