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Biomedical subjects

V M Bernhard

Publications and source records attributed to V M Bernhard.

At least 73 records · Page 4Linked to original sources
PubMed1984

Acute limb ischemia following aortic reconstruction. A preventable cause of increased mortality.

Acute limb ischemia following aortic reconstruction is primarily related to intraoperative technical errors and is associated with significantly increased mortality. Elective aortic reconstruction was performed on 262 patients between 1975 and 1981. Surgical indications were aneurysm in 84 patients (32%), occlusive disease in 125 (48%), and both of these in 53 (20%). Acute limb ischemia developed postoperatively in 27 patients (10.3%); it was noted at the conclusion of the operation in five (19%) of them and within the first 48 hours in 22 (81%). The mortality was greater in the combined aneurysm and occlusive disease group than in the aneurysm-only and occlusive disease-only groups, primarily because of an increased incidence of myocardial disease in the combined group. Postoperative limb ischemia was mainly a result of technical error and resulted in increased mortality in all groups.

Aged↗
PubMed1984

Optimal use of tolazoline in arteriography.

Intraarterial tolazoline, injected before the contrast medium in peripheral and visceral arteriography, has been shown to enhance the diagnostic value of the examination by inducing vasodilation. The time of maximal dilatation after injection, however, has not been clearly established. Photophlethysmography (PPG) was used to measure blood flow changes in 20 consecutive patients with lower-extremity arterial disease at rest and during the first 10 min after intraarterial tolazoline injection. Neither time to maximal dilatation (mean, 5.9 +/- 2.1 min) or PPG amplitude increase (mean, 251 +/- 177.2%) was significantly affected by the level of disease, severity of disease, or number of vessels present at the ankle. To make optimal use of tolazoline's vasodilatory effect, a waiting period of 6 min is recommended between tolazoline administration and contrast-medium injection in peripheral arteriography.

Arterial Occlusive Diseases↗
PubMed1984

Autotransfusion in complex abdominal aneurysms.

We have used a simple adaptation of the cardiotomy suction apparatus for autotransfusion during operation for four aortocaval fistulas and two ruptured internal iliac aneurysms. This has allowed significant blood salvage and maintenance of intraoperative hemodynamic stability. We have had no intraoperative complications and have noted no renal or pulmonary compromise postoperatively. One patient had minor coagulopathy postoperatively that was corrected with fresh frozen plasma and platelet transfusion during the first 12 hours. Autotransfusion for aortocaval fistulas and ruptured internal iliac aneurysms is safe, simple, clinically beneficial and cost effective.

Aneurysm↗
PubMed1982

Effect of increased arterial blood flow on localization and progression of atherosclerosis.

Unilateral femoral arteriovenous fistulas were constructed in New Zealand white female rabbits that were subsequently placed on a 1% cholesterol diet for two months. Experimental animals were divided into three groups: group 1 (N = 7), the fistula remained patent for two months; group 2 (N = 7), the fistula occluded after the first month of the observation period; and group 3 (N = 6), the fistula closed after the first month, but the rabbits were maintained on the cholesterol diet for a total of three months. In group 1, 59% (+/- 13%) of the surface area of the donor iliac artery had atherosclerotic lesions compared with 18% (+/- 3%) of the contralateral iliac artery. A similar distribution of atherosclerotic lesions was noted in groups 2 and 3. Increasing arterial blood flow did not have a protective effect on the donor artery but seemed to promote atherosclerosis.

Animals↗
PubMed1982

Noninvasive ankle pressure measurements by oscillometry.

Noninvasive ankle systolic, mean and diastolic pressures were obtained with an oscillometric instrument available commercially. Systolic pressures were also measured at either the posterior tibial or dorsal pedal artery by using the Doppler technique with the ultrasound probe. Ankle pressures were obtained in normal subjects and in patients with peripheral vascular disease, particularly patients with calcified or incompressible vessels or with different posterior tibial and dorsal pedal Doppler pressures. Systolic pressures by oscillometry and by Doppler were equal in normal subjects and in functionally normal limbs of patients. In the presence of mild vascular disease, systolic pressure was decreased and mean and diastolic pressures were within normal limits. Measurements by Doppler and by oscillometry were similar. In patients with moderate disease, the systolic pressure by oscillometry, although decreased, was consistently higher than Doppler pressures, and the mean ankle pressure was decreased. In patients with different posterior tibial and dorsal pedal pressures, the systolic oscillometric pressure was closer to the highest Doppler pressure measured. In contrast, in patients with partially incompressible vessels, the systolic oscillometric pressure was consistently lower than Doppler pressures. The oscillometric instrument available did not detect pressure pulses in patients with severe vascular disease; the weak pressure pulses present can, however, be detected with more sensitive instrumentation.

Journal Article↗
PubMed1982

Randomization of autogenous vein and polytetrafluorethylene grafts in femoral-distal reconstruction.

A randomized, prospective, controlled study comparing autogenous saphenous vein and polytetrafluoroethylene (PTFE) grafts in infrainguinal arterial reconstructions has been initiated in three different institutions. A total of 446 operative procedures were divided into six groups, depending on the site of distal bypass insertion into the popliteal or an infrapopliteal artery and on whether the patient received a randomized vein or PTFE graft or an obligatory PTFE graft. The randomized saphenous vein graft patency to infrapopliteal arteries was significantly better (P less than 0.005) at 2 1/2 years than the patency of randomized or obligatory PTFE grafts to the same level. No significant differences between randomized vein grafts and randomized or obligatory PTFE grafts in the femoropopliteal position could be demonstrated up to 2 1/2 years, either above or below the knee. The need for such a study and the limitations of this preliminary report are discussed. The requirement for longer observation of greater numbers of cases is stressed. A current plan for usage of the PTFE graft in the lower extremity is presented.

Adult↗
PubMed1982

Neurologic deficit following carotid endarterectomy.

Neurologic deficit immediately following carotid endarterectomy, most commonly, is the result of a technical error. Permanent neurologic deficit developed in nine patients and temporary neurologic deficit developed in seven in the early postoperative period. The cause was determined by immediate re-exploration or angiography in eight of the nine of the permanent deficit group, and a technical error was demonstrated in six. The cause of the temporary deficit was determined in four of seven patients. Emboli were the cause in three patients and coagulation abnormality was the cause in the fourth. Patients in whom deficits developed in the early postoperative period should immediately undergo exploration. If thrombosed, a thrombectomy and revision of the repair should be done and, if patent, operative angiography should be performed to identify abnormalities which should be corrected.

Brain Diseases↗
PubMed1981

Fasciotomy: an appraisal of controversial issues.

Fourty-eight fasciotomies performed for conventional indications were analyzed, focusing primarily on the reliability of clinical diagnosis and the effectiveness of the operative technique. Decompression was accomplished immediately after hospital admission or arterial repair in 27 patients and deferred until the appearance of signs and symptoms in 21 others. Myoneural degeneration occurred in the delayed group only as a result of massive trauma or when obvious signs of compartment syndrome were ignored. A high index of suspicion and careful attention to clinical findings were reliable for establishing the diagnosis and indicating the timing of myofascial decompression. Tissue-pressure measurements were not used. The technique of four-compartment fasciotomy through a single lateral incision without fibulectomy was used in 21 limbs and compared with 18 four-compartment fasciotomies utilizing conventional methods. This procedure is rapid, simple, effective, and atraumatic and provides excellent exposure for direct visualization and selective decompression of all compartments and their individual muscles.

Compartment Syndromes↗
PubMed1981

Antithrombin deficiency--a cause of unexplained thrombosis in vascular surgery.

Antithrombin deficiencies may be the reason for seemingly unexplained thrombosis and graft failure. We treated seven patients who developed clotting difficulties as a result of antithrombin II and/or III deficiencies. In four, arterial thrombosis occurred after arterial reconstruction--three with occluded femoral grafts and one with runoff and digital vessel thrombosis that developed during profundoplasty. Two patients has spontaneous thrombosis of the arterial system of the vessels of the lower leg, and one developed ileofemoral phlebitis. Three patients had abnormally low levels of both antithrombin II and III, whereas two had low levels of antithrombin II only and two had low levels of antithrombin III. Of the four patients in whom this disorder occurred during vascular reconstruction, three experienced graft occlusion that resulted in below-knee amputation in two. There were no common predisposing factors. Antithrombin deficiency should be suspected when there is an unusual propensity to develop thrombus, when heparin cannot prolong coagulation time, and when measurements show reduced levels of antithrombin. Fresh frozen plasma should be given initially and long-term Coumadin therapy started. Early recognition and treatment is necessary to avoid limb loss or death.

Adult↗
PubMed1981

Profundaplasty in perspective: limitations in the long-term management of limb ischemia.

The ultimate value of profundaplasty in the management of lower extremity ischemia was determined by multifactoral analysis of 239 operated limbs in 209 patients followed up to 110 months. In patients who underwent operation for claudication (n=83), patency without the need for subsequent revision or distal bypass was achieved in 77% at 5 years. By contrast, profundaplasty patency was maintained in only 23% of 154 limbs operated upon for salvage. The patient survival rate was 75% at 5 years and 56% at 7 years among the claudication group but only 29% at both 5 and 7 years in the limb salvage group. Of the 104 survivors in the limb salvage category, 43 required amputation, 79% within the first year, and 13 limbs were saved by additional revascularization procedures. Profundaplasty is a durable procedure for relief of claudication. However, it is significantly less effective in patients threatened with limb loss. When amputation is inevitable, effective profunda perfusion is essential for preservation of the knee joint.

Actuarial Analysis↗
PubMed1980

Profundapopliteal collateral index. A guide to successful profundaplasty.

The response to profundaplasty was evaluated in 232 limbs (163 patients) and correlated with segmental pressures and operative flow measurements. Of 150 limbs operated on for rest pain or ischemic necrosis, an inflow procedure (aortofemoral, femorofemoral, etc) combined with profundaplasty was successful in achieving limb salvage in 80 of 96 limbs (83%), but after profundaplasty alone only 26 of 54 limbs (48%) were salvaged. Using segmental pressure measurements, an index of the resistance of the profundapopliteal collateral system (PPCI) was calculated from the segmental pressure decrease across the knee, and demonstrated an inverse correlation with circulatory improvement. When profundaplasty was performed alone, successful limb salvage was associated with a mean PPCI of .18, compared with .46 in the group with unsatisfactory results. The PPCI is an accurate predictor of the hemodynamic potential of the geniculate collaterals and is useful in the selection of patients for profunda repair.

Blood Pressure↗
PubMed1980

Radiologic follow-up of vena cava filter devices.

A total of 66 vena cava filters was implanted to prevent pulmonary emboli: 33 Mobin-Uddin umbrellas and 33 Kim-Ray-Greenfield devices. Radiologic examinations were available in 59 patients, 37 having one or more follow-up studies. Most of the Mobin-Uddin umbrellas became thrombosed. Although most Kim-Ray-Greenfield devices remained patent, some migrated, and several penetrated the cava wall; this latter finding can be diagnosed on plain films. Neither of these devices is fully safe nor effective in preventing pulmonary emboli; further improvements are needed.

Filtration↗
PubMed1980

Pneumatic tourniquet as a substitute for vascular clamps in distal bypass surgery.

The pneumatic tourniquet is an effective substitute for vascular clamps in tibial and popliteal artery surgery. Intimal trauma due to clamping is avoided. Because circumferential dissection of the vessel is not necessary, the vasa vasorum are preserved minimizing ischemic injury to the vessel wall. The technique has been employed in 40 distal popliteal and tibial reconsteal and tibial reconstructions during the past year with only one complication that may possibly be related to its use. Early patency was 92% at the patient's time of discharge from the hospital. In all four patients requiring below-knee amputation, primary wound healing and successful prosthetic rehabilitation were achieved. This technique appears to be safe and simplifies distal reconstructions for lower extremity ischemia.

Arteries↗
PubMed1980

The relationship of postoperative hypertension to complications following carotid endarterectomy.

Severe postoperative hypertension following carotid endarterectomy is a serious and poorly understood clinical problem associated with an increased mortality rate and increased incidence of neurologic deficit. This complication, which is defined as a sustained elevation of systolic pressure greater than 200 mm Hg requiring pharmacologic control, occurred following 19% of 253 carotid procedures. Preoperative hypertension is the single most important determinate in the development of postoperative hypertension. The incidence of preoperative hypertension in patients who developed postoperative hypertension was 79.6% to 57.4% in patients who did not develop this complication (P < 0.01). There was a significantly increased incidence of neurologic deficit and operative mortality rate in the group who developed postoperative hypertension. There were five neurologic deficits in the group who developed postoperative hypertension, for an incidence of 10.2%. The incidence of neurologic deficit in the group who did not develop postoperative hypertension was 3.4%. The only deaths were in the postoperative hypertensive group. The hypertensive patient is at greater risk for postoperative hypertension, which is associated with increased neurologic morbidity and mortality.

Carotid Arteries↗
PubMed1979

Periorbital ultrasound findings. Hemodynamics in patients with cerebral vascular disease.

The direction of supraorbital and frontal artery flow and its response to compression of the superficial temporal, facial, and angular arteries were measured in 250 carotid arteries in 114 patients. All patients had arch and/or selective carotid arteriography. The carotid arteries were placed into the following three groups: hemodynamically normal, greater than 60% occlusion of the internal carotid artery, and total occlusion of the internal carotid artery. The test's accuracy was 94.5% in the hemodynamically normal group, 68.8% in the totally occluded group, and only 51.4% in the group with hemodynamically significant stenosis. Although the carotid Doppler examination is not reliable in detecting hemodynamically significant lesions of the internal carotid artery, it is valuable in assessing the adequacy of collateral cerebral circulation.

Carotid Artery Diseases↗
PubMed1979

White clot syndrome. Peripheral vascular complications of heparin therapy.

Heparin sodium-induced thrombosis is insidious and difficult to diagnose. If untreated, it results in death or major amputation. We have treated seven patients with thromboses resulting from platelet aggregation induced by heparin. Four patients had acute arterial ischemia of the lower extremity, venous gangrene developed in two, and one patient had an occluded autogenous vein femoral popliteal bypass in the immediate postoperative period. The platelet count was noticeably reduced in affected patients. White platelet thrombi were noted in four patients, three of whom had acute arterial occlusion. A white thrombus was the cause of immediate failure of a femoral popliteal graft. Electron microscopic examination of these thrombi demonstrated predominantly fibrin platelet aggregates with an occasional entrapped WBC and a rare RBC. All patients receiving heparin therapy must have platelet counts performed regularly. If thrombocytopenia is detected, platelet aggregation studies are indicated. When abnormal platelet aggregation is noted, heparin therapy should be reversed with protamine sulfate and the patient treated with low-molecular-weight dextran and warfarin sodium.

Aged↗