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W D Roth

Publications and source records attributed to W D Roth.

15 recordsLinked to original sources
PubMed2005

Infra-inguinal percutaneous transluminal angioplasty for limb salvage: a retrospective analysis in a single center.

PURPOSE: To review the feasibility of infra-inguinal angioplasty in the management of critical limb ischemia (CLI). MATERIAL AND METHODS: Data on 221 patients with 230 critically ischemic limbs, treated with consecutive percutaneous transluminal angioplasty (PTA) at Helsinki University Central Hospital between January 2000 and December 2002 were collected and analyzed retrospectively. Patency, limb salvage, and survival rates were calculated on an intention-to-treat basis. Comparisons were done with univariate (Kaplan-Meier) and multivariate analysis (Cox regression). RESULTS: Overall primary patency, secondary patency, limb salvage, and survival rates were 47%, 59%, 92%, and 76%, respectively, at 12 months. In the multivariate analysis, low toe pressure (< or =30 mmHg) was a significant risk factor for poor patency. Uremia with hemodialysis, low toe pressure (< or =30 mmHg), and hemodynamic failure of the endovascular procedure were found to increase significantly the risk of amputation. Uremia with hemodialysis, coronary artery disease, tissue loss as indication for PTA (Fontaine stage IV), and age over 70 years were all found to increase significantly the risk of death. CONCLUSION: Infra-inguinal PTA is feasible in patients with CLI and resulted in good limb salvage.

Adult↗
PubMed2005

Early elective conversion for failing EVAR.

BACKGROUND: The aim of the study was to assess the long term results of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms at the Helsinki University Central Hospital 1996-2004 with a special emphasis on elective conversion procedures and their outcome. METHODS: Treatment results and follow-up data of all 110 elective EVAR procedures performed in our institution were gathered prospectively and evaluated. RESULTS: Conversion to open surgery was performed in 23 (21%) of 110 EVAR patients. 30-day mortality after elective stent-graft deployment was 0% as it was also on elective conversions (n = 20). Secondary elective conversions were performed due to infection in two and after failing stent-graft treatment in 12 patients. Six of the conversions were performed primarily. Three urgent conversions (3% overall) were performed: two of these patients died, corresponding to an overall mortality of 9% (2/23) in all conversions. Five-year aneurysm-related mortality after EVAR among patients with elective conversion was 0% and 19% in patients with secondary procedures other than elective conversions. CONCLUSIONS: As conversions seem to be hazardous only when performed in urgent situations, elective conversion could be an alternative treatment method in complex failing first-generation stent-grafts as it may reduce mortality associated with urgent conversions or repeated attempts to maintain graft integrity with endovascular procedures.

Aged↗
PubMed2002

Endovascular treatment of aortic aneurysms in Finland: the first four years' experience.

BACKGROUND AND AIMS: In this study the results of endovascular treatment of aortic aneurysms in Finland are presented and compared to the results of the Eurostar registry. MATERIAL AND METHODS: A total of 229 patients with aortic aneurysm were treated in five different Finnish centres during 1996-2000. The data of these patients were collected prospectively by surgeon or interventional radiologist involved. During the same period of time 2464 patients were registered in the Eurostar registry. RESULTS: The procedure was performed successfully in 97% of patients in Finland, and the 30-day mortality was 0,9%. A graft limb thrombosis was detected in 9% of the patients in Finland. A permanent primary endoleak at the first 30-day control was seen in 23 patients (10%). During the follow-up 17 secondary endoleaks (7%) were detected. A secondary intervention was necessary in 26% of the patients. Three patients (1.3%) had late rupture of the abdominal aortic aneurysm. CONCLUSIONS: According to the Finnish short-time results, endovascular treatment of aortic aneurysms is safe and associated with relatively low morbidity and mortality. The mid-term results are more disappointing with relatively many graft thromboses and endoleaks, and a frequent need of secondary interventions.

Adult↗
PubMed2001

Transfer function index of pulse volume recordings: a new method for vein graft surveillance.

OBJECTIVE: Color flow duplex scanning is currently the best method available for vein graft surveillance. However, it puts a considerable strain on the workload of a vascular unit and requires a highly trained operator. The aim of this study was to develop and validate a new, noninvasive tool for graft surveillance. The utility of transfer function index (TFI) of pulse volume recordings is tested for this purpose. METHODS: The design of the study was a blind comparative study that involved 70 testing procedures that were performed on 58 different infrainguinal vein bypass grafts. The TFI was measured with a portable vascular laboratory multi-cuff unit. Ankle/brachial indexes were obtained with the same device. Color flow duplex scanning was used as a diagnostic standard. A graft was defined as at risk, according to duplex scanning, if a local stenosis with a V2/V1 more than 2 was found or if peak systolic velocity remained less than 45 cm/s throughout the graft. The repeatability of the method was tested on 30 grafts. RESULTS: A total of 63 tests were available for analysis. Seven tests were excluded. Four were excluded because they had unreliable TFI measurement due to cardiac arrhythmias, and in three tests, the whole graft could not be visualized in the duplex scan. Forty normal and 22 at-risk grafts were found. One graft was occluded. The TFI was significantly lower for at-risk grafts (0.89) versus normal grafts (1.09; P =.005). A TFI of 1.02 or less correctly detected 21 of 22 at-risk grafts. The sensitivity, specificity, and accuracy were 96%, 65%, and 76%, respectively. The ability of the ankle/brachial index to detect the at-risk grafts was clearly inferior to the TFI. The repeatability of the method at proximal thigh, distal thigh, and proximal calf was +/- 0.21, +/- 0.07, and +/- 0.14, respectively. CONCLUSION: The TFI is a sensitive and reliable method to detect an at-risk graft. The examination is noninvasive, simple, quick to perform, and well tolerated by the patients. We suggest that the TFI could be the first-line screening method in vein graft surveillance.

Blood Volume↗
PubMed2001

Preliminary results with endoluminal femoropopliteal thrupass.

BACKGROUND AND AIMS: Results of endovascular procedures to the superficial femoral artery and popliteal artery are not as good as at the iliac level. The purpose of this study is to evaluate the long-term results of a new endoluminal stent-graft for the management of lesions of the femoropopliteal segment. MATERIAL AND METHODS: Fifteen patients underwent endoluminal treatment of femoropopliteal lesions with a PTFE covered stent-graft. Nine patients had critical leg ischaemia, two patients had acute leg ischaemia, two patients were claudicants, one patient had a ruptured popliteal artery aneurysm, and one had a large adjuvant therapeutic arteriovenous fistula. RESULTS: The procedure was successfully carried out in all patients. Thrombosis occurred in two stent-grafts 4.5 months and 12.5 months after the procedure. One of them was successfully thrombolysed. During the two-year follow-up, a haemodynamically significant decrease in ankle/brachial index was observed in two patients. Ankle/brachial index was the same or higher than the immediately postoperative value in six patients. Primary patency rates at 1 month, 1 year and 2 year follow-up were 100%, 93% and 84%, respectively. Assisted primary patency rates at the same intervals were 100%, 93% and 93%, respectively. No patient had limb loss during the follow-up period. CONCLUSIONS: Endoluminal femoropopliteal bypass using PTFE covered stent-graft can be successfully performed with good two-year results.

Aged↗
PubMed2000

Interobserver agreement in duplex scanning for vein grafts.

BACKGROUND: although the precision of duplex scanning is of utmost importance in vein-graft surveillance, it has not been properly assessed. This study aims to analyse interobserver agreement on duplex scanning. METHODS: a blinded comparative trial of 69 infrainguinal vein bypass reconstructions. Two consecutive duplex scans were performed by different examiners and duplex ultrasound machines on the same patient. The duplex examinations were also compared with angiography, when available, and clinical follow-up. RESULTS: interobserver agreement in Kappa statistics was 0.69, signifying "good" agreement between the examinations in detecting haemodynamically significant changes in the grafts. The sensitivity, specificity and accuracy figures compared with a combination of angiography and follow-up data for the two scans were 80%, 91%, 88% and 85%, 93%, 91%, respectively. The limits of agreement were, however, wide for Doppler-derived velocity characteristics. CONCLUSION: duplex scanning is an accurate and reproducible method for detecting haemodynamically significant changes in infrainguinal vein grafts.

Arterial Occlusive Diseases↗
PubMed2000

Preoperative angiographic score and intraoperative flow as predictors of the mid-term patency of infrapopliteal bypass grafts.

OBJECTIVES: preoperative angiographic characteristics of the outflow tract have emerged as a predictive factor for the outcome of infrapopliteal reconstructions. Direct flow measurement can be routinely performed intraoperatively, but little is known regarding its impact on graft outcome. The present study was undertaken to compare the value of these parameters in predicting the mid-term patency of infrapopliteal bypass grafts. DESIGN: retrospective clinical study. PATIENTS: 172 infrapopliteal reconstructions using autogenous vein were performed, of which 92 had a crural and 80 a pedal recipient artery. METHODS: the preoperative angiogram was scored according to the SVS/ISCVS Ad Hoc Committee. At the end of the operation flow was measured with a transit-time flowmeter. Follow-up consisted of pressure measurements and duplex scanning. RESULTS: the runoff score had no impact on femorocrural graft patency. For pedal grafts there was a tendency for inferior outcome with high runoff score, as the 1-year assisted primary patency for grafts with a completely occluded pedal arch was 11% compared with 52% for grafts with lower scores (p=0.056). Both intraoperative volume graft flow and maximum flow capacity had a highly significant influence on the outcome on crural reconstructions on univariate analysis. For pedal reconstructions only a a severely reduced maximum flow capacity after injection of papaverin was associated with an adverse outcome. Multivariate analysis revealed that maximum flow capacity was an independent significant factor affecting patency of femoroinfrapopliteal grafts (relative risk=0.53 per 30 ml/min increase, p<0.001). The runoff score was also a weak independent predictor of 1-year assisted primary patency in these grafts (relative risk=1.9 for a score >4 in crural and a score >5.5 in pedal grafts, p=0.036). CONCLUSIONS: a completely occluded pedal arch in preoperative angiography was associated with poor infrapopliteal bypass outcome. Graft flow and maximal flow capacity are good predictors of the 1-year graft patency of femorocrural bypasses.

Adult↗
PubMed2000

Successful percutaneous endovascular treatment of a ruptured popliteal artery aneurysm.

A rupture of the popliteal artery is a rare but dangerous complication of aneurysmal disease. It accounts for 4% of all popliteal artery aneurysms encountered and threatens the loss of the extremity and, infrequently, is also life-threatening.(1) when this clinical entity is confronted, a prompt operative intervention is indispensable for increasing the chances of limb salvage. We report the first, to our knowledge, successful endovascular treatment of a ruptured popliteal artery aneurysm with a new polytetrafluoroethylene stent-graft in a patient who was unfit for a conventional surgical approach because of his severe pulmonary disease.

Alloys↗
PubMed1999

Automated stereotactic core needle biopsy of microcalcifications with correlation to surgical biopsy.

PURPOSE: To compare pathologic findings from stereotactic core and excisional biopsies in patients with microcalcifications in the breast. MATERIAL AND METHODS: Stereotactic core needle biopsies of 101 lesions with mammographic evidence of microcalcifications were performed with long-throw (2.2 cm) automated core biopsy devices fitted with 2.1-mm needles. The core specimens were placed on microscope slides and radiographed. The pathologic features of core and excisional specimens were compared. RESULTS: In 100 of the 101 breast lesions, a correct choice for an additional diagnostic procedure or definitive treatment could have been made upon histopathologic findings of the core needle biopsy. CONCLUSION: Stereotactic core needle biopsy is a reliable alternative to surgical biopsy of breast lesions with microcalcifications provided that specimen radiography has been performed to ensure that appropriate tissue has been obtained. Excisional biopsy may be avoided if microcalcifications are visible in radiographs of core biopsy specimen with benign histology.

Biopsy, Needle↗