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Biomedical subjects

W Hepp

Publications and source records attributed to W Hepp.

At least 19 recordsLinked to original sources
PubMed2003

Graft patency and clinical outcome of femorodistal arterial reconstruction in diabetic and non-diabetic patients: results of a multicentre comparative analysis.

OBJECTIVE: in diabetic patients with critical limb ischaemia (CLI) an inferior success rate following infrainguinal bypass surgery is quite often suggested. The aim of this retrospective analysis was, therefore, to evaluate the graft patency and, particularly, the clinical outcome at 1 year in diabetic compared with non-diabetic patients. MATERIAL AND METHODS: two hundred and eleven patients (diabetics 94; non-diabetics 117) with femorodistal reconstruction for CLI were studied. Groups were comparable with regard to the Fontaine classification, the distribution of vascular risk factors, graft material, distal anastomosis site, and the angiographic runoff grading. RESULTS: diabetes did not adversely affect graft function. For diabetics and non-diabetics primary cumulative patency rate at 1 year was found to be 66 and 56%, respectively (p=0.10) and a virtually identical limb salvage rate of 85 and 83% was achieved (p=0.76). With regard to healing of ischaemic foot ulcers a trend against diabetics was noted with a healing rate of 81% compared to 96% in non-diabetics at 1 year (p=0.067); gangrenous foot lesions could be equally remedied in 94% and in 87% among patients with and without diabetes (p=0.44). The survival rate of diabetics, however, was significantly lower with 78% at 1 year compared with 95% in non-diabetic patients (p=0.0004). CONCLUSIONS: our preliminary results support the view that infrainguinal bypass grafting can be safely done even in diabetics. Despite increased mortality in this group, liberal indication for reconstructive vascular surgery seems to be justified by favourable patency rates and clinical outcome in selected patients.

Aged↗
PubMed1996

[Perioperative evaluation of internal carotid artery stenoses: value of multislab MR angiography].

PURPOSE: Evaluation of the diagnostic potential of high resolution multislab 3D-TOF-magnetic resonance angiography (MRA) in the pre- and postoperative assessment of carotid artery stenosis in comparison to conventional angiography. METHODS: 120 Patients were evaluated with MRA and DSA prior to carotid endarterectomy (CEA). Additionally 26 patients underwent MRA after CEA. All MRA examinations were carried out on a 1.5 T MR-unit (Siemens Magnetom SP63) using a Helmholtz surface coil. For the visualization of the vascular structures in the head and neck region, flow compensated GE-sequences were employed. Both original MRA data set and MIP angiograms were included in the evaluation. The determination of the extent of stenoses was performed according to the recommendation of NASCET. RESULTS: In 195 (92.9%) of 210 cases included in the review MRA revealed the same results as DSA (grade I+II: 114, grade III: 24, grade IV: 44, grade V: 13). None of the cases showed a deviation higher than one grade. The sensitivity and specificity of hemodynamic relevant stenoses (> 60%) was 0.964 respectively 0.952. 23 out of 26 patients with postoperative follow-up examination revealed regular reperfusion of the former affected internal carotid artery. The remaining 3 patients showed a restenosis of the operated vessel (n = 2) and a reocclusion of the ICA after surgery (n = 1). MRA proofed to be an accurate and reliable method for the perioperative evaluation of vascular structures in the head and neck region. Despite of some drawbacks MRA reached a high accuracy in the diagnostic imaging before and after CEA. MRA is accurate and useful in screening carotid artery diseases. The indication of MRA employment therefore not only covers the screening of vascular structures but also includes pre- and postoperative evaluation of vascular stenoses.

Adult↗
PubMed1996

[Extracranial carotid aneurysms].

Extracranial carotid artery aneurysms occur very seldom. Here will be reported on 15 aneurysms (11 arteriosclerotic, 3 false and 1 dissecting aneurysm). Therapy of choice during the second half of this period was aneurysm exstirpation and PTFE interposition, twice with reinsertion of the external carotid artery. No patient died perioperatively, one permanent and one transient ischemic neurologic deficit occurred. Three lesions of the cranial nerves recovered completely. As to avoid cerebral embolisation each extracranial carotid artery aneurysm should be operated on if possible. This can be managed with tolerable risk and represents an effective embolic prophylaxis.

Adult↗
PubMed1995

[Multiple slab MR angiography of the A. carotis interna: a preoperative comparative study].

PURPOSE: With the introduction of MR angiography (MRA) into clinical routine, arteriosclerotic lesions of the supraaortic vessels may be well demonstrated. MATERIAL AND METHODS: The comparison between Multislab MRA (gradient echo, TOF) and X-ray angiography (XRA) as reference in 70 patients suspicious of stenotic lesions in the internal carotid artery proved the high reliability of these methods. RESULTS: In determining the degree of stenosis, according to the NASCET study (North American Symptomatic Endarterectomy Trial), a correlation between MRA and XRA of 92.3% could be calculated. The principal problem of MRA is the overestimation of high-grade stenoses; we observed 5 false-positive results in severe stenosis. Sensitivity and specificity were 95.6 and 92.6%, respectively, for detection of severe (> 60%) stenosis. CONCLUSION: Despite its limitations, MRA is a clinically important noninvasive technique for preoperative evaluation of patients undergoing carotid endarterectomy.

Adult↗
PubMed1994

[Infra-inguinal suture aneurysm].

Anastomotic aneurysms represent late complications of reconstructive surgery. They are preferably localized in the inguinal area. From 1975 to 1989 forty patients were operated for 50 infrainguinal anastomotic aneurysms (46 inguinal, 4 popliteal). They developed after a mean time interval of 60.6 months. In nine cases bilateral inguinal aneurysms occurred. Three of the inguinal aneurysms were infected. The inguinal aneurysms were usually treated by total excision followed by prosthetic graft interposition with distal anastomosis to the deep femoral artery. If the superficial femoral artery was patent, it was inserted into the interposed graft. The infected aneurysms were treated with aseptic extra-anatomic bypass procedures. Five patients died after the operation. In one case a transmetatarsal amputation had to be performed and in one case a relapsing aneurysm occurred after three years. In general surgical repair of anastomotic aneurysms following vascular reconstructions should be performed before complications occur. In the inguinal area this can be performed with low local and general risk and with good longterm results.

Adult↗
PubMed1994

[(123 I)-anti-NCA95 antibodies in diagnosis of bacterial wound infections after prosthetic vascular replacement. Comparison with computerized tomography].

Immunoscintigraphy (IS) with [123I]-anti-NCA95 labelled autologous granulocytes and computer-tomography (CT) examinations were performed in 21 patients with clinical suspicion of a vascular graft infection. The results of both IS and CT were compared with bacteriological and surgical findings. In this study the sensitivity was higher for IS compared with CT (92% and 67%, respectively). However, specificity was lower in IS compared with CT (89% and 100%, respectively). No false positive results have been found in CT. False positive results were observed in IS within 30 days after vascular surgery and may be due to a unspecific accumulation of granulocytes in perivascular hematomas. In later infection of a vascular graft (i.e. more than 30 days after surgery) no false positive findings were made by IS. In contrast, CT was false negative in two cases. IS with [125I]-anti-NCA95 labelled autologous granulocytes represents a useful tool for the detection of vascular graft infection, since granulocyte accumulation in infected tissue can be visualized with high sensitivity and specificity.

Antibodies, Monoclonal↗
PubMed1994

[Autogenous reconstruction in mycotic inguinal aneurysm--long-term result].

A ruptured mycotic aneurysm of the left femoral artery in the groin area in a 44-year-old man had to be surgically treated in 1990 by an autogenous in-situ-repair consisting of aneurysmectomy including the femoral bifurcation, autologous vein interposition using medium-term absorbable suture material, and local application of an antibiotic bonded collagen. The infection could be checked in a short time. Three years after the operation the check-up gave evidence of an excellent local result with good arterial circulation in both legs. Autogenous in-situ-repair appears to be the most efficient procedure for treatment of an arterial infection or an infected graft. Especially in the area of bifurcations (i.e. inguinal and popliteal as well) this management is preferable to the aseptic extra-anatomic bypass procedure, since only this method can preserve the orthograde perfusion of the bifurcation branches.

Adult↗
PubMed1993

[Which factors have an effect on primary and long-term results in carotid surgery].

In a 2 1/2 years period between 1.1.1984 and 30.6.1986 292 carotid endarterectomies were carried out on 235 patients. The aim of this study was to find out prognostic factors influencing early results and long term patency. Therefore we worked on 33 parameters for statistical significance. A high statistical correlation was found in three working hypotheses: 1. Higher incidence of neurological troubles when coincidence with stenosis in the rear brain arteries. 2. Shorter life expectancy if previous insults occurred. 3. Higher rate of restenosis when preoperatively high grade stenosis. A lower statistical correlation was found in the following hypotheses: 1. Older patients have more concomitant risk factors for arteriosclerosis than younger. 2. Older patients present preoperatively a more severe degree of arteriosclerosis. 3. Risk of severe insult is correlating with age. For the rest of the 33 parameters no statistical significance was found. The results are presented in detail.

Adult↗
PubMed1992

[Catheter-induced femoral artery lesions: diagnosis with B-mode ultrasound, Doppler ultrasound and color Doppler ultrasound].

A total of 44 patients were evaluated to compare the value of B-mode sonography, Doppler sonography and colour coded Doppler sonography. All patients were studied because of suspected lesions of the femoral arteries following diagnostic and/or therapeutic cardiac catheterisation. B-mode sonography was unable to reliably differentiate between haematoma and pseudo-aneurysms, a.v.-fistula or combined lesions. Colour coded Doppler sonography can better demonstrate haematoma and thrombi in pseudo-aneurysms. The neck of a pseudoaneurysm can be exactly depicted by colour coded Doppler sonography. A.v.-fistula is shown by colour coded Doppler sonography based on typical colour coding and the Doppler spectrum. Combined lesions of pseudo-aneurysm and a.v.-fistula cannot reliably be detected by colour coded Doppler sonography, duplex sonography and B-mode sonography.

Adult↗
PubMed1992

[Catheter-induced vascular lesions: a comparison of the diagnostic value of Doppler color sonography versus angiography].

One hundred and thirty-two patients with suspected lesions of the femoral arteries following diagnostic and/or therapeutic cardiac catheterisation were studied by colour Doppler sonography (CDS) and digital subtraction angiography (DSA) and the results were compared. CDS was unable to demonstrate 5 out of 23 av fistulae. Intra-arterial DSA showed all av fistulae found at operation. CDS showed lower reliability (95%) than DSA (100%) for the demonstration of pseudoaneurysms. CDS can indicate hematoma and thrombi in pseudo-aneurysms and their exact extent is better shown by sonography. Arterial dissections (2 cases) and intra-luminal thromboses or occlusions of the femoral artery (4 cases) are shown equally well by the two procedures.

Adult↗
PubMed1992

Acetazolamide stimulation test in patients with unilateral internal carotid artery obstructions using transcranial Doppler and 99mTc-HM-PAO-Spect.

Fifteen patients with symptoms of cerebral ischaemia and angiographically confirmed unilateral stenoses or occlusions of the extracranial internal carotid artery (ICA) and 20 controls were studied by a 2 MHz transcranial Doppler (TCD) at rest and after stimulation with 1 g acetazolamide i.v., a cerebral vasodilator. In addition, the patients underwent 99mTc-HM-PAO-Spect measurement of regional cerebral blood flow (rCBF) at rest and after stimulation with 1 g acetazolamide. In 10 patients with ICA stenoses greater than 80% or occlusions, time-mean velocity (Vmean) increase and pulsatility index (PI) decrease in the postobstructive middle cerebral artery (MCA) as well as the increase of the ipsilateral rCBF were reduced in comparison with the contralateral side. The remaining 5 patients showed a normal Vmean increase and PI decrease in TCD.

Acetazolamide↗
PubMed1992

[Measuring model for intraoperative determination of vascular resistance in crural vascular surgery].

The measurement of the vascular outflow resistance during reconstructive vascular operations was applied since 1989 on 45 subjects with reliable results. This measurement is an aid for decision of additional treatment increasing the outflow, like a jump- or sequential bypass or a pharmacological therapy. The principle of measurement is based on the injection of a known volume of saline in the vessel and the integration of the intravascular pressure during this injection. In the prototype used, the pressure integration was performed by means of a modified analog/digital conversion method, hereby the results could be achieved directly as numerical values. Further an automatic, microcomputer based implementation of the outflow resistance measurement, showed remarkable improvements of accuracy in laboratory tests.

Foot↗
PubMed1992

[Effect of vascular resistance on results in crural artery surgery].

Between February 1989 and June 1991 the peripheral outflow resistance was measured at 45 patients during infragenual bypass surgery. In order to find out whether there is a correlation between successful bypass grafting and measured outflow resistance, all patients were controlled regularly. There was a significant difference in mean resistance between those grafts remaining patent and those that failed. 8 out of 11 bypasses, that failed up to one month after operation, had measured peripheral resistance higher than 1.1 mmHg x min/ml. 12 out of 15 bypass grafts remained patent for more than one month and had an outflow resistance less than 0.55 mmHg x min/ml. There is no definite correlation between a measured outflow resistance from 0.55 to 1.1 mmHg x min/ml because of the low number of patients in this group. The purpose of resistance measurement during peripheral vascular surgery was to determine a final value for a decision, if additional surgical or non surgical treatment for a better runoff is necessary. In our study this value is 1.1 mmHg x min/ml. Additional treatments are the peripheral AV-fistula and a jump- or sequential-graft. Another possibility is the intra- and postoperative application of Prostaglandin, which is in an experimental study in our clinic.

Aged↗