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Biomedical subjects

W Hepp

Publications and source records attributed to W Hepp.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Acute ischemia syndrome of the lower extremity: a disease picture with unsatisfactory treatment results].

The acute ischemia of the lower extremities represents a serious threat for limb and life and needs emergency treatment. The results of surgical therapy concerning a twelve year period were demonstrated (172 lower extremities in 156 patients). There was an operative mortality of 37.8% and an amputation rate of 9.6%, 2 years survival rate was 48.3% and run up to 37.1% after 5 years. Regarding to outcome age, primary disease, preexisting arterial occlusive disease, early reocclusion and prolongation of ischemic interval have proved as limiting factor resulting in unsatisfactory early results.

Aged↗
PubMed1987

[Thrombendarterectomy in pelvic artery sections: an wrongly neglected therapeutic procedure?!].

Surgical repair was applied to the aortofemoral region in 491 cases, between 1975 and 1984, including 48.5 per cent of in situ approaches. The ratio were 2.2:1 for aortofemoral thrombendarteriectomy and 4:1 in relation to revascularised extremities. Surgical lethality, postoperative complications, and amputations following aortofemoral thrombendarteriectomy did not differ with significance from conditions in the wake of bypass procedures. Long-time functional results were good to satisfactory in 90.3 per cent of all cases and thus compared well with results obtained from bypass procedures which were of comparable quality in 89.1 per cent. Aortofemoral thrombendarteriectomy, today, is found to be a method which had certainly suffered unwarranted neglect in the past.

Amputation, Surgical↗
PubMed1986

Fragmentation of gallstones by extracorporeal shock waves.

We treated nine patients with functioning gallbladders containing one to three symptomatic radiolucent stones not larger than 25 mm in diameter, as well as five patients with stones in the common bile duct that were not removable by endoscopic procedures, by means of extracorporeally generated shock waves during general anesthesia. The patients with gallbladder stones received adjuvant treatment with a combination of ursodeoxycholic acid and chenodeoxycholic acid. All gallbladder stones were disintegrated into sludge or fragments with diameters of no more than 8 mm. In six of the nine patients the fragments disappeared completely within 1 to 25 weeks. No adverse effects were detected during a follow-up period of 10 to 34 weeks, except transient biliary pain in two patients, with mild pancreatitis in one. In four of the five patients with common-bile-duct stones, shock-wave treatment permitted stone disintegration and successful endoscopic extraction or spontaneous passage of fragments. We conclude that gallstone disease may be treated successfully and without serious adverse effects by extracorporeally generated shock waves in selected patients.

Adult↗
PubMed1986

Diagnostics of extra-cranial carotid stenoses. Comparison of CW-Doppler sonography and intravenous digital subtraction angiography.

In 98 internal carotid arteries, continuous-wave ultrasound Doppler sonography (USD) and i.v. digital subtraction angiography (DSA) of the internal carotid arteries were performed. The findings were compared with each other prospectively and on the basis of conventional angiography findings. The aim of this investigation was to clarify, whether DSA would show stenoses with lumen restriction of less than 50% more precisely than USD, or whether it would enable clearer localization of any vascular lesions. The results revealed that in cases of haemodynamic effective stenoses and occlusions both procedures correlated well with each other and also with catheter angiography. However, USD and DSA showed increasing discrepancies of findings with decreasing degree of severity of the stenosis. The accuracy for localization of stenoses also decreased markedly for both methods with increasing distance from the carotid bifurcation. In the case of congruent findings of USD and DSA in haemodynamic effective stenoses (degree of stenosis more than 75%) or occlusions conventional angiography did not increase the diagnostic information, and it seems therefore dispensable for vascular surgical decisions. However, in cases with existing clinical symptoms with contradictory or negative USD and DSA findings angiography is still indicated.

Adult↗
PubMed1986

The management of infected grafts in reconstructive vascular surgery.

Aseptic bypass graft and graft-preserving open local treatment have proved to be the 2 suitable procedures for therapy of infected grafts in vascular surgery (stage III Szilagyi) with preservation of the limb extremity. After 685 reconstructive operations (1982 to 1984) for chronic arterial occlusive disease in the supraaortic as well as in the iliac and femoral segments, 9 infections involving the graft (1.31%) occurred. These infections were more common in superficial extra-anatomical bypass. The incidence of inguinal infection was 0.44%. In 2 cases an aseptic bypass with abandonment of the infected vascular segment and in 4 cases open local treatment of the infected graft proved successful in treating the infection and led to secondary wound healing. The transplant had to be abandoned and an amputation performed in 3 patients, one of whom died. That is to say, the infection was successfully treated (with respect to the original aim of the operation) in 66.7% of cases. The aforementioned methods do not represent alternative procedures: the aseptic bypass is considered in retroperitoneal and inguinal infections, whereas the open local treatment is used in cases of superficial extra-anatomical bypass grafts and in the infrainguinal and supraaortic artery segments. The success of the latter treatment, however, depends on several preconditions. In former years, loss of the limb extremity was almost unavoidable and, because of septicemia, the outcome often lethal. By applying the above-discussed principles of management this could be drastically improved.

Adult↗
PubMed1986

[Angiomorphology of arteriosclerotic changes in the area of the carotid bifurcation].

100 intravenous digital subtraction angiograms of bifurcations were compared to one hundred plain film arteriograms. Both types of examinations were of excellent image quality. Arteriosclerotic lesions in the posterior circumference of the internal carotid artery were found in 55% plain film angiograms and in 49% of intravenous DSA examinations. Plain film angiography was significantly more accurate in the evaluation of arteriosclerotic ulcerations than i.v. DSA. The total amounts of arteriosclerotic stenoses with a smooth or rough surface were equal with both methods. The interindividual comparative study demonstrated that in respect of diagnosis of ulcerative lesions, i.v.. DSA is inferior to plain film angiography, even if an excellent image quality for all projections is achieved in i.v. DSA.

Aged↗
PubMed1985

[High recurrence rate following axillofemoral bypass: is continued use still justified?].

124 axillofemoral bypass grafts were performed in 105 high risk patients with chronic aortoiliac occlusive disease (1970-1983). Graft thrombosis occurred in 49.35% of 77 unilateral grafts, mostly as early occlusion, whereas in cases of 20 axillobifemoral bypass procedures the incidence of graft thrombosis was 35.0%. By graft thrombectomy, if necessary combined with reconstruction of the femoropopliteal artery segment, and graft exchange the patency rates could be improved in both groups. After 5 years of patency rate was 52.57% in the unilateral and 81.48% in the bifemoral group. In both groups the patency times of every second graft could be prolonged respectively for 16 and 18.8 months. On the whole considering the bifemoral procedure was superior to the unilateral. Considering the high rate of graft thrombosis and the poor long term results, esp. in cases of unilateral grafts, the initial euphoria of using the axillofemoral bypass was not justified. Therefore nowadays the indication for axillofemoral bypass is handled more strictly: high risk patient without any other possibilities to avoid amputation.

Aortic Diseases↗
PubMed1984

Traumatic occlusion of both internal carotid arteries.

Two cases of bilateral occlusion of the extracranial internal carotid artery after blunt trauma to the head and neck are presented. Sixteen similar cases have been reported in the literature, and at least 150 case reports exist on unilateral blunt trauma of carotid arteries. The 25-day post-traumatic latent interval in one of our cases is the longest to date. The diagnosis of both of our cases was established by directional cw-Dopplersonography, whereas previously the only diagnostic method available in cases with negative CT scan and latent interval was angiography. In the differential diagnosis of craniocerebral or craniocervical trauma, particularly following delay between injury and onset of neurological symptoms, Dopplersonography is a necessary test additional.

Adult↗
PubMed1984

[Transplant occlusion following aortofemoral bifurcation bypass: causes, therapeutic measures and results].

35 patients with graft thrombosis following aortobifemoral bypass grafting were analysed retrospectively (1971-1983). In 24 of these patients aortobifemoral bypass graft was performed in our own hospital and the thrombosis rate was 9.1%. 40 bypass branches and 54 graft occlusions were involved. Late occlusions were more common (75.9%), occurring after an average time interval of a little more than 5 years. Inadequate peripheral run-off with progression of the atherosclerosis was the cause in 37.5%. In 40.0% the site of occlusion was in the proximal segment of the graft, where kinking related to anastomotic technical problems played a major role. The transfemoral ring or balloon thrombectomy was successful in 45.5%. In 24.2%, however, this had to be combined with a bypass procedure (femoropopliteal or femorocrural). A change of the graft was indicated in 48.5%, but this was considered too risky in 30.3% (extraanatomic bypass: change of graft = 1.7:1). In the case of poor distal run-off a peripheral corrective procedure was a must for graft patency. In every second patient this could be achieved by profunda revascularisation. Occlusions at the central bifurcation segment are better prevented by proper anastomotic techniques. A graft with a short main trunk anastomosed to the high infrarenal aortic segment ensures a safer anastomosis and a proper position of the graft branches with little possibility of kinking. Since the routine use of this method a graft thrombosis caused by central technical problems has not been seen.

Aged↗
PubMed1984

[Diagnostic significance of intravenous digital subtraction angiography of the supra-aortic extracranial vascular system. Comparative study of i.v. DSA and plain film angiography].

Digital intravenous subtraction angiography (DSA) and conventional film angiography were used to evaluate the diagnostic reliability of DSA-examinations. In 90% of 650 DSA-angiogramms the image quality was diagnostic. For 124 carotid angiographies a comparison of both methods was possible and gave a sensitivity of 87%, a specificity of 96% and an accuracy of 90% for the DSA examinations. The authors believe that digital subtraction angiography is suitable as a screening method for supraaortal vascular occlusive diseases.

Aged↗
PubMed1983

[Value of intravenous digital subtraction angiography (DSA) for the assessment of surgical blood vessel reconstruction].

Intravenous digital subtraction angiography (DSA) was obtained in 55 cases after reconstructive procedures of the carotid arteries, the pelvic and lower limb arteries. In 48 cases (87%) the studies were of technically satisfactory or good quality. On DSA 32 vascular reconstructions were normal and 16 had typical complications like occlusions, stenoses, aneurysms and insufficient run-off. -Experience indicates that the spatial resolution of DSA is adequate for clinical purposes such as determining graft patency or the presence of postoperative complications. Because DSA is less invasive than catheter angiography, postoperative evaluation of patients having undergone peripheral surgical revascularization should start with DSA.

Aged↗
PubMed1982

[The axillofemoral bypass as an aortoiliac principle of reconstruction in high risk patients. Long term results from 1970-1979 (author's transl)].

A total of 95 consecutive high-risk patients (average age of 68.28 years) underwent 114 axillofemoral bypass operations for revascularization of 116 lower extremities (1970-1979); 84.48% were in stage III and IV. Four bypass variations were used: unilateral bypass (70.8%), crossing bypass (4.4%), bilateral procedure (10.6%) and axillobifemoral bypass (14.2%). In elective operations, the operative mortality was 6.3%; in emergency operations one of 3 patients died. The unilateral bypass including the 5 patients on whom the crossing bypass was used showed a cumulative 5-year patency rate of 51.60%; the bifemoral bypass had a rate of 77.14% and in cases of bilateral bypass no graft was patent after 5 years. Graft thrombosis was the most common complication (47.37%); successful revision was possible in only 53.75%. In case of bifemoral procedure, graft thrombosis occurred in only 29.41%. Therefore, the authors recommend that stricter indications be employed for surgery: an axillofemoral bypass operation should only be performed in cases in stage III and IV for limb salvage and only in a "real" high-risk patient. In addition, the axillobifemoral variation should also be preferred in all cases of bilateral occlusive disease with unilateral symptomatology.

Age Factors↗