Investigations of the incidence and the extent of the asymptomatic early stages of extracranial arterial disease (EAD) have been restricted for methodical reasons. Direct Continuous Wave-Doppler examination has given highly accurate results in the location and correct estimation of the degree of EAD both for the carotid (97%) and the vertebral arteries (90%), as shown from a detailed comparison with carotid (n = 604) and vertebral (n = 426) angiograms. Compared with this degree of reliability, the validity of normal auscultation for the diagnosis of EAD is shown to be poor: if bruits are taken as the only signs of associated EAD in patients with systemic atherosclerosis, only 27.6% in a group of 123 patients would have been correctly diagnosed. This parallels the number of false-positives (22.6%) in patients with normal results. The frequency and degree of EAD was studied by the use of direct Doppler examination in 2009 neurologically asymptomatic patients admitted either with severe vascular (n = 375) or coronary atherosclerosis (n = 262) or with high-risk factors (n = 1370). The frequency was significantly higher (32.8%) in patients with peripheral vascular disease than in those with coronary artery disease (6.8%) and in risk-factor patients (5.9%). The combination and degree of vessel involvement are presented in detail and their possible prognostic significance discussed.

Aged↗

PubMedDate not supplied

Limits of coronary artery surgery. Clinical and postmortem findings.

In the first series of 90 continuous patients with coronary artery disease 9 patients died after aorto-coronary bypass procedures (10%). There were 7 operative deaths, and 2 postoperative deaths (respiratory failure after bronchopneumonia and bleeding duodenal ulcer; acute necrosis of the liver following hepatitis). The study of the deceased patients made evident that postoperative impairment of left ventricular function is caused by ventricular aneurysms. This fact can be shown by the poor ventricular function with an elevated left ventricular enddiastolic pressure (LVEDP) of more than 18 mm Hg. The results in patients with congestive heart failure could not be improved by multiple bypass-grafts. Probably the prolonged surgical intervention may cause additional stress to the predamaged myocardium. So, in our group the indication for using multiple grafts in cases with ventricular aneurysm is confirmed with great caution.

Autopsy↗

PubMedDate not supplied

Effects of renal artery reconstruction on kidney perfusion and tubular function measured by new radionuclide techniques.

Therapeutic effects of renal artery reconstruction on kidney perfusion and function were studied in 36 patients using new methods for analyzing radionuclide studies. Effective renal plasma flow, glomerular filtration fraction and parameters indicating perfusion and tubular transport improved significantly in patients with postoperative normalization of blood pressure. Patients with a patent renal artery on angiogram but without normalization of blood pressure showed an improvement of parameters such as effective renal plasma flow, glomerular filtration fraction and tubular transport time, whereas the perfusion index remained unchanged. In the group with re-stenosis or re-occlusion all parameters deteriorated after surgery. Discriminant analysis of preoperative data showed that success of surgery could be predicted with high degree of certainty (65% for improvement and 92% for no improvement). The results indicate, that radionuclide methods and arteriography are complementary in the evaluation of the hemodynamic consequences of a renal artery stenosis. They also help to assess the effects of reconstructive surgery and to predict operative success.

Glomerular Filtration Rate↗

PubMedDate not supplied

Subclavian-carotid transposition. Experience in 33 cases.

Thirty-three patients with a lesion of the proximal subclavian artery are treated by transposition of this endarterectomised vessel into the common carotid artery. The main advantages of this technique are the short operative time, the extra-thoracic approach, the absence of prosthetic material and the construction of an hemodynamic favorable anastomosis. There was a low morbidity and zero mortality in this series. All patients were selected by careful extensive continuous wave ultrasound Doppler examination of the extracranial arteries. Angiography is only required in case of an unclear Doppler finding, a multivessel extracranial or a peripheral arterial disease and in case of a redo-subclavian surgery. Good results of the technique can only be guaranteed if the donor arterial system is free of hemodynamically significant lesions. If not so, these lesions should be repaired first. Vertebral blood-flow is normalized in 97% of the patients (32/33 patients). Because of the excellent hemodynamic and clinical results, the subclavian artery transposition is the method of choice in the operative treatment of the proximal subclavian lesions.

Adult↗

PubMedDate not supplied

Reevaluation of surgical therapy in acute deep venous thrombosis of the lower limbs.

Surgical treatment of phlebothrombosis is not uniformly accepted. The presented results in a series of 53 patients, show nevertheless that thrombectomy and valvular destruction are no longer synonyms. Adequate "vein-respecting" technique - and severe patient selection guarantee better results than thrombolytic or heparin therapy as well in relation to patency as valvular function. Surgical therapy consists of a venous thrombectomy and a distal arterio-venous fistula. The importance of the ultra-doppler-sonography (UDS) in pre- and postoperative examinations is stressed. Forty-seven of the 53 patients had a complete repermeabilization of the venous system (90 %). Forty-four patients with complete repermeabilization could be followed-up for 1 to 3 1/2 years. Ninety-four per cent (42 patients) have an adequate valvular function reflected in a good clinical result. All normalized UDS-curves of the early postoperative period remained unchanged at repetitive postoperative controls up to 3 1/2 years and guaranteed a good clinical results. Phlebographic resolution of the thrombi doesn't mean a restored venous function, the post-thrombotic syndrome can only be avoided in case of competent venous valvular function. Any treatment of acute deep phlebothrombosis should therefore be evaluated functionally by UDS rather than by phlebography.

Acute Disease↗