PubMed · 9047917
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
A Kusaba. 1996. [Postphlebitic syndrome].. https://pubmed.ncbi.nlm.nih.gov/9047917/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
BACKGROUND: Some surgeons who use carotid patching favour using the saphenous vein, whilst others favour synthetic materials. OBJECTIVES: The objective of this review was to assess the effect of different materials for carotid patch angioplasty. SEARCH STRATEGY: We searched the Cochrane Stroke Group trials register, Medline (1966 to 1995), Embase (1980 to 1995) and Index to scientific and technical proceedings (1980 to 1994). We handsearched Annals of Surgery (1981 to 1995), British Journal of Surgery (1985 to 1995), European Journal of Vascular and Endovascular Surgery (1987 to 1995) and World Journal of Surgery (1978 to 1995). SELECTION CRITERIA: Randomised trials comparing one type of carotid patch with another for carotid endarterectomy. DATA COLLECTION AND ANALYSIS: One reviewer applied the inclusion criteria and extracted the data. Trial quality was assessed. MAIN RESULTS: Three trials involving 326 operations were included. The trials compared saphenous vein patches with synthetic polytetrafluroethylene patches. Allocation was not adequately concealed in two trials, and only one followed-up patients until hospital discharge. Intention-to-treat analysis was only possible for the latter trial. In all trials a patient could be randomised twice and have each carotid artery randomised to different treatment groups. One trial was excluded from the analyses of death and any stroke because it was not possible to clarify how many patients, rather than arteries, were allocated to each treatment. There were too few events to determine whether there was any difference between the patch materials for perioperative stroke, death and arterial complications. During longterm follow-up for more than one year, no difference was shown between the two types of patch for the risk of stroke, death, or arterial restenosis. However, the number of events was small. Based on 236 patients in two trials, there were significantly fewer pseudoaneurysms associated with synthetic patches (odds ratio 0.15, 95% confidence interval 0.05 to 0.44). REVIEWER'S CONCLUSIONS: There is not enough evidence to differentiate between venous and synthetic patches in carotid endarterectomy.
BACKGROUND: Carotid patch angioplasty (with either a venous or a synthetic patch) may reduce the risk of carotid artery restenosis and subsequent ischaemic stroke. OBJECTIVES: The objective of this review was to assess the effect of routine or selective carotid patch angioplasty compared to carotid endarterectomy with primary closure. SEARCH STRATEGY: We searched the Cochrane Stroke Group trials register, Medline (1966 to 1995), Embase (1980 to 1995) and Index to Scientific and Technical Proceedings (1980 to 1994). We handsearched Annals of Surgery (1981 to 1995), British Journal of Surgery (1985 to 1995), European Journal of Vascular and Endovascular Surgery (1987 to 1995) and World Journal of Surgery (1978 to 1995). SELECTION CRITERIA: Randomised trials comparing carotid patch angioplasty with primary closure in any patients undergoing carotid endarterectomy. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed eligibility, trial quality and extracted the data. MAIN RESULTS: Six trials involving 794 patients and 882 operations were included. The quality of trials was generally poor. Follow-up varied from hospital discharge to five years. Carotid patch angioplasty showed a reduction in the risk of stroke of any type, ipsilateral stroke, and stroke or death, during the perioperative period and longterm follow-up. However, data were not available from all trials, the number of events was small and there was significant loss to follow-up. Patching appeared to reduce the risk of perioperative arterial occlusion (six trials, odds ratio 0.17, 95% confidence interval 0.06 to 0.46). Patching was also associated with decreased restenosis during longterm follow-up in five trials, (odds ratio 0.32, 95% confidence interval 0.19 to 0.53). However, these results are uncertain because of loss to follow-up and the small number of events. Very few arterial complications, including haemorrhage, infection, cranial nerve palsies and pseudo-aneurysm formation were recorded with either patch or primary closure. REVIEWER'S CONCLUSIONS: Limited evidence suggests that carotid patch angioplasty may lower the risk of perioperative arterial occlusion and restenosis. It is unclear whether this reduces the risk of death or stroke.
PURPOSE: To assess differing mechanisms of thrombolysis determining time to reperfusion, completeness of thrombus dissolution, and embolic potential. MATERIALS AND METHODS: An in vitro perfusion model designed to mimic arterial flow conditions was created. Bifurcated limbs allowed continuous flow through one channel and the placement of radiolabeled (iodine-125) thrombus housed in a 5-cm segment of polytetrafluoroethylene graft in the other. The three experimental groups consisted of a standard continuous urokinase infusion, a pulsed pressurized injection of saline, and a similar injection with urokinase. A continuous infusion of 5% dextrose served as a control group. Time to reflow (as assessed with ultrasonic flow monitoring), completeness of thrombus dissolution (I-125 liberated into solution), and the number and size of embolic particles produced (detected by a series of graduated filter sizes) were analyzed. RESULTS: Time to reflow was significantly faster for both groups when pressurized injections were used (P < .001). There was no reflow in the control arm at 90 minutes. Completeness of thrombus dissolution was higher when a continuous infusion of urokinase was used in comparison to either of the power injection groups or the control (P < .05). The amount of embolic debris produced was significantly lower with a continuous infusion of urokinase compared with either of the power lysis groups (P < .05), but significantly greater than the control arm (P < .001). The size of the embolic particles in the power pulsed lysis groups was significantly decreased by the addition of urokinase (P < .05). CONCLUSIONS: Reflow is more rapidly established by the use of mechanical means. However, a less complete dissolution of thrombus in conjunction with a greater amount of embolic debris is achieved with this approach. The size of the embolic particles produced is reduced by the addition of a thrombolytic agent.