Endovascular stent-grafting in the treatment of superficial femoral artery occlusive disease.

PURPOSE: To explore the feasibility of using a flexible stent-graft in the treatment of superficial femoral artery occlusive lesions. METHODS: Thirty-five patients (26 men; median age 65 years, range 41-85) with long-segment occlusions of the femoropopliteal arteries were treated with the Hemobahn endovascular prosthesis. The median occlusion length was 22 cm (range 4-40). Endografting was performed in conjunction with additional recanalization procedures as needed. RESULTS: Primary recanalization and deployment of 47 Hemobahn endografts was successful in all cases; 12 patients had 2 devices implanted. The adjunctive recanalization techniques included balloon thrombectomy (n = 28), ring-stripper disobliteration (n = 7), local thrombolysis (n = 2), mechanical rotational thrombectomy (n = 2), local thromboendarterectomy and femoral bifurcation patch angioplasty (n = 14), iliac artery stenting (n = 3), and bypass grafting (n = 2). The median ankle-brachial index rose from 0.25 preoperatively to 0.87. Over an average 7-month follow-up (range 1-18), 10 (28.6%) occlusions occurred; 6 stent-graft thromboses were treated successfully with thrombectomy only. The other 4 occlusions were permanent. Life-table analysis documented cumulative primary and secondary patency rates of 73.2% and 82.6%, respectively, at 1 year. CONCLUSIONS: Intraoperative use of the Hemobahn endograft is feasible and effective in restoring adequate distal perfusion in the short term, especially when combined with conventional recanalization techniques.

[Recanalization of extensive arterial occlusion in the thigh using an endovascular PTFE stent graft (Gore Hemobahn) as an alternative to a femoropopliteal P1 bypass]. / Rekanalisation langstreckiger Oberschenkelarterien-Obliteration mittels endovasculärer PTFE-Stentprothese (Typ gore Hemobahn). Eine Alternative zum femoropoplitealen P1-Bypass.

A few months ago an endovascular implantable PTFE stent graft became commercially available. Since May 1998 we have treated 15 patients with extensive vascular occlusion at the femoropopliteal level. The implantation is carried out via a single inguinal approach in combination with conventional vascular surgical techniques like orthograde ringstripping of the superficial femoral artery, local TEA and patch-grafting of the femoral bifurcation, angioplasty, local lysis, etc. The self-expanding thin-walled PTFE stent prothesis appears to be a viable alternative to the femoropopliteal P1 bypass and can be performed under local anesthesia, percutaneously or through a small inguinal incision. The implantation can be carried out with minimal tissue trauma.

[Laparoscopic therapy of mechanical or adhesion ileus of the small intestine--preliminary results]. / Laparoskopische Therapie des Briden- oder Adhäsionsileus des Dünndarms--vorläufige Ergebnisse.

Small bowel ileus is often caused by adhesions and might be treated by laparoscopic adhesiolysis. Therefore we tried to select those cases of ileus by anamnesis, clinical investigation, sonography and X-ray scan. 25 out of 74 patients with small bowel ileus were supposed to have ileus caused by adhesions and were further diagnosed by laparoscopy: 15 patients were operated laparoscopically, 5 were operated conventionally after diagnostic laparoscopy and 3 converted into open operation after laparoscopic start (conversion rate 12%). 2 patients showed ileus due to gastrointestinal infection without necessity of operation. Out of 49 (66.2%) ileus-patients operated conventionally 5 might have been operated laparoscopically. Thus, 15 of our patients with ileus of the small bowel (20.3%) were treated laparoscopically. Based on these results we suppose that following a proper selection about 25% of small bowel ileus can be treated adequately by laparoscopic adhesiolysis.

[Laparoscopic therapy for internal hernias. Presentation of three cases]. / Möglichkeiten der laparoskopischen Therapie innerer Hernien. Darstellung an drei Fällen.

Internal abdominal hernias are rare and often are first seen when causing ileus. Three different internal hernias were operated on laparoscopically: a patient with a hernia duodeno-jejunalis causing recurrent pain in the upper bowel, vomitus and ileus; two patients with an intersigmoidal hernia and pelvic hernia causing ileus without prodroma. Each case was operated on laparoscopically during or short after ileus. In all cases the hernia could be assured and treated by retracting the gut into the abdominal cavity and either wide opening of the hernia's entrance or closing it by suture. It is concluded that internal hernias can be diagnosed and treated laparoscopically as well as in conventional operation techniques.

[Hypogangliosis of the sigmoid colon: possibilities of sonographic diagnosis]. / Hypoganglionäre Sigmaveränderungen: Möglichkeiten sonographischer Diagnostik.

This case report concerns a 53-year old woman suffering from recurrent spastic pain and a painful "resistance" in the left lower bowel for the last 30 years. Earlier clinical investigations including endoscopy and laparoscopy did not yield any results. In a recent investigation, only sonography showed wall thickening and an echo-poor wall pattern of the sigmoid colon indicating this to be the site of painful resistance. Resection of the sigmoid colon was performed. Histologically a slight hypogangliosis of the colon and muscular hypertrophy were detected (as the only pathological signs). The patient was free from symptoms since operation. This case report proves that ultrasound may yield pointers (or confirm the diagnosis) in unclear abdominal diseases.