[False aneurysm of the popliteal artery after implantation of an alloplastic bypass: surgical treatment]. / Die chirurgische Behandlung des Aneurysma spurium der poplitealen Anastomose nach femoro-poplitealem Prothesenbypass.

The false aneurysm of the popliteal artery is a rare complication in bypass surgery after the implantation of an alloplastic prosthesis. We saw this complication in 0.7 % of our patients. We report on 6 cases successfully treated by surgery. The false aneurysm developed within 2 weeks up to 44 months following the operation. We describe the symptoms, the details of diagnosis and of surgical treatment. In most cases the false aneurysm is symptomatic and should be operated immediately.

[Revascularization of the profunda femoris artery in ischemia of the stump after above knee amputation]. / Profundarevaskularisation bei Stumpfischämie nach Oberschenkelamputation.

We describe a severe complication after above knee amputation: persisting ischemia of the stump, and its treatment by vascular surgery. Only 4 (2.3%) of 168 above knee amputations performed in our department between June 1985 and September 1999 were followed by ischemia of the stump non responding to conservative treatment. We decided on subsequent revascularization of the ipsilateral deep femoral artery. A femorofemoral bypass graft was successfully implanted. A reamputation or an exarticulation of the hip joint could be avoided. We call special attention to the importance of the deep femoral artery.

[Spontaneous complete rupture of a thrombotic aneurysm of the tibiofibular trunk]. / Spontaner kompletter Durchriss eines thrombosierten Aneurysmas des Truncus tibiofibularis.

True arterial aneurysms of the infrapopliteal vessels are a rare finding. During surgical treatment of convergent aneurysms of the popliteal artery and the tibiofibular trunk we discovered a complete spontaneous rupture of the thrombotic aneurysm of the right tibiofibular trunk. We describe the special features of diagnosis, histology, and the surgical treatment of aneurysms of the crural arteries. We recommend that even asymptomatic aneurysms be electively operated on to prevent further complications.

[Late results after below-knee revascularization of the popliteal artery with thin-wall InterGard vascular prosthesis]. / Spätergebnisse nach infragenualer Revaskularisation der Arteria poplitea mit der dünnwandigen InterGard-Gefässprothese.

We report on our clinical experience with a knitted Dacron prosthesis: thin-walled, spirally reinforced InterGard prosthesis. Between 1993 and 1996, 81 prostheses were implanted in 72 patients with an infrainguinal connection. We describe the special features of the prosthesis. The entire group of patients was analyzed. Indications for operation were disabling claudication in 42 cases (51.8%) and critical limb ischemia in 39 (48.0%) cases. The angiographic run-off was poor in 71 (87.9%) implantations. The perioperative mortality rate was 1.2% (1 patient). The primary cumulative patency rate calculated by the life-table method was 70% at 69 months. Our results suggest that PTFE offers no clear advantage over Dacron and the preferential use of PTFE needs to be reassessed.

[Clinical experience with a new antimicrobially coated InterGard-IgK/AM vascular prosthesis in surgical treatment of deep wound infection with involvement of the synthetic bypass: report of 2 cases]. / Unsere klinische Erfahrung mit der neuen antimikrobiell beschichteten InterGard-IGK/AM-Gefässprothese bei der chirurgischen Behandlung des tiefen Wundinfektes mit Beteiligung des Kunststoff-Bypasses: Bericht über 2 Fälle.

We report 2 cases of infected vascular prosthesis, where the infected alloplastic material was removed and the revascularisation of the lower extremity was done by implantation of the new antimicrobial surface-coated InterGard prosthesis in the area of the former infected graft. An extra-anatomical bypass was not promising in these cases. Clinical, bacteriological and granulocyte-scintigraphic examinations have provided no evidence for persisting infection 12 and 11 months after implantation of this prosthesis. We are aware that the postoperative observation periods are too short to allow definitive assessment. Nevertheless we still consider that this prosthesis means a new and promising option in the treatment of infected vascular graft.

[Acute rupture of an aneurysm of the popliteal artery: case report]. / Akute Ruptur eines Aneurysmas der Arteria poplitea: Fallbericht.

A case of acute rupture of an atherosclerotic popliteal aneurysm is reported. The popliteal aneurysm was partially resected and revascularisation of the leg was successfully performed by implantation of an e-PTFE-prosthesis. The postoperative course was uneventful and the patient remained asymptomatic two years later. The peculiarities of the diagnosis and the surgical treatment of the acute rupture of a popliteal aneurysm are reported. We think that in the management of the popliteal aneurysm a prophylactic surgical repair is the treatment of choice.

[Relevance of heparin-induced type II thrombocytopenia in surgery: report of 3 cases]. / Die Relevanz der heparininduzierten Thrombozytopenie (HIT) Typ II in der Chirurgie: Bericht über 3 Fälle.

Heparin-induced thrombocytopenia (HIT) is a frequent type of drug induced thrombocytopenia. The clinically benign type I has to be distinguished from the life threatening type II due to the risk of thromboembolic complications. Three cases of type II HIT with acute thrombosis of the pelvic and lower extremity arteries and successful surgical treatment are reported. The majority of cases of an imminent type II HIT can be recognized in time by monitoring platelet count. The laboratory tests relevant to diagnosis are discussed. An immediate stop of the heparin therapy represents the causal treatment of type II HIT. As an alternative, anticoagulants may be used.

[Patch enlargement of the aortic valve ring. Description of a new operation method. An experimental and clinical study]. / Erweiterungsplastik des Aortenklappen--Ringes. Beschreibung einer neuen Operationsmethode. Eine experimentelle und klinische Studie.

This communication describes a new surgical procedure of enlarging the narrow aortic valve ring by extending the aortic incision through the fibrous origin of the aortic leaflet of the mitral valve into this leaflet. A fusiform patch is sutured to the V-shaped defect in the aortic leaflet of the mitral valve and in the aortic annulus. This procedure permits the enlargement of the hypoplastic aortic valve ring of more than 20 mm and the replacement of the aortic valve by a suitable prosthesis. The operative technique is described, experimental and clinical results are reported.

Patch enlargement of the aortic and the mitral valve rings with aortic-mitral double-valve replacement.

In 1 patient, patch enlargement of the aortic valve ring was accomplished by extending the aortic incision into the anterior mitral leaflet. The pericardial patch broke from the aortic leaflet of the mitral valve on the fourth postoperative day. The resultant acute mitral incompetence necessitated mitral valve replacement also. An aortic-mitral double-valve replacement with attendent enlargement of both the aortic and mitral valve rings ensued. To our knowledge, enlargement of the aortic and mitral valve rings with aortic-mitral double-valve replacement has not been described in the literature.

Patch enlargement of the aortic and mitral valve rings with aortic and mitral double valve replacement. Experimental study.

The experimental results of patch enlargement of the aortic and mitral valve rings with aortic and mitral double valve replacement are reported. The operative technique of this new surgical method is described and the indications are discussed.

Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique.

This communication describes a new surgical procedure of enlarging the narrow aortic valve ring by extending the aortic incision through the fibrous origin of the aortic leaflet of the mitral valve into this leaflet. A fusiform patch is sutured to the V-shaped defect in the aortic leaflet of the mitral valve and in the aortic anulus. This procedure permits the replacement of the aortic valve by a suitable prosthesis. Between June of 1976 and February of 1978, eight patients underwent this surgical procedure. At the time of operation the patients were between 8 and 50 years old. The estimated enlargement of the aortic root ranged from 10 to 25 mm. The operative technique is described, peculiarities of this method are discussed, and the results are reported. Six to 27 months following operation, the clinical condition of six patients is good. Four patients show no impairment of mitral valve function. In one case, preoperatively diagnosed mitral incompetence persists. In another patient the pericardial patch broke from the aortic leaflet of the mitral valve, so that the valve had to be replaced on the fourth postoperative day. One patient died of myocardial necrosis because of insufficient myocardial protection during operation. One child with acute aortic insufficiency caused by staphylococcal endocarditis and congestive heart failure died of septicemia 3 months postoperatively. Mitral incompetence was not detectable in this child.

[Corrected transposition of the great arteries: surgical treatment of associated cardiac defects (author's transl)]. / Korrigierte Transposition der grossen Arterien: Chirurgische Behandlung von begleitenden Herzmissbildungen.

Corrected transposition of the great arteries is often associated with other cardiac anomalies. We report our experience with the correction of the associated cardiac defects in 13 cases: ventricular septal defect with pulmonary hypertension (5 cases), ventricular septal defect with obstruction of pulmonary outflow tract (5 cases), obstruction of pulmonary outflow tract (2 cases), ostium primum defect (1 case). The possible surgical approaches for repair of the cardiac anomalies are described and the results of the operative correction are communicated. Precise diagnosis, the knowledge of the unusual disposition of the conducting tissues and new surgical approaches are prerequisite for successful correction.

[Surgical considerations on levo-atrial systemic vein (author's transl)]. / Zur Chirurgie der laevo-atrialen Systemvene

The levo-atrial systemic vein is a special type of persistent left superior vena cava and is associated with other intracardiac lesions most often. Hemodynamically there is a right to left shunt. The operative procedure may consist in a ligature in relation to the anatomic situation. The intraatrial correction intends a drainage to the right atrium. Of 7 cases four times a intracardiac rerouting was achieved but two times a ligation was performed.

[A new method for patch enlargement of hypoplastic aortic annulus. An experimental study (author's transl)]. / Erweiterungsplastik des hypoplastischen Aortenklappenringes: Beschreibung einer neuen Operationsmethode. Eine experimentelle studie

The purpose of this communication is to propose a new surgical procedure to enlarge the hypoplastic aortic valve ring of more than 20 mm and to permit the replacement of the aortic valve with a suitable prosthesis. The aortic incision is extended about 20 mm across the fibrous origin of the mitral ring downwards into the aortic leaflet of the mitral valve. A fusiform Dacron patch was sutured to the defect in the aortic leaflet of the mitral valve with running suture lines. In acute experiments mitral valve abnormalities are excluded by hemodynamic data, angiocardiography and echocardiography.

[Ventricular septal defect associated with fibrous subvalvular aortic stenosis: problems in the diagnosis and in the surgical management (author's transl)]. / Ventrikelseptumdefekt mit fibröser subvalvulärer Aortenstenose: Probleme der Diagnostik und der chirurgischen Behandlung

Only 9 of more than 900 operated patients with ventricular septal defects suffered from this rare combination. The problems of the diagnosis are discussed. Only in one case this diagnosis was made praeoperatively, in 6 cases intraoperatively and in two cases only postoperatively. In the last two cases a reoperation was necessary. The surgical methods are described and the results of surgery are communicated.

[Early postoperative diagnostic management by arterial-reobstruction after vascular operations using the ultrasonic flowmeter (author's transl)]. / Frühdiagnose arterieller Verschlüsse nach Gefässeingriffen mit dem Doppler-Ultraschall-Gerät

The Doppler ultrasonic method can confirm the success of the operation in the early post-operative phase after reconstructive vascular operations as an essential non-invasive technique or clear a doubtful improvement of the blood flow. Thus an arteriography can be indicated in good time. On the basis of reconstructive cases the usefulness and the advantageous application of the Doppler ultrasonic flowmeter in the operating theater is demonstrated.

[Interruption of the aortic arch with tetralogy of Fallot. Report of a successful one-stage correction of both anomalies, and review of the literature (author's transl)]. / Unterbrechung des Aortenbogens mit Fallot'scher tetralogie (Bericht über eine einzeitige erfolgreiche Korrektur beider Missbildungen. Zugleich eine Literaturübersicht)

In a ten year old girl, a combination of interruption of the aortic arch (IAA) and tetralogy of Fallot was corrected simultaneously using cardiopulmonary bypass. The interruption was bypassed by implantation of the proximal end of the left subclavian artery into the ascending aorta. The simultaneous correction of both malformations was possible by a left anterolateral transsternal thoracotomy. The success of this operation was confirmed by cardiac cathetherization and angiography. As far as we know this the first report of a successful simultaneous correction of this unusual combination of cardiac malformations.