Analysis of 274 Omniflow Vascular Prostheses implanted over an eight-year period.

BACKGROUND: Polytetrafluoroethylene (PTFE), dacron, and, more recently, collagen prostheses are finding increasing use for femoropopliteal reconstruction when a suitable vein is not available. The main factors to be considered when choosing a prosthesis are patency, susceptibility to infection and formation of aneurysms. METHODS: Sheep collagen prostheses were implanted on 274 occasions in the femoropopliteal or crural regions. RESULTS: The patency rate for supragenual bypass after 3 years was 61.9% with good vascular periphery and 44% with poor vascular periphery. If the prosthesis extended below the knee, the patency rate was 55.4% with good and 35.3% with unfavourable vascular periphery. Patency for the femorocrural bypass was 28.7% after 2 years. The rate of infection was 0% and an aneurysm occurred in three patients (1.1%). CONCLUSIONS: With this low infection rate and very slight danger of aneurysm, the long-term results suggest that the ovine collagen prosthesis can be recommended for use when no suitable vein is available.

Posttraumatic extracranial aneurysm of the internal carotid artery: combined endovascular treatment with coils and stents.

We report a case of a posttraumatic extracranial pseudoaneurysm of the internal carotid artery that was treated successfully via embolization with Guglielmi detachable coils and placement of a Wallstent after surgical repair failed.

[Femoropopliteal vascular replacement: vein, ePTFE or ovine collagen?]. / Zur Problematik des femoropoplitealen Gefässersatzes: Vene, ePTFE oder ovines Kollagen?

In an eight year-period from 1988 to 1995 653 femoropopliteal and femorocrural bypasses were performed. 347 above-knee reconstructions 206 below-knee reconstructions and at last 100 femorocrural bypasses were analysed. The cumulative patency rate after a follow up of three years for above-knee vein bypasses was 90%, patency rate for PTFE grafts in the same period was 52%, for ovine collagen grafts 56%. For below-knee bypasses with autologous saphenous vein a function rate of 76% could be observed in the same period, the rate of PTFE grafts in this position was only 30%. In this position 3-year patency rates of 50% were achieved with ovine collagen grafts. This difference was statistically significant. Three years cumulative patency rate for femorocrural reconstructions with greater saphenous vein was 72%, the function rate for PTFE in this position was below 30% after a follow up of one year, with ovine grafts below 40%. Graft infection, aneurysm formation and postoperative mortality were low in all groups. Our data demonstrate, that patency rates of autologous vein bypasses could not be achieved with PTFE or ovine collagen prosthesis in any femoropopliteal the femorocrural position. We therefore cannot confirm the recommendation to use alloplastic grafts as primary choice for above knee bypasses to spare the saphenous vein.

[Local vascular complications after iatrogenic femoral artery puncture]. / Lokale Gefässkomplikationen nach iatrogener Femoralarterienpunktion.

Over a period of 5 years 81 vascular complications after 15,460 catheterizations of the femoral artery for diagnostic (n = 11,883) or therapeutic (n = 3577) procedures were registered. The following complications were observed in declining frequency: 1. False aneurysm (n = 65), 2. arterial occlusion (dissection, embolia, thrombosis) (n = 8), 3. vascular lesion causing profuse bleeding (n = 7), 4. AV-fistula (n = 1). The total complication rate was 0.52%. The complication rate was significantly higher in therapeutical procedures (1,03%) than in diagnostic investigations (0.37%). Pseudoaneurysms were complicated by thrombosis of the femoral vein (n = 3), lymphatic fistula (n = 3) and deep wound infection (n = 9); secondary complication rate 18.5%. Risk factors for local vascular complications are old age, female gender, high grade arteriosclerosis at the puncture site, overweight, manifest arterial hypertension and medication with cumarin, acetylsalicylic acid or heparin. Further complicating factors are connected with technical risks such as duration of the procedure. French size of the catheter, the catheter sheath and multiple punctures. Vascular repair was performed by simple angiography in most cases, but in 14.8% more extensive surgical procedures were required. In patients with signs of occlusive vascular disease the external iliac artery was replaced by a PTFE-vascular access graft in 4 cases and an arterioplasty of the deep femoral artery was performed in 2 patients. 36% of the operations were undertaken as emergencies. Reintervention was necessary for a postoperative bleeding complication in 1 case (surgical complication rate 1.2%). A female patient suffering from aortic valve stenosis died during emergency operation due to massive retroperitoneal hemorrhage after cardiac catheterization (mortality rate 1.2%). Over a median follow-up period of 37 months no late complications of the intervention were recorded, nor recurrences of peripheral arterial occlusive disease.

Diagnosis and treatment of carotid body tumors.

Carotid body tumors are rare although they must always remain part of the differential diagnosis of a neck mass. Sonography as the screening method of choice followed by angiography determines the diagnosis. In 11 patients 12 carotid body tumors were extirpated. The reconstruction of the internal carotid artery with an interposition of the greater saphenous vein was necessary in two cases after resection of the tumor. One patient underwent preoperative embolisation because of a huge tumor. Two postoperative radiotherapies were undertaken because of malignancy in one case and a partially extirpated tumor in the other. After a 9 year follow-up period all patients are alive. One patient suffers from a persistent palsy of the hypoglossal nerve and another complains of permanent headache supposedly caused by the reocclusion of the venous interposition of the carotid artery. In conclusion, our data support the diagnostic strategies in patients with suspected carotid body tumors. Regarding the exact therapeutic regimen, we suggest the surgical resection, followed by radiotherapy in cases of confirmed malignancy or partially resectable lesions.