Vena cava filter placement using a cutdown of the superficial epigastric vein.

Percutaneous placement of vena cava filters through the femoral vein has been associated with insertion site venous thrombosis. Reported incidence varies from 2% to 41%. In the majority of placements, sequential dilators are used to create the venotomy and subcutaneous tract. This technique disrupts all layers of the vein wall. The injured area may extend as far proximal as the dilator or sheath is placed. The authors present their experience with placement of vena cava filters using a cutdown of the superficial epigastric vein. During a 5-year period, 27 patients underwent placement of the LGM-Vena Tech vena cava filter via a femoral approach. A cutdown of the superficial epigastric vein was performed. The guidewire, dilator, and introducer sheath were inserted under direct fluoroscopic examination. After removal of the dilator, the LGM-Vena Tech filter was placed through the introducer. There were no wound infections and no clinical signs of insertion site venous thrombosis in the postoperative period. Insertion site venous thrombosis is a well-documented complication of percutaneous filter placement. Superficial epigastric vein cutdown is a reasonable alternative technique, which allows gentle atraumatic manipulation of the femoral vein. It is a simple, safe procedure that can be performed without any significant increase in operative time and no additional morbidity.

Double-layer everted saphenous vein patch angioplasty for carotid endarterectomy.

Saphenous vein patch angioplasty is the preferred method of closure of the arteriotomy site during carotid endarterectomies. A major early complication of the saphenous vein patch is rupture of the patch which can occur within the first few postoperative days. The reported incidence varies from 0.5% to 4%. Patch rupture can result in stroke or death. From May 1992 to April 1999, autogenous everted double-layer saphenous vein patch was used in 192 carotid endarterectomies performed on 168 patients; 96 males and 72 females. The age range was from 54 to 94 years with a mean age of 73 years. The saphenous vein is harvested from the ankle. It is everted and then used as a double-layer patch. The follow-up period was from 3 to 74 months, with a mean of 24 months. Postoperatively, there were no patch ruptures or late aneurysm formation. There was no perioperative mortality. Everted double-layer saphenous vein patch eliminates the risk of patch rupture and at the same time retains the benefits of an autologous nonprosthetic graft. Saphenous vein from the ankle can be safely used for carotid angioplasty as a double layer patch.

Use of a Fogarty catheter to open an incompletely expanded Vena Tech-LGM vena cava filter--a case report.

A Vena Tech-LGM 30D/U filter (B. Braun/Vena Tech; Evanston, IL) opened incompletely after transjugular placement in the infrarenal vena cava. The cephalic points of the stabilizing side rails were open and had engaged the caval wall. The base of the filter failed to open. The filter would not successfully inhibit the clots and could possibly migrate. The filter base was not placed in a clot as shown with intraoperative venography before and after the placement. The balloon of a 6F Fogarty catheter was used successfully to dilate the distal legs of the filter, and fully expand the base.

Laparoscopic pyloroplasty in idiopathic hypertrophic pyloric stenosis in an adult.

BACKGROUND AND OBJECTIVES: Idiopathic hypertrophic pyloric stenosis, in adults, is a rare disease. Partial gastrectomy, gastroenterostomy, pyloromyotomy, pyloroplasty and endoscopic dilatation have all been recommended with variable results. A 54-year-old white female is presented with the onset of symptoms of idiopathic hypertrophic pyloric stenosis one year prior to operation. Two endoscopic pyloric sphincter balloon dilatations provided only temporary relief. METHOD: A laparoscopic pyloroplasty was performed. RESULT: The patient tolerated a solid diet on postoperative day three. The patient was symptom-free at a 13 month follow-up. CONCLUSIONS: Idiopathic hypertrophic pyloric stenosis in adults can be treated with laparoscopic pyloroplasty, offering a minimally invasive alternative to open repair.

Multiple platelet surface receptors mediate platelet adhesion to surfaces coated with plasma proteins.

The interactions between platelets and plasma proteins previously shown to adhere to biomaterials were evaluated, using monoclonal antibodies (mAbs) against specific platelet surface glycoprotein (GP) receptors. Purified 51Cr-labeled human platelets in plasma-free medium were incubated with each of the following antibodies: mAb 10E5 [anti-GP IIb/IIIa; fibrinogen, von Willebrand factor (vWF), and fibronectin receptor]; mAb 6D1 (anti-GP Ib-IX; vWF receptor); mAb IV.3 (anti-Fc gamma RII; IgG receptor); polyclonal antiserum A108 or mAb BIIG4 (anti-GP Ic-IIa; fibronectin receptor). Antibody-treated platelets were added to microtiter wells coated with fibronectin, fibrinogen, vWF, IgG, vitronectin, albumin, or platelet-poor plasma (PPP). 51Cr-labeled platelet adhesion to matrix proteins was expressed as a percentage of that measured on PPP-coated surface. Platelets adhered to fibrinogen, fibronectin, vWF, or IgG immobilized on polystyrene. Limited binding to either vitronectin or albumin was detected. Binding to fibrinogen and IgG was blocked by mAb 10E5. Binding to IgG was also blocked by mAb IV.3. Binding to fibronectin, reduced in the presence of mAb 10E5, mAb BIIG4, or the polyclonal antiserum A108 alone, was further reduced by combined 10E5 and BIIG4 or 10E5 and A108. Neither mAb 10E5 nor 6D1 alone blocked adhesion to vWF; however, the combination of 10E5 and 6D1 significantly reduced platelet adhesion to this matrix. Finally, platelet adhesion to the plasma-coated surface was reduced by mAbs 10E5 and BIIG4. These results indicate that multiple adhesion receptors can mediate platelet adhesion to matrix proteins immobilized on surfaces.