Peripheral arterial obstruction: prospective study of treatment with a transluminally placed self-expanding stent-graft. International Trial Study Group.

PURPOSE: To evaluate the safety and efficacy of an endoluminal prosthesis for treatment of peripheral arterial occlusive disease (PAOD). MATERIALS AND METHODS: A self-expanding endoprosthesis with an expanded polytetrafluoroethylene tube inside a nitinol support structure was implanted in 127 patients with symptomatic PAOD in the iliac (61 limbs) and femoral arteries (80 limbs). Clinical category status, ankle-brachial index, and color duplex flow imaging results were recorded before treatment, at discharge, and at 1, 3, 6, and 12 months after treatment. Aspirin was administered throughout the study, and heparin was administered during and for 2 days after the procedure. RESULTS: Endoprosthesis deployment was technically successful in all patients. Complications occurred in 24 of 141 procedures and included three major complications. Early thrombosis (within 30 days) occurred in one iliac and three femoral arteries. Late restenosis or reocclusion was observed in five iliac and 14 femoral arteries within the 1st year. Primary patency rates in iliac arteries were 98% +/- 3% (standard error) and 91% +/- 4%, respectively, at 6 and 12 months after treatment. Primary patency rates in femoral arteries were 90% +/- 3% and 79% +/- 5%, respectively, at 6 and 12 months. Secondary patency rates were 95% and 93% for iliac and femoral arteries, respectively, at 12 months after treatment. CONCLUSION: The device used in this study can be implanted without additional risks to the patient and provided encouraging patency rates up to 1 year.

Carotid surgery under locoregional anaesthesia. Description of technique and results of our first 100 consecutive operations.

In a 28-month-period 100 consecutive carotid operations were performed on 91 patients under locoregional anaesthesia. The indications were 37 TIAs, 16 recovered strokes, 12 cases presenting with amaurosis fugax, eight with vertigo and 27 patients with severe but still asymptomatic stenosis. In 20 cases a shunt had to be used. Twice a transient neurological syndrome developed, two strokes occurred. One stroke patient died in the postoperative course. Carotid surgery under locoregional anaesthesia seems to be a safe method with advantages for the patient and the surgeon.

A case against immediate revascularisation after uni- or bilateral removal of infected aortobifemoral (end-to-side) prosthetic grafts. Report based on three cases.

More than 75% of the infections of Dacron aortobifemoral grafts occur in the groin. Early removal of the infected limb will enable the vascular surgeon to leave the abdominal part and opposite limb of the graft in place. In aortoiliac occlusive disease and with end-to-side proximal and distal anastomoses, simple removal of the infected graft will not threaten the viability of the limb. Complicated and often incomplete extra-anatomical revascularisation is therefore not necessary and consequently operative time and risk are reduced. Close pre- and postoperative monitoring of the peripheral circulation and painstaking decubitus prophylaxis are mandatory. After 3 to 6 months "in situ" bypass can be performed to correct claudication. Three patients that have been successfully treated according to this philosophy are presented.

[Approach in the treatment of combined aorto-iliac and femoro-popliteal lesions]. / Welke houding aannemen bij de behandeling van gekombineerde aorto-iliacale en femoro-popliteale letsels.

Recognition of the hemodynamic importance of aorto-iliac and femoro-popliteal stenoses or occlusions is essential for correct vascular reconstruction. Non-invasive examinations, arteriography, pressure- and flow-measurements add their value to clinical judgment and surgical experience. Practical guides are given to decide for one-level-reconstruction, concomitant or delayed two-stage-repair, or a combination of balloon-dilation together with arterial reconstruction.

[Contribution of femoral hemodynamics (intra-arterial velocity, pressure) in indications for vascular reconstruction in ischemia of the lower limbs. Preliminary study]. / Apport de l'hémodynamique fémorale (vitesse, pression intra-artérielle) dans les indications des reconstructions vasculaires pour ischémie des membres inférieurs. Etude préliminaire.

The choice of the best operative procedure in vascular reconstructions for ischemic lower limbs, is mainly guided by clinical experience and by arteriography. Doppler wave analysis and femoral artery pressure measurements are new diagnostic tools. In those difficult cases of multiple-level-disease, the intra-operative measurement of the femoral artery pressure proved to be an important step for the operative decision.

[Membranous obstruction of the inferior vena cava]. / Membraneuze obstructie van de vena cava inferior.

A case of idiopathic membranous obstruction of the inferior vena cava (MOVC) is reported. Varicose veins of both lower limbs associated with dermatitis and venous ulceration were the presenting symptoms. Diagnosis was made by cavography after phlebography of both legs had revealed a normal deep system. Ultrasonography demonstrated a 4 mm thick membrane in the inferior vena cava just above the level of the hepatic veins. Stripping of the greater saphenous vein and ligation of incompetent perforating veins was performed to partially correct the venous insufficiency of the most affected limb. The patient refused further treatment of the MOVC. Concise review of the literature. Up to date therapeutic possibilities are discussed.

[The surgical treatment of pulmonary embolism]. / De chirurgische behandeling van het longembool.

Acute pulmonary embolism with major hemodynamic derangement may be treated by thrombolysis or surgically by direct pulmonary embolectomy under cardiopulmonary bypass or by a transvenous method with a steerable aspiration catheter unit. The key to success in massive pulmonary embolism is a quick and correct diagnosis while the vital haemodynamic parameters are maintained by supportive means.

[Surgical therapy of pheochromocytoma (author's transl)]. / Heelkundige behandling van het feochromocytoom.

Between 1958-1978 a total of 19 patients, 11 men and 8 women, were treated for pheochromocytoma. Their age varied between 9 and 67 years (overage 39 years). In all cases with unilateral tumor located in the adrenal gland a lateral approach was preferred. When not certain of the tumor location or when presumed outside the adrenals a laparotomy was deemed necessary. Fourteen thoraco-abdominal lateral approaches and 5 laparotomies were performed. Due to minimal manipulation, especially with the lateral approach, peroperatory hypertensive crises could be reduced to a minimum. Sofar no recurrence has been seen. There was no operative mortality.

Autotransfusion in surgical practice.

The authors have used autotransfusion of intraoperatively collected blood in 58 vascular surgery cases over a period of more than two years. The clinical results confirm the experimental and laboratory studies on the quality of the autotransfused blood. A more liberal use of intraoperative autotransfusion is advocated. Intraoperative autotransfusion is a simple, safe, inexpensive and cost-effective technique. It saves homologous banked blood and provides a readily available, compatible, normothermic transfusate with superior hematologic qualities.

[Bronchussuture (author's transl)]. / Bronchussutuur

We describe the method of manual bronchussuture, used from 1968 until new, which gave us complete satisfaction. Many of the important factors are discussed. The results are analysed and concluding we expose the reasons why we found manual bronchussuture better than any automatic stapling device.