[Coronary artery bypass without use of the heart-lung-machine]. / Koronar bypass uden hjerte-lunge-maskine.

INTRODUCTION: Off pump coronary artery bypass via sternotomy (OPCAB) and via a small left anterior thoracotomy (MIDCAB) on the anterior coronary arteries of the heart was introduced at the present center in 1997. Starting this year we decided to increase OPCAB and MIDCAB to constitute at least 50% of CAB procedures including the posterior aspect of the heart. METHODS: From January 1st through April 16th 1999 we performed 152 CAB procedures: 108 CABG, 6 MIDCAB, 13 OPCAB (on the anterior cornary arteries) and 25 OPCAB-Cx (including the circumflex artery). OP procedures were done using OCTOPUS-II to expose and stabilize the arteriotomies, and control angiography was performed before discharge. RESULTS: Off pump CAB was performed in 2% of the first 50 CAB patients, 36% of the next 50 and 50% of the last 52. The CABG and OPCAB-Cx groups were comparable as regards degree of coronary artery disease and number of distal anastomoses, but differed as regards poor left ventricular function and unstable preoperative status. Early mortality was 1.9% in the CABG group and 0% in the OP groups. Control angiograms in the OP groups showed a patency from 92 to 100%. CONCLUSIONS: In this short preliminary series, it was possible to increase the fraction of OP procedures to nearly 50% with good results.

[Iatrogenic lesions of extraanatomic vascular prostheses]. / Iatrogene laesioner af ekstraanatomisk forløbende karproteser.

The course of extra-anatomic vascular bypass is not common knowledge in surgeons and gynaecologists. We describe two cases of accidental lesion of an extra-anatomic bypass during laparotomy. In both cases immediate repair was done and the lesion did not result in further complications. Attention must be given to the possibility of extra-anatomic course of vascular prosthesis in patients with a previous history of vascular surgery. Patients must be informed, when having vascular surgery, about their operation and risks.

[Value of routine follow-up after infrainguinal arterial reconstruction]. / Vaerdien af rutinemaessig opfølgning efter infraingvinal arteriel rekonstrucktion.

Longterm patency of infrainguinal bypass procedures may be established on the basis of clinical evaluation and ankle pressure measurements. With the aim of assessing whether these parameters could predict grafts at risk for occlusion, we identified 24 patients in whom the bypass had occluded between 3 and 12 months postoperatively, but following at least one follow-up. These patients were compared with a control group consisting of further 24 patients operated on during the same period, but in whom the bypass was patent. Prior to graft occlusion only nine (39%) patients had complained of claudication, and a significant drop in ankle pressure was demonstrated in seven (29%) patients. These figures were significantly higher than the one (4%) patient in the control group who complained of claudication and the other (4%) patient who developed a drop in ankle pressure (p < 0.02 and 0.05, respectively). Graft surveillance based on patients' history and ankle pressure measurements are insufficient parameters for identification of grafts at risk for occlusion. However, the occurrence of claudication and/or a significant drop in ankle pressures are associated with a high incidence of graft thrombosis.

[Acute ischemia in the upper extremity caused by cervical rib]. / Akut overekstremitetsiskaemi som følge af costa cervicalis.

Young patients presenting with acute ischemia of the upper extremity and no cardiac source of embolism are uncommon. Two cases of cervical ribs are reported. Early recognition of this anatomical abnormality is the key to appropriate management.