[Surgical treatment of abdominal aortic aneurysms. Risk factors and complications]. / Kirurgisk behandling av abdominale aortaaneurismer. Risikofaktorer og komplikasjoner.

Between January 1985 and April 1991 156 patients underwent surgery for abdominal aortic aneurysm at Nordland Regional Hospital. Of these, 90 underwent elective surgery; 36 were operated on for symptomatic aneurysm; 30 for ruptured aneurysm. The mortality rates were respectively 10%, 14% and 47%. Surgery for aortic aneurysm is on the increase. Advanced age, and associated serious cardiac disease predispose to postoperative complications and death. To reduce mortality better preoperative evaluation and treatment are essential.

[Abdominal aortic surgery. Transperitoneal or retroperitoneal approach?]. / Abdominal aortakirurgi. Transperitoneal eller retroperitoneal tilgang?

During the past five years a retroperitoneal approach was used in 34 patients and the transabdominal route in 49 patients for treatment of abdominal aortosclerosis. Both groups were identical with respect to age, sex and preoperative morbidity. In patients with previous laparotomy the retroperitoneal approach was always chosen. There was no significant difference with regard to postoperative complications. The only significant difference between the two groups after the operation was a trend towards earlier defecation among the patients treated by the retroperitoneal approach. We can not demonstrate any important advantage or disadvantage of the retroperitoneal approach. The transabdominal approach provides an opportunity to examine the abdominal organs for malignancy. We found one asymptomatic gastric cancer. The retroperitoneal approach is particularly suitable in patients who have undergone laparotomy before for expected severe abdominal adhesions.

[Surgical treatment of aortic occlusion and obliterating aorto-iliac arteriosclerosis]. / Kirurgisk behandling av aortaokklusjon og oblitererende aortoiliakal arteriosklerose.

From 1985 to March 1991, 83 patients with the diagnosis aortoiliac obliteration and aortic occlusion were operated on at the Department of Surgery, Nordland Central Hospital. The main symptom was claudicatio intermittens. 16 patients had pain while at rest, and two had gangrene. The surgical technique was either Y-prosthesis or thrombendarterectomy. Four patients (4.8%) died postoperatively, three of myocardial infarction and one of intestinal ischemia and peritonitis. In our study 66 patients with aortoiliacal atherosclerosis were compared with 17 patients with aortic occlusion. Patients with aortoiliacal atherosclerosis demonstrated by angiography had much more severe infrainguinal arterial pathology. In the occlusion group the postoperative outcome, as measured by ankle/brachial index, was significantly better (p < 0.01). The study included four female patients less than 50 years of age with total infrarenal aortic occlusion. Their symptoms and signs are discussed.

[Surgical treatment of acute intestinal ischemia. Successful treatment with embolectomy of the superior mesenteric artery]. / Kirurgisk behandling av akutt tarmiskemi. Vellykket behandling med embolektomi av a. mesenterica superior.

We describe a patient with acute intestinal ischemia successfully treated with embolectomy of the superior mesenteric artery. Over the last four years, 11 patients with the same disease were treated with bowel resection at Nordland Regional Hospital. The mortality rate after bowel resection was 45%. Long duration of symptoms, and high frequency of associated cardiovascular disease was characteristic. In elderly patients with acute abdominal pain and cardiovascular disease, a diagnosis of acute mesenterial ischemia should be seriously considered. In patients with acute mesenteric ischemia and no bowel necrosis, embolectomy must be considered in preference to bowel resection.

[Arteria gastroepiploica dextra in coronary surgery. Complete revascularization in angina pectoris]. / Arteria gastroepiploica dextra i koronarkirurgi. Komplett arterialisering ved angina pectoris.

We have used the right gastroepiploic artery as a viable jump graft to the distal right coronary artery in two patients. The first patient was a 37 year-old man with recurrent angina after coronary bypass surgery with three vein grafts eight years previously. The second patient was a man aged 45 with angina in New York Heart Association Class III to IV. In both cases coronary angiography revealed severe triple vessel disease with multiple proximal and distal occlusions or stenosis. Both internal mammary arteries were also used in the two patients to revascularize the LAD and circumflex systems. Thus, a complete revascularization was achieved by use of only viable arteries as conduits. Both patients recovered well and were free from angina. At present only the first patient has had a postoperative angiogram, which showed good patency of the gastroepiploic artery jump graft. If the long-term patency of this type of graft is similar to that of the internal mammary arteries, it is another suitable arterial conduit for revascularization of the ischemic myocardium.

Inflammatory reaction as an occlusive mechanism in aortocoronary bypass grafts?

Morphological changes in aortocoronary vein grafts are described in two cases; one dying 5 hours post operatively and the other reoperated 8 months after aortocoronary bypass surgery for graft occlusion. Occlusive thrombi and fibrin deposition on the intimal surface and a focal inflammatory process in the wall of the vein grafts were found in the former. Thrombotic encrustation and organization similar to the manifestations of the thrombogenic theory of atherosclerosis were demonstrated in the latter.

A quantitative study of endothelial cell injury in aorto-coronary vein grafts.

Criteria indicating injury of endothelial cells (craters, protrusion, denudation) in saphenous veins for aorto-coronary bypass grafting have been examined and quantitated by use of light-(LM), scanning electron (SEM) and transmission electron microscopy (TEM). The specimens were fixed either by immersion or under pressure. It was shown that the conventional way of handling saphenous vein grafts prior to implantation results in serious damage of the endothelial lining. The factors responsible are presumed to be hypoxia, manual flushing and distension with isotonic saline for blood removal, control of leakage, and counteracting spasm of the graft. Even samples collected by a "no touch" technique and exposed to a short hypoxic interval sometimes revealed slight injury.

Crater formation and endocytosis in human endothelial cells in vitro.

The formation of craters under in vitro hypoxic conditions in the human venous endothelium was studied by scanning-(SEM) and transmission electron microscopy (TEM). Craters are a result of collapsed intracytoplasmatic vesicles which is probably due to extraction of fluid during processing. Thus craters are thought to be artefacts of preparation. This investigation indicates that fusion of caveolae is involved in intracytoplasmatic vesicle formation. A new quantitative method is described for studying endocytosis. Whole vein wall preparations immersed in isotonic saline (approximately 1 h) revealed reduced endocytotic activity in the luminal plasma membrane (LPM) of endothelial cells compared to the basal plasma membrane (BPM), where the endocytotic activity was increased.