Neointimal hyperplasia following argon ion laser carotid endarterectomy: with and without endothelial cell seeding.

BACKGROUND AND OBJECTIVE: This study compares the development of neointimal hyperplasia following conventional and argon ion laser carotid endarterectomy and assesses the potential advantage of endothelial cell seeding. STUDY DESIGN/MATERIALS AND METHODS: Eight dogs underwent conventional endarterectomy in one carotid artery and an argon ion laser endarterectomy in the other. After 42 days, these arteries were harvested and the intimal thickness were compared. Six additional dogs underwent bilateral argon ion laser carotid endarterectomy with endothelial cell seeding on the one side only. These arteries were harvested after 65 days and their mean intimal thickness were compared. RESULTS: At 42 days, the mean intimal thickness in the conventional endarterectomy group was 0.070 +/- 0.007 mm; in the argon ion laser endarterectomy group it was 0.058 +/- 0.001 mm (P = 0.76, NS). At 65 days, the mean intimal thickness in the group without endothelial cell seeding was 0.125 +/- 0.003 mm vs. 0.061 +/- 0.001 mm on the seeded side (P = 0.043). CONCLUSION: Argon ion laser carotid endarterectomy results in no more neointimal hyperplasia than conventional endarterectomy. The neointimal hyperplasia is reduced by endothelial cell seeding.

Nonocclusive mesenteric ischemia remains a diagnostic dilemma.

BACKGROUND: Despite reports of low mortality and high bowel-salvage rates in nonocclusive mesenteric ischemia (NOMI), our experience has been much less favorable. This study analyzes our experience with NOMI. PATIENTS AND METHODS: A retrospective chart review (1979 to 1992) identified 113 patients with acute mesenteric ischemia, of whom 13 (12%) met our criteria for NOMI. RESULTS: Patients were grouped into early and late presenters. The 5 early presenters were women, younger (mean age [+/- SD] 50 +/- 5.8 years), with no risk factors, and had vague symptoms leading to a delay in diagnosis. The 7 late presenters were older (mean age [+/- SD] 63 +/- 5.3 years) with identifiable risk factors; all had bowel infarction at the time of initial diagnosis. CONCLUSIONS: Vague symptoms and a wide range of patients at risk make early diagnosis of NOMI uncommon. In the absence of early diagnosis, bowel resection with its high morbidity and mortality remains the only applicable treatment option in the vast majority of patients.

Current theories of pathogenesis and treatment of nonocclusive mesenteric ischemia.

Nonocclusive mesenteric ischemia (NOMI) is a poorly understood condition marked by progressive intestinal ischemia leading to infarction, sepsis, and death in a high proportion of patients. The mortality rate for this intestinal disorder remains high, even when the diagnosis is made early in the disease course. This paper presents a comprehensive review of NOMI with a detailed discussion of its history, pathophysiology, diagnosis, and treatment.