The use of spliced vein bypasses for infrainguinal arterial reconstruction.

Purpose: The use of autogenous vein, whether in situ or excised, for arterial bypass procedures is well accepted. However, this usually requires the presence of a length of good-quality vein of adequate diameter. In patients lacking sufficient length of vein, two or more pieces of vein may be spliced together to complete the reconstruction.

Comments on "Silicon models of lateral inhibition" [with reply].

The commenters refer to the above mentioned paper by Wolpert and Micheli-Tzanakou (ibid. p.955-61, 1993), and point out the oversight of previous activity in circuit design.

Can the deep femoral artery be used reliably as an inflow source for infrainguinal reconstruction? Long-term results in 563 procedures.

Purpose: Historically, most infrainguinal bypasses originated from the common femoral artery. In spite of sporadic reports of the use of the deep femoral artery as an inflow source, its durability has not been critically reviewed.

Methods: From 1977 to 1994, 2829 infrainguinal reconstructions have been performed.

Presentation and patterns of aortic aneurysms in young patients.

Purpose: Although aortic aneurysm (AA) is primarily a disease of older age groups, younger (< 51 years) patients infrequently are admitted requiring AA surgery. We sought to compare the characteristics of these patients with those of a randomly selected group of older patients with AA.

Methods: We identified 26 patients with AA (group I) under age 51 (mean age 44.

Efficacy of the cued-listening task in the evaluation of binaural hearing aids.

To evaluate the efficacy of the cued-listening task (CLT) in the evaluation of binaural hearing aid performance, we tested 10 experienced binaural hearing aid users. Subjects listened for a speech target embedded in continuous discourse from either the right or left directions while simultaneously suppressing similar continuous discourse from the other direction. The task was carried out in the presence of multitalker babble from an overhead source.

Carotid endarterectomy can be safely performed with acceptable mortality and morbidity in patients requiring coronary artery bypass grafts.

Background: Patients undergoing the placement of coronary artery bypass grafts (CABG) with hemodynamically significant carotid artery lesions pose a difficult problem for both cardiac and vascular surgeons. Despite numerous studies, there has been no consensus of opinion as to the proper management of these patients. In numerous series, the combined mortality and perioperative stroke rates in concomitant carotid endarterectomy and CABG procedures have ranged from 8% to 40%.

Retroperitoneal approach for bilateral renal and visceral artery revascularization.

Revascularization for renal and visceral arterial occlusive disease has traditionally been performed via a transperitoneal approach. Exposing these arteries transperitoneally is often difficult, however, and may require extensive medial visceral rotation. An alternative is a left retroperitoneal approach for renal and visceral arterial revascularization, including procedures involving the right renal artery.

The durability of different reconstructive techniques for atherosclerotic renal artery disease.

Purpose: Among various surgical techniques for renal artery reconstruction (RAR), anatomic aortorenal bypass has been the preferred standard. Yet concern regarding origin of the bypass from a diseased aorta and desire to avoid a major aortic operation in these patients who are often at poor risk has led to increasing use of extraanatomic bypass grafting, particularly hepatorenal and splenorenal bypass. This study was conducted to compare the safety and long-term performance of these different techniques of renal artery reconstruction.

Clostridial aortic graft infection.

Aortic graft infection represents one of the most formidable challenges encountered by the vascular surgeon. Current principles of treatment are based on experience primarily derived from infection with Staphylococcus and enteric bacteria. Anaerobic prosthetic infection is a case event.

Carotid endarterectomy in awake patients: its safety, acceptability, and outcome.

Purpose: The purpose of this study was to determine the safety and efficacy of performing carotid endarterectomy procedures with the patient receiving cervical block anesthetic.

Methods: Over the last 14 years, 654 carotid endarterectomy procedures were performed with patients receiving regional anesthetic. Intraluminal shunts were placed on demand, if neurologic changes with clamping of the carotid artery developed in the patient.

Pelvic ischemia following aortoiliac reconstruction.

Clinically evident compromise of parietal or visceral pelvic function secondary to interruption of pelvic blood flow occurs infrequently after aortoiliac reconstruction. Certain patterns of aortoiliac or occlusive aneurysmal disease or graft infection may require exclusion of the hypogastric or profunda femoral arteries. In these situations collateral blood flow or retrograde iliac flow may be insufficient to perfuse the pelvis and may cause ischemia.

Increased limb salvage by the use of unconventional foot amputations.

Purpose: Limb salvage in the presence of ischemic foot necrosis requires revascularization followed by debridement or partial foot amputation. Necrosis extending beyond the toes and metatarsal heads may require the use of unconventional types of amputations.

Methods: Over a 15-year period 2105 ischemic limbs were treated with infrainguinal revascularization.

Carotid endarterectomy for unstable and compelling neurologic conditions: do results justify an aggressive approach?

Purpose: In a retrospective study the outcome of 70 carotid endarterectomies (CEA) in 68 patients with neurologically unstable conditions or anatomically compelling findings on carotid angiography was examined to more accurately identify patients who might benefit from CEA in this setting.

Methods: Out of a total of 1734 CEAs performed from 1978 to 1992, five groups of patients were selected: group A, stroke in evolution with tight stenosis (n = 5); group C, crescendo transient ischemic attacks (CTIA) continuing despite heparin (n = 14); group D, CTIA (above criteria) ceasing with heparin (n = 21); and group E, anatomically compelling situation on carotid angiography (n = 13). Data collected included preoperative and postoperative Neurologic Event Severity Score (NESS), CHAT classification, arteriosclerosis risk factors, demographics, and long-term overall and transient ischemic attack/stroke-free survival rates.

Treatment of the diabetic foot from a vascular surgeon's viewpoint.

Diabetic foot lesions are caused by neurologic, orthopaedic, immunologic, and vascular derangements. Whereas some lesions may be initially caused by trauma and others directly caused by vascular disease, improvement of arterial perfusion often plays an important role in the successful salvage of these limbs. Fortunately, in the last several years, there has been a major improvement in the identification and treatment of those patients in whom correction of arterial occlusive disease is necessary for healing.

Ultrasonic characterization of the saphenous vein.

The most frequently used conduit for infrainguinal or coronary artery bypass is the saphenous vein, and this report describes the ultrasonic evaluation of anatomic variations in over 1400 limbs. The thigh portion of the greater saphenous vein consisted of a single venous conduit in 67% of the limbs, a complete double system in 8%, a branching double system in 18% and a closed loop double system in 7%. In 92% of the cases, the vein was in medial position, with the remaining 8% positioned laterally.

Optimal outcome after tibial arterial bypass.

To evaluate factors for the optimal outcome after tibial arterial bypass for lower extremity ischemia, we analyzed our experience with 1,359 such bypasses during the last ten years. There were 869 males and 490 females, of whom 739 patients (54 percent) had diabetes. The average age was 68 years.

Aortic replacement for abdominal aortic aneurysm in elderly patients.

Improvements in the operative mortality and morbidity rates in elective aortic replacement, which are largely a result of refinements in surgical technique and perioperative management, have allowed a more aggressive approach in the treatment of abdominal aortic aneurysm (AAA) in elderly patients. To evaluate this approach, we reviewed the records of 116 patients 80 years of age and older (range: 80 to 93 years) who consecutively underwent aortic replacement for AAA. Seventy-seven patients underwent elective aortic replacement with 8 complications and a 3% operative mortality rate (2 of 77).

Sequencing of cDNA from 50 unrelated patients reveals that mutations in the triple-helical domain of type III procollagen are an infrequent cause of aortic aneurysms.

Detailed DNA sequencing of the triple-helical domain of type III procollagen was carried out on cDNA prepared from 54 patients with aortic aneurysms. The 43 male and 11 female patients originated from 50 different families and five different nationalities. 43 patients had at least one additional blood relative who had aneurysms.

Outcome following blunt vascular trauma of the upper extremity.

Blunt trauma to the upper extremity may cause extensive vascular damage in addition to severe musculoskeletal injury. Over a 5.5-year period, 17 patients with a total of 23 arterial injuries were treated.

Familial carotid body tumors: incidence and implications.

Carotid body tumors may occur sporadically (90%) or in a familial pattern (10%). One third of the patients with familial disease have bilateral tumors. We report the case of a patient with bilateral carotid body tumors and a strong family history of such tumors.