Risk of heparin-induced thrombocytopenia from heparin-bonded vascular prostheses.

Heparin can be bonded to vascular devices to improve their patency. The purpose of this study was to determine if a clinically utilized heparin-bonded Dacron((R)) graft (HBG) places patients at risk for heparin-induced thrombocytopenia (HIT) and its complications. A commercially available HBG was divided into 1 cm long segments, which were incubated in platelet-poor plasma (PPP) for 24 hr at 37 degrees C.

Hypercoagulable states: a review.

Vascular surgeons are often asked to evaluate patients with recurrent thromboses or thromboses in unusual locations either arterial or venous. There may be obvious inciting factors, but in many of these patients the possibility of a previously undiagnosed hypercoagulable state must be considered. Hypercoagulable states can be acquired (smoking, medication, change in physiologic status as occurs with pregnancy) or congenital.

Gastrointestinal bleeding as the initial manifestation of a polyarteritis nodosa-associated hepatic artery aneurysm-duodenal fistula--a case report.

The authors report an unusual case of upper gastrointestinal bleeding from a hepatic artery aneurysm-duodenal fistula in a 21-year-old male. Arteriography revealed multiple visceral artery aneurysms. Biopsy of the hepatic artery aneurysm (HAA) revealed focal areas of necrosis, medial degeneration, fibrosis, and giant cells.

Heparin-associated antiplatelet antibodies increase morbidity and mortality in hemodialysis patients.

Background: Patients are frequently exposed to heparin during hemodialysis (HD) to prevent thrombosis of the extracorporeal circuit. Other groups with frequent heparin exposures have a high rate of development of heparin-associated antiplatelet antibodies (HAAb). We sought to define the prevalence of HAAb in HD patients and evaluate their effects.

Inhibition of intimal hyperplasia by direct thrombin inhibitors in an animal vein bypass model.

Many functions of the coagulation system have nonthrombotic effects. The indirect thrombin inhibitor heparin has been previously shown to be effective in limiting intimal hyperplasia (IH). We sought to study the effect of thrombin on IH by using two direct thrombin inhibitors (DTIs), argatroban and lepirudin.

Heparin-induced thrombocytopenia: twenty-nine years later.

Objective: To determine the current frequency, types of patients, indications for testing, morbidity and mortality, and management of heparin-induced thrombocytopenia (HIT).

Methods: Between December 1998 and July 2001, the charts of 102 inpatients that tested positive for heparin-associated antiplatelet antibodies (HAAb) were reviewed. There were 33,941 inpatients, 10,348 of them having received unfractionated or low molecular weight heparins.

Abdominal aortic sarcoma: report of a case with long-term survival and review of the literature.

We present a case of an intimal epitheliod aortic sarcoma. Diagnosis was established after an aortic endarterectomy. The tumor was subsequently resected and an aortic graft was inserted.

Small bowel motility and transit after aortic surgery.

Objective: The inability to tolerate feedings after aortic surgery prolongs hospitalization. The aim of this study was to define jejunal manometric and small bowel transit characteristics associated with the ileus that follows transperitoneal aortic surgery.

Methods: Five male patients who underwent transperitoneal infrarenal aortobifemoral bypass had intraoperative placement of a jejunal multilumen catheter.

The Ehlers-Danlos specter revisited.

Ehlers-Danlos type IV is a major concern to vascular surgeons because it is often associated with spontaneous hemorrhage from arteries containing decreased type III collagen. Five members of a family with Ehlers-Danlos type IV and a review of another family of five with Ehlers-Danlos type IV are reported. Evaluation of the recent family included clinical evaluation as well as assay of collagen production.

Heparin-induced thrombocytopenia: pathophysiology and management.

Immune-mediated heparin-induced thrombocytopenia (HIT) is a well-defined syndrome. Clinical criteria (thrombocytopenia, resistance to heparin anticoagulation, or thromboses during heparin therapy) are defined, and serologic diagnostic tests are available. Earlier recognition of HIT syndrome has allowed for significant advances in therapy, leading to marked reductions in morbidity and mortality from HIT syndrome.