Langenbeck's Archives and the early development of vascular surgery in Germany.

Langenbeck's Archives of Surgery and its predecessor Archiv für Klinische Chirurgie have addressed vascular surgical problems from the early beginning. In 1860, Bernhard von Langenbeck published a review on venous injuries during tumor surgery, and in 1907, Erich Lexer heralded the era of vascular reconstructive therapy in Germany when he treated an axillary aneurysm by use of a segment of the longer saphenous vein. The Archiv für Klinische Chirurgie has significantly promoted the development of vascular surgery in Germany especially at the end of the nineteenth and first decades of the twentieth century.

The impact of model assumptions on results of computational mechanics in abdominal aortic aneurysm.

Objective: In principle, superiority of computational wall stress analyses compared with the maximum diameter criterion for rupture risk evaluation of abdominal aortic aneurysm (AAA) has been demonstrated. The results of finite element analyses should be evaluated carefully, however, because computational strains and stresses are highly dependent on the quality and complexity of each step of AAA simulation. Most clinically active vascular specialists are not familiar with the processes of computational mechanics to evaluate the quality of AAA simulations.

Combined open and endovascular treatment of thoracoabdominal aneurysms and secondary expanding aortic dissections: early and mid-term results from a single-center series.

Background: We present a review of our experience with combined surgical therapy with endovascular stent repair and conventional revascularization of the supraaortic and/or visceral/renal arteries (hybrid procedure) in the treatment of thoracoabdominal aortic aneurysms and dissections.

Methods: We followed 20 patients (7 women, median age 58.3 years, age range 37-68 years) prospectively.

Ultrasonographic screening for the detection of abdominal aortic aneurysms.

Background: The prevalence of abdominal aortic aneurysms (AAA) with a maximal diameter of 3 cm or more is age-dependent; among persons over age 65, it lies between 4% and 8% in men and between 0.5% and 1.5% in women.

Multiple biological predictors for vulnerable carotid lesions.

Background: In this study a multiscore analysis of various biomarkers including matrix metalloproteinases (MMPs), inflammatory factors and other clinical parameters was performed to establish a set of reliable biomarkers for improved detection of plaque instability in patients with advanced carotid stenosis.

Methods: Study patients (n = 101) were classified as histologically stable (n = 37) or unstable (n = 64). Serum levels of MMP-1, -2, -3, -7, -8, -9, MMP inhibitors TIMP-1, -2, and inflammatory factors such as tumor necrosis factor (TNF-alpha), interleukin (IL)-1beta, -6, -8, -10, and -12 were measured by ELISA assays.

Inflammatory infiltrates and neovessels are relevant sources of MMPs in abdominal aortic aneurysm wall.

Objectives: Abdominal aortic aneurysm (AAA) wall is characterized by degradation of extracellular matrix through matrix metalloproteinases (MMPs), chronic inflammatory cell infiltration and extensive neovascularization. So far, MMP expression within AAA wall in association with infiltrates and neovascularization has not yet been studied.

Methods: Vessel walls of 15 AAA patients and 8 organ donors were analyzed by immunohistochemistry for expression of various MMPs (MMP-1, -2, -3, -7, -8, -9, -12 and -13) in all cells located within the AAAs and correlated with infiltrates and neovascularization.

Floating caval thrombus arising from the ovarian vein.

We describe the case of a 37-year-old pregnant woman, who was admitted to hospital for suspicion of chorioamnionitis. An emergency C-section was performed. Four days later, the patient suffered from abdominal pain and fever.

Association between carotid diameter and the advanced glycation end product N-epsilon-carboxymethyllysine (CML).

Background: Nepsilon-carboxymethyllysine (CML) is the major non-cross linking advanced glycation end product (AGE). CML is elevated in diabetic patients and apparent in atherosclerotic lesions. AGEs are associated with hypertension and arterial stiffness potentially by qualitative changes of elastic fibers.

Evaluation of serum matrix metalloproteinases as biomarkers for detection of neurological symptoms in carotid artery disease.

Objective: Relevant soluble matrix metalloproteinases (MMPs), their inhibitors, tissue inhibitor of metalloproteinases (TIMPs), and serological factors were analyzed as possible biomarkers for neurological symptoms in patients with carotid artery stenosis.

Methods And Results: Asymptomatic (n = 76) and symptomatic (n = 69) patients were evaluated. Serum levels of collagenases (MMP-1, -8), gelatinases (MMP-2, -9), stromelysin (MMP-3), matrilysin (MMP-7), and TIMP-1, -2 were determined by enzyme-linked immunosorbant assay (ELISA).

Idiopathic aneurysm of the common iliac artery in an 11-year-old child.

Arterial aneurysms are very rare in children, and aneurysms with an idiopathic etiology have been reported in only a few cases. In most cases, aneurysms are caused by infection, arteritides, collagen vascular disease, vascular malformations, or trauma. We report the case of an 11-year-old girl with an idiopathic and symptomatic left common iliac artery aneurysm.

Long-term results of balloon-expandable LifePath endografts in abdominal aortic aneurysm: a single-center experience.

Objective: This retrospective single-center study analyzed long-term results after LifePath (Edwards Lifesciences LLC, Irvine, Calif) endoprosthesis implantation for abdominal aortic aneurysm (AAA), primarily focusing on the wire form fracture issue and consecutive endoleak rate.

Methods: Between 1999 and 2004, all consecutive patients with LifePath AAA devices in our institution were included in the retrospective analysis. All patients had computed tomography angiography (CTA) imaging preoperatively and image postprocessing.

Complex abdominal aortic pathologies: operative and midterm results after pararenal aortic aneurysm and type IV thoracoabdominal aneurysm repair.

The aim of the study was to describe the clinical outcome of pararenal aortic aneurysm (PAAA) and type IV thoracoabdominal aneurysm (TAAA) repair, with special consideration placed on disease-related complications and midterm follow-up. Data were collected retrospectively between 1997 and 2004 for patients with PAAA or type IV TAAA repair. Comorbidities, operative details, and early and late outcome were analyzed to predict disease-related complications.

The value of the serum neurofilament protein heavy chain as a biomarker for peri-operative brain injury after carotid endarterectomy.

This prospective study examined the value of serum neurofilament protein levels for detecting peri-operative brain damage following carotid endarterectomy. An ELISA was used for quantification of neurofilament protein heavy chain (NfH(SMI35)) levels from patients undergoing endarterectomy for symptomatic (n = 17) and asymptomatic high-grade internal carotid artery stenosis (n = 30). All patients underwent diffusion-weighted brain imaging before and after the procedure.

Middle mesenteric artery arising from an inflammatory infrarenal aortic aneurysm.

We report of a patient with an inflammatory infrarenal aortic aneurysm with a diameter of 6.5 cm, a middle mesenteric artery (MMA) arising from the aneurysm, and a review of the literature. The patient underwent successful surgical treatment by using an interposition tube graft (Dacron graft, 18 mm) with replantation of the MMA.

Novel role of the CXC chemokine receptor 3 in inflammatory response to arterial injury: involvement of mTORC1.

Atherosclerosis, restenosis, and posttransplant graft atherosclerosis are characterized by endothelial damage, infiltration of inflammatory cells, and proliferation of smooth muscle cells. The CXCR3-activating chemokines interferon-gamma inducible protein 10 (IP10) and MIG (monokine induced by interferon-gamma) have been implicated in vascular repair and remodeling. The underlying molecular mechanisms, however, remain elusive.

Improvement of microcirculation after percutaneous transluminal angioplasty in the lower limb with prostaglandin E1.

Objective: The aim of the study was to investigate prospectively the microcirculation after angioplasty and its improvement with additional Prostaglandin E1 (PGE1) therapy assessed by transcutaneous pressure of oxygen.

Patients And Methods: 45 patients with intermittent claudication eligible for angioplasty were enrolled in a prospective randomised controlled clinical trial. Patients received either intra-arterial bolus of 40 microg PGE1 in addition to angioplasty or a 40 microg PGE1 intravenous infusion.

Differences in complication rates among the centres in the SPACE study.

Introduction: Despite the high grade of standardisation of study protocols, there is still room for variability among the centres in specific treatment aspects. We evaluated the treatment risk in stent-protected angioplasty of the carotid versus endarterectomy (SPACE) associated with the specific patient enrollment rates of the centres.

Materials And Methods: The analysed endpoints were ipsilateral stroke or death [primary outcome event (pOE)] and any stroke or death [secondary outcome event (sOE)] until 30 days after treatment.

Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial.

Background: The SPACE trial is a multinational, prospective, randomised study to test the hypothesis that carotid artery stenting is not inferior to carotid endarterectomy for treating patients with severe symptomatic carotid artery stenosis. We did not prove non-inferiority of carotid artery stenting compared with carotid endarterectomy for the 30-day complication rate, and we now report the results at 2 years.

Methods: Between March, 2001, and February, 2006, patients with symptomatic, severe (>or=70%) carotid artery stenosis were recruited to this non-inferiority trial and randomly assigned with a block randomisation design to have carotid artery angioplasty with stenting or carotid artery endarterectomy.

Increased 18F-fluorodeoxyglucose uptake in abdominal aortic aneurysms in positron emission/computed tomography is associated with inflammation, aortic wall instability, and acute symptoms.

Objective: With the established computed tomographic (CT)- morphologic parameters, only the relative, but not the individual rupture risk of abdominal aortic aneurysm (AAA), can be determined. So far, increased aortic 18F-fluorodeoxyglucose (FDG) metabolism measured by positron emission tomography (PET) has been reported in AAA with increased rupture risk. The aim of the study was to analyze the histopathologic changes in AAA wall correlated with increased FDG uptake for further implications on aortic wall stability and AAA rupture risk.

Clinical and angiographic risk factors for stroke and death within 30 days after carotid endarterectomy and stent-protected angioplasty: a subanalysis of the SPACE study.

Background: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are used to prevent ischaemic stroke in patients with stenosis of the internal carotid artery. Better knowledge of risk factors could improve assignment of patients to these procedures and reduce overall risk. We aimed to assess the risk of stroke or death associated with CEA and CAS in patients with different risk factors.

American Society of Anesthesiology and Rankin as predictive parameters for the outcome of carotid endarterectomy within 28 days after an ischemic stroke.

Objective: Recent studies suggest that carotid endarterectomy (CEA) is more effective when performed closer to an ischemic event than after an arbitrary 4- to 6-week delay. Factors need to be identified to evaluate potential perioperative complications after early CEA.

Methods: We investigated the influence of several clinical and morphological variables on the perioperative combined stroke and mortality rate and their influence on the modified Rankin-scale (mRS).

Transcutaneous oximetry compared to ankle-brachial-index measurement in the evaluation of percutaneous transluminal angioplasty.

Objective: To investigate transcutaneous oximetry as parameter of the microcirculation is correlated to ankle-brachial-index as parameter of the macrocirculation after peripheral angioplasty procedures.

Design: Prospective study.

Materials And Methods: 60 patients suffering from intermittent claudication were scheduled for angioplasty treatment.