Fluid transfer as a mechanism leading to endotension.

Some abdominal aortic aneurysms bridged with a minimally invasively introduced stent graft prosthesis increase in size without any diagnosable evidence of endoleakage (endotension). There are three possible pathways proposed through which undetectable low rates of blood flow may cause an aneurysm sac to be refilled: through the thrombus at the prosthesis attachment sites, through the clotted collaterals and through the clotted stent graft wall. If the inflow is more rapid than any drainage through the wall of the aneurysm is re-pressurised.

[General surgery under discussion. From the viewpoint of vascular surgery].

Vascular diseases are common and their frequency is rising. Statistics show that 15% of the German population over 65 display some kind of peripheral arterial pathology. Even aneurysmatic degeneration and cardiac and visceral perfusion disorders are being observed more frequently, while peak age is dropping.

Certification of vascular centers - a project of the German Society for Vascular Surgery.

Objectives: Due to the progress vascular medicine has made in conventional vascular surgery, endovascular procedures, and conservative therapy close, interdisciplinary cooperation is required. In order to assure the contextual and structural quality of vascular centers, the German Society for Vascular Surgery established a list of criteria for certification of each interdisciplinary vascular center.

Material And Methods: Between July 2002 and December 2005, 77 centers have submitted a written application and have been audited by the commission for quality assurance of the German Society for Vascular Surgery, 59 vascular centers were certified for a period of 3 years with one center in each in Austria and in Switzerland, 13 centers were not certified (16.

[Results of the certification of vascular centers by the German Society for Vascular Surgery].

Introduction: Advances in conventional vascular surgery, endovascular procedures and conservative treatment require close interdisciplinary cooperation. The term Vascular Centre indicates to patients and referring doctors optimal professional and organisational competence.

Methods: 73 applications by vascular centres for certification were made between June 2002 and December 2005, of which after audit 54 were successful for three years, including one centre each in Austria and Switzerland.

Mycotic aneurysms affecting both lower legs of a patient with Candida endocarditis--endovascular therapy and open vascular surgery.

The purpose of this study was to report the endovascular and open surgery treatment of Candida-associated mycotic aneurysms in both lower limbs. A 53-year-old patient suffering from Candida endocarditis following aortic valve replacement developed mycotic aneurysms in both lower limbs. The angiography revealed a large aneurysm of the tibioperoneal trunk affecting the right leg.

[Adjusting a surgery department to new conditions in the German health service: day surgery, short-stay surgery, vascular centers and wound centers].

In April 1994, after the preconditions for ambulatory surgery came into effect, the day surgery ward was opened in the Hamburg-Harburg General Hospital. Besides ambulatory operations, this ward provides all surgical pre- and postoperative care. In addition to the surgical sections, different departments (urology, gynecology, dentistry, radiology, ophthalmology) take advantage of the ward.

What can we learn from explanted endovascular devices?

Objective: To examine the durability of the Stentor and Vanguard endovascular devices in human implants.

Methods: The textile covering, the polypropylene ligatures and the stent metal of 34 devices (25 Stentor, 9 Vanguard) with a mean duration of implantation of 28.8 +/- 16 months was examined by means of stereomicroscopy and scanning electron microscopy.

[Injury of polyester grafts by vascular clamps].

Unlabelled: Protected vascular clamps are not new. Clamp associated damage of human arteries has already been published over 20 years ago. The necessity of protective clamps seems to have been forgotten.

[Late complications after alloplastic vascular replacement].

The follow-up of 273 AAA patients operated 1981-1985 showed a mean dilation of polyester grafts of 17.4% in 12 days and 34.8% in 3 years.

[The giant, pendulant goiter. A case report].

A 48-year-old woman with a monstrous goiter was referred to our hospital. She noticed a growth of the goiter for about 20 years, until now she did not undergo surgery because she was afraid of the operation. In September 1999 she suffered from a cardiac decompensation because of a hyperthyreosis, so she decided to be operated.

Corroded nitinol wires in explanted aortic endografts: an important mechanism of failure?

Purpose: To analyze surface alterations and fractures observed in the nitinol stent wires of explanted endovascular grafts used for treatment of abdominal aortic aneurysm.

Methods: Twenty-one explanted Stentor devices and 1 Cragg stent were received from investigators in Germany and France. After macroscopy and photography, the explants were cleaned and the polyester coating removed.

Longitudinal ruptures of polyester knitted vascular prostheses.

Aim: The purpose of the study was the characterization of a type of rupture occurring on warp-knitted polyester vascular prostheses.

Materials And Methods: We studied 20 cases of warp-knitted polyester vascular prostheses that were explanted from humans that showed a longitudinal rupture as a part of a collaborative retrieval program. All the prostheses were immediately fixed in a 10% formaldehyde solution after their explantation in the operating room.

Vascular tumors simulating occlusive disease.

Two cases of vascular tumors of large vessels with intraluminal growth simulating venous thrombosis and arterial occlusive disease are reported. One was a borderline malignant epithelioid hemangioendothelioma of the femoral vein and the other a malignant epithelioid angiosarcoma of the carotid artery. Immunohistochemical studies permitted to classify the tumors.

[Stent wire fractures and mesh loosening in explanted endovascular prosthesis].

Unlabelled: Vascular grafts are available since the middle of the 50's. Explant retrieval studies still reveal not published material degradation today, after over 40 years of product development. Endovascular grafts exist since the beginning of the 90's.

The effect of autoclave resterilisation on polyester vascular grafts.

Objectives: polyester grafts are expensive, single-use items. Some manufacturers of uncoated, woven grafts include instructions for autoclave resterilisation to be performed at the surgeon's own request. Others warn against such manipulation.

Aortobifemoral prosthetic infection treated by cryopreserved arterial homografts of the European Homograft Bank.

The excision of an infected aortobifemoral Dacron graft 9 years after implantation and bilateral axillofemoral Dacron bypass reconstruction led to reinfection of the extra-anatomic bypass grafts. A new aortobifemoral reconstruction was performed using cryopreserved homografts delivered by the European Homograft Bank in Brussels and both axillo-femoral prostheses were removed. No signs of infection and no alterations of the homografts can be detected 3 years later.

Frame dislocation of body middle rings in endovascular stent tube grafts.

Objectives: To understand the cause, and propose a mechanism for frame dislocation in endovascular grafts.

Materials And Methods: Five tube grafts were explanted due to secondary distal leakage 15-21 months after operation. One bifurcated graft was removed during emergency operation after aortic rupture caused by secondary leakage.

Semiclosed iliac recanalisation by an inguinal approach--modified surgical techniques integrating interventional procedures.

Objectives: Technical success and early outcome of modified surgical techniques integrating interventional procedures for iliac recanalisation performed through an incision in the groin.

Materials: Sixty-one consecutive iliac arteries in 59 patients with long occlusions in 16, occlusions of the common iliac in 11, occlusions of the external iliac in 24 and multiple stenoses of the iliac in 10 cases underwent semiclosed recanalisation through a groin incision.

Methods: Passage of the lesion by guidewire permits retrograde ring-stripper endarterectomy over the wire as a guiding splint or thrombectomy with a double lumen balloon catheter.

[The possibilities and risks of outpatient PTA in patients with peripheral arterial obstructive disease].

Purpose: To evaluate risk and feasibility of outpatient PTA in patients with iliac-femoral artery disease we conducted a prospective study.

Material And Method: Out of a total group of 263 patients we selected 100 p. (38%) according to pre-defined criteria.

Long-term in vivo alterations of polyester vascular grafts in humans.

Objectives: To examine the influence of in vivo hydrolysis on the physical properties of polyester grafts and their correlation to the period of implantation in the human body.

Materials And Methods: Sixty-five explanted vascular grafts were obtained after 0-23 years of implantation due to suture aneurysms (18), occlusion (12), graft infection (12), failure of graft material (7) and post-mortem (16). The surface was examined by scanning electron microscopy, the molecular integrity by infra-red spectroscopy and physical strength by probe puncture.