Effects of pentoxifylline on central hemodynamics in patients with congestive heart failure.

Pentoxifylline, a xanthine derivative with vasoactive and hemorheologic properties, was studied in regard to effect on central hemodynamics in ten patients with congestive heart failure due to aortic or mitral valve disease, mainly in NYHA group III or IV. The drug was infused intravenously in a dose of 4 mg/kg b.w.

Negative effects of dihydroergotamine (Orstanorm) on central haemodynamics and aorto-coronary bypass blood flow. An intraoperative study.

Dihydroergotamine (DHE), Orstanorm, because of its strong constrictor action on capacitance vessels, is used in the treatment of hypotension caused by orthostatism or spinal or epidural anaesthesia. Lately Orstanorm has also been used in combination with heparin as prophylaxis against postoperative thromboembolism. In the present study, Orstanorm (0.

The advantage of the thoraco-retroperitoneal approach for aortorenal bypass grafting.

Postoperative angiographic studies after aortorenal saphenous vein bypass grafting have revealed a high incidence of graft dilatation and aneurysms. The aortorenal bypasses in all these series were performed via the transabdominal approach which gives an angle of at least 90 degrees between the graft and aorta. The routine approach in the present study has been the thoraco-retroperitoneal one which has been used since more than 20 years in 189 patients.

Central, high flow subclavian artery-internal jugular vein fistula for venous access.

A subclavian artery--internal jugular vein shunt was created for intermittent parenteral infusions in six patients who had undergone extensive intestinal resection because of Crohn's disease or ulcerative colitis. The flow rates through the shunt were initially around 1000 ml/min. In three patients the flow later increased, giving rise to mild cardiac symptoms.

Surgical management of obliterative disease of the brachiocephalic trunk. Experience from 24 cases.

Transsternal endarterectomy was performed in 24 patients for symptomatic obliterative disease of the brachiocephalic trunk in the period 1961-1981. In 10 of the patients the vessel was occluded, and in 14 there were various degrees of stenosis. Reversal of vertebral artery flow was found in 15 patients.

Subclavian steal-carotid recovery phenomenon. Experience of 7 operated patients.

Subclavian steal-carotid recovery phenomenon, which accompanies an occlusion of the brachiocephalic trunk, is a rare cause of transient ischemic attacks. In the actual study, including 7 operated patients, preoperative symptoms, results of directional Doppler ultrasound examinations further evaluated by sonography, angiography, peroperative flowmetry and postoperative outcome are presented and discussed. Fits of vertigo, right-sided blindness and left-sided paralysis were the most common symptoms.

Monitoring direction of vertebral artery blood flow by Doppler shift ultrasound in patients with suspected "subclavian steal'.

A significant subclavian or innominate artery obliteration may cause reversal of flow in the ipsilateral vertebral artery causing vertebro-basilar ischaemia with cerebral symptoms, called the subclavian steal syndrome. Until recently, angiography was the only method of diagnosing a subclavian steal. In the present study, a non-invasive technique (Directional Doppler ultrasound) was used to determine the direction of flow in the vertebral arteries.

The effect of etilefrine (Effortil) on regional blood flow during arterial reconstructive surgery.

Etilefrine is a sympathomimetic amine with high affinity for alpha- and beta2-receptors. Following vascular reconstructions in 38 patients the effect of intravenously administered etilefrine on cardiac output, mean systemic blood pressure, blood flow and vascular resistance of the carotid, subclavian, mesenteric, iliac and femoral arteries was studied intraoperatively. Cardiac output and the mean systemic blood pressure were significantly increased.

Unusual indications for carotid artery surgery.

Nineteen patients with transient ischaemic attacks (TIA), selected from a series of 420 patients who underwent carotid endarterectomy during the last 10 years were studied. All had one occluded and one stenosed internal carotid artery with neurological symptoms from the contralateral brain hemisphere in relation to the stenosis. Carotid endarterectomy was performed on the stenosed side utilizing temporary bypass with continuous bypass blood flow measurements.

The effect of etilefrine (Effortil) on central hemodynamics and aorto-coronary bypass blood flow. A pre-operative study.

In an attempt to elucidate the function of an aorto-coronary bypass in patients with coronary artery obliterative disease, intravenous injection of etilefrine was used to bring about variations of central hemodynamics. Etilefrine proved to cause a significant increase of cardiac output (QPA), mean systemic blood pressure and aorto-coronary bypass flow. Calculations of peripheral myocardial resistance showed a rather pronounced decrease in all vascular regions studied.

Abdominal aortic aneurysms. II. Long-term follow-up of operated and unoperated patients.

Survival rate, causes of late death, employment, general health, walking capacity and sexual activity were investigated in 87 patients operated on for abdominal aortic aneurysms and 44 unoperated patients. The life expectancy was higher in the operated patients. The higher mortality for the non-operated patients was mainly due to aneurysmal rupture.

Abdominal aortic aneurysms. 1. Selection of patients and operative results.

Between 1958--1976 204 patients with abdominal aortic aneurysms were admitted to the surgical ward for evaluation. One hundred and thirty-eight patients were operated on, 7 died prior to operation and 59 patients were not recommended operation for different reasons. Elective surgery was performed in 60 patients and 78 underwent acute surgery.

Haemodynamic studies in renal artery stenosis.

With the aid of an electromagnetic flowmeter and a mechano-electrical pressure transducer, peroperative renal artery blood flows and pressures in the aorta and the renal artery distal to the stenosis were measured in 48 patients with renovascular hypertension before and after renal artery reconstruction. Calculations of pressure difference across the stenosis and resistances over the stenosis and the renal parenchyma were made. There was a significant blood flow increase through the renal artery after arterial reconstruction in all patients, irrespective as to whether they were normotensive, improved or failures postoperatively.

Intrathoracic approach for subclavian and innominate artery reconstruction.

A subclavian or innominate artery obliteration may cause a retrograde flow in the vertebral artery, a subclavian steal. The steal has been associated with cerebral symptoms indicating vertebrobasilar ischaemia, the subclavian steal syndrome. As there still are no objective means of measuring the effect of the steal on the brain circulation, the syndrome can only be proved by experience from the results of surgical attempts to correct the steal.

Non-invasive methods of the evaluation of obliterative disease of the subclavian or innominate artery.

The preoperative investigation of 25 patients referred for evaluation of subclavian artery obliteration is reported. Non-invasive methods were used prior to angiography to assess arm circulation and the direction of blood flow in the vertebral artery. A retrograde flow in one vertebral artery was found in 18 patients, but only 7 had symptoms judged to be caused by the reversal of flow.

Persisting hypertension after renal artery reconstruction. A follow-up study.

Twenty-four patients with persisting hypertension after renal artery reconstruction were re-investigated 1--8 years after surgery. They underwent renal arteriography, determination of plasma renin activity, renography and renal function studies in order to find the causes of the postoperative hypertension. Restenosis was found in 6 patients, in 3 of whom it was of functional significance according to the positive renin tests (renin ratio greater than 1.

Renal artery reconstruction in renovascular hypertension.

Over a period of 8 years, 52 patients (31 females and 21 males) between 12 and 59 years of age (mean age 40 years) underwent renal artery reconstruction for correction of renovascular hypertension. Five patients were operated on bilaterally. A thoracoretroperitoneal approach was chosen at 48 of 57 renal artery reconstructions.

[Doppler ultrasound technique compared to angiography, intraoperative pressure gradients and blood flow measurements in carotid surgery (author's transl)].

Doppler ultrasound technique was used in 32 patients to differentiate between non-signigicant stenosis, significant stenosis and occlusion of the internal carotid artery. The results were then compared to angiographic findings and peroperative pressure gradients and blood flow measurements. The Doppler examinations showed good agreement with the angiograms.

Superior mesenteric artery and aorto-iliac blood flow after surgical reconstruction in the aortic bifurcation.

In order to evaluate the possibility of a redistribution of blood from the superior mesenteric artery to the iliac-femoral region, as a cause of intestinal gangrene after surgical reconstruction in the aortic bifurcation, 149 patients operated upon during the last 10 years were reviewed. Aorto-iliac blood flow was studied in all the patients. Blood flow measurements on the superior mesenteric artery before and after release of the aortic clamp and after intra-arterial injection of a vasodilator were made in seven patients.

Monitoring coronary artery blood flow by Doppler shift ultrasound.

By monitoring arterial blood flow signals across the chest wall in the area of the heart and timing them to the electrocardiogram or the heart sounds, it is often possible to differentiate between coronary artery flow and systemic artery flow. A Doppler ultrasound technique was used for the postoperative follow-up coronary artery reconstruction in ten patients suffering from intractable angina pectoris. Pre-operative coronary angiography showed stenosis or occlusion of the coronary arteries in all the patients.