When is thrombolysis for acute lower limb ischemia worthwhile?

Objectives: To find variables associated with outcome following thrombolytic treatment for acute lower limb ischemia.

Design: Re-analysis of a prospective multicentre study.

Material And Methods: One hundred and twenty-one patients with acute lower limb ischemia previously included in a randomised study comparing high- with low-dose thrombolysis were re-analysed ignoring the mode of lytic treatment.

Thrombolysis for acute lower limb ischaemia--a prospective, randomised, multicentre study comparing two strategies.

Objectives: To test if initial high-dose, pulse-spray thrombolysis improves the early and late outcome of lower limb ischaemia as compared with low-dose infusion alone.

Design: Prospective randomised multicentre study.

Material And Methods: Patients with acute and sub-acute (<30 days) lower limb ischaemia were randomised following angiography.

Venous thrombectomy for iliofemoral vein thrombosis--10-year results of a prospective randomised study.

Objectives: To study if venous thrombectomy prevents late post-thrombotic sequelae, venous obstruction reflux, and improves venous physiology following an acute iliofemoral venous thrombosis.

Design: Prospective randomised controlled study.

Material: Thirty patients returned for follow-up 10 years after an acute iliofemoral venous thrombosis initially treated with conventional anticoagulation treatment (medical group, n = 17) or with thrombectomy combined with a temporary arteriovenous fistula and anticoagulation (surgical group, n = 13).

Secondary aortoenteric fistulae--changes from 1973 to 1993.

Aim: To investigate a series of patients with secondary aortoenteric fistulas and compare it with a previous series (1985-93 vs. 1973-84).

Design: Retrospective study of medical records.

Polymorphonuclear leucocytes increase reperfusion injury in skeletal muscle.

Objective: To study the effect of polymorphonuclear leucocytes (PMNLs) on reperfusion injury in rabbit skeletal muscle and to evaluate the role of oxygen-derived free radicals in PMNL-mediated reperfusion injury.

Experimental Design: An isolated rabbit limb perfusion model. Amputated hindlimbs were subjected to 4 hours of ischaemia followed by 2 hours of reperfusion with oxygenated Krebs' buffer.

The effect of mannitol on reperfusion injury and postischaemic compartment pressure in skeletal muscle.

Mannitol has previously been shown to reduce skeletal muscle reperfusion injury and postischaemic compartment pressure. The present study was designed to evaluate whether these effects result from hyperosmolarity or free radical scavenging. A rabbit hindlimb perfusion model was used to compare the effects of mannitol (n = 6), glucose (n = 6)--an isomer of mannitol without scavenging effect--and fasciotomy (n = 6) on oedema, compartment pressure, energy charge, and muscle injury after 4 hours of ischaemia and 2 hours of reperfusion.

Experimental evaluation of oxygen free radical scavengers in the prevention of reperfusion injury in skeletal muscle.

Objective: To evaluate the role of oxygen-derived free radicals in reperfusion injury of skeletal muscle in rabbits.

Design: Open experimental study.

Setting: Department of experimental surgery.

Metabolic and electrophysiological changes in rabbit skeletal muscle during ischaemia and reperfusion.

Objective: To clarify the effects of ischaemia and reperfusion on membrane potential of skeletal muscle in rabbits, and to study its correlation with the energy charge and the lactate content.

Design: Open experimental study.

Material: 20 isolated rabbits' hindlimbs.

Preoperative assessment of the risk for cardiac death following thrombo-embolectomy for acute lower limb ischaemia.

Cardiac monitoring and the selective use of initial non-operative management is reported to reduce the high mortality rate in patients with acute lower limb ischaemia. Early estimation, prior to selection of initial therapy, of the risk for intraoperative or postoperative cardiac death following thrombo-embolectomy is therefore important. The aim of this prospective multi-centre study was to develop a simple and clinically useful index for assessment of the risk of post-operative cardiac death.

Allopurinol--a free radical scavenger--reduces reperfusion injury in skeletal muscle.

Reperfusion of ischaemic skeletal muscle may lead to increased vascular permeability, oedema and ultimately muscle necrosis. Oxygen-derived free radicals have been suggested as aetiological factors in reperfusion injury. Amputated rabbit hindlimbs were subjected to 4 h of ischaemia followed by 2 h or reperfusion with Krebs' buffer.

Long-term results of venous thrombectomy combined with a temporary arterio-venous fistula.

Forty-one patients with acute iliofemoral venous thrombosis were randomised to conventional anticoagulation or acute thrombectomy combined with a temporary arterio-venous fistula (AVF) and anti-coagulation. Follow-up after 5 years in 22 medical and 19 surgical patients revealed slightly more asymptomatic patients (37 vs. 18%) and less frequent severe post-thrombotic sequelae (16 vs.

Venous function assessed during a 5 year period after acute ilio-femoral venous thrombosis treated with anticoagulation.

To determine the chronological changes of venous physiology following major thromboses, 20 patients were repeatedly examined for over 5 years after an acute ilio-femoral thrombosis which was treated with conventional anticoagulation. Radionuclide angiography showed that 70% of the patients had obstructive lesions of the iliac vein with only minor changes occurring from 6 months to 5 years. In spite of this, the plethysmographic maximum venous outflow increased from 31 to 45 ml/min/100 ml (P less than 0.

Effect of platelet inhibitors on platelet and fibrin deposition following transluminal angioplasty of the atherosclerotic rabbit aorta.

Experimental atherosclerosis was induced in a rabbit model by intimal damage of the infrarenal aorta followed by two months cholesterol feeding. The influence of four different antiplatelet drug regimens on acute platelet and fibrin deposition after transluminal angioplasty of the atherosclerotic abdominal aorta was then evaluated. The study group consisted of 32 New Zealand rabbits: 7 controls, 7 treated with prostacyclin (10 mg/kg/min i.

Radionuclide angiography in the evaluation of iliofemoral venous patency.

Radionuclide angiography (RNA), was compared to contrast phlebography (CP) for evaluation of iliofemoral venous patency. Twenty-three patients that six months earlier had been treated for iliofemoral venous thrombosis were investigated. The reproducibility of RNA was good as the interindividual and intraindividual variation was 80-85% and 90-95% respectively.

Late cerebrovascular accidents after repair of abdominal aortic aneurysms.

In this follow-up of 1,112 patients operated on for abdominal aortic aneurysm (AAA) it was noted that cerebrovascular accidents (CVAs) caused significant (8.2%) late mortality. Seventy-one patients developed non-fatal or fatal CVAs at 5.

Management of inflammatory abdominal aortic aneurysm.

Some of the pitfalls in the management of inflammatory abdominal aortic aneurysm are stressed in the presentation of six illustrative cases. Background data on the presumed etiology and common symptoms are provided. The diagnostic value of computed tomography for preoperative detection of the fibrosis surrounding these aneurysms and the differentiation from other conditions are also discussed.

Early and late comparison of umbilical vein and PTFE grafts in control and piroxicam-treated dogs.

For comparative analysis of small vessel prostheses, 78 dogs underwent femoral artery replacement with autogenous vein, polytetrafluoroethylene (PTFE) or human umbilical vein (HUV) grafts. Thirty-six animals received antiplatelet therapy with piroxicam orally once a day. Three-hour deposition of 111In-labeled platelets was less on HUV than on PTFE grafts but still greater than on autogenous vein grafts.