Carotid thromboendarterectomy for recent total occlusion of the internal carotid artery.

Background: The efficacy of emergency carotid thromboendarterectomy (CTEA) for acute internal carotid artery (ICA) thrombosis has been questioned. We evaluated the use of CTEA in patients with recent ICA occlusion.

Methods: From August 1989 to December 1999 patients who underwent urgent CTEA for recent ICA thrombosis were retrospectively evaluated.

Effects of completion angiography on the outcome of carotid endarterectomy.

The carotid endarterectomy results of a single surgeon were analyzed over an 8-year period to determine how routine completion angiography affected endarterectomy outcome. Completion angiography was performed in 80% of cases. A total of 145 patients (86%) were symptomatic while 23 (14%) were symptom-free.

Venous and arterial anomalies of the lower extremities diagnosed by duplex scanning.

The complex embryologic development of the vascular system often results in a myriad of clinically relevant anomalies. It has been stated that the classic anatomic venous pattern in the lower extremity is found in only 16 percent of patients. Previous studies on this topic are limited to isolated venous dissections or phlebography that lack complete anatomic detail.

Operative management of greater saphenous thrombophlebitis involving the saphenofemoral junction.

Forty-three consecutive patients with greater saphenous vein (GSV) thrombosis extending to the saphenofemoral junction (SFJ) were treated. Twenty-three patients had extension of thrombus into the common femoral vein (CFV). Twenty patients had thrombus extending to but not within the CFV.

Superficial thrombophlebitis diagnosed by duplex scanning.

Since July 1982, this noninvasive vascular laboratory has performed 12,856 lower extermity venous duplex examinations. All cases of acute venous thrombosis have been categorized and entered into a computer data base. One thousand four hundred twelve examinations were positive for acute venous thrombosis.

Upper extremity venous thrombosis diagnosed by duplex scanning.

The incidence of axillary-subclavian venous thrombosis continues to rise, while reports of noninvasive methods to diagnose this condition have been sparse. A review of the records of 693 consecutive upper extremity duplex scans was performed, and a diagnosis of acute venous thrombosis was made in 123 of these patients. Of these, 85 involved the axillary or subclavian vein.

Comparison of autogenous fistula versus expanded polytetrafluoroethylene graft fistula for angioaccess in hemodialysis.

A hundred patients with RCAV fistulas we compared with 100 patients with expanded PTFE fistulas created during the same time period. The fistulas were analyzed to compare early and late thrombosis, life table patency, infection rate, venous hypertension, and vascular steal. There was a significantly greater incidence of early thrombosis in the RCAV fistula group.

Ischemic colitis following repair of ruptured abdominal aortic aneurysm.

Seven patients--six of whom died--underwent surgical repair of a ruptured abdominal aortic aneurysm and developed postoperative ischemic colitis. All patients were male, with a mean age of 62 years. Resection of the necrotic colon with a colostomy was necessary within the first postoperative week for the six patients who did not survive and on the 40th postoperative day for the patient who lived.

Endothelial cell seeding of a new PTFE vascular prosthesis.

Previous attempts to line polytetrafluoroethylene (PTFE) prostheses with enzymatically derived endothelial cells have not been as successful as similar work with Dacron grafts because of the failure of such prostheses to develop a satisfactory subendothelium. This article reports our experience with a new, highly porous, unreinforced PTFE prosthesis that appears to circumvent this problem. Segments (4 mm I.

Efficacy of low-dose streptokinase in acute arterial occlusion and graft thrombosis.

In a review of 35 patients undergoing local thrombolysis using selective infusion of low-dose streptokinase, the overall success rate was 43%. Streptokinase appears to be most effective in occlusion of native arteries, in high-flow segments, and in autogenous saphenous vein grafts. Local streptokinase was least effective in occluded prosthetic grafts in the femoropopliteal segment (19% success).

Surgical therapy for recent total occlusion of the internal carotid artery.

From January 1980 until May 1983, 24 patients had surgical exploration of the carotid bifurcation for suspected recent total occlusion of the internal carotid artery (ICA). All patients had recent onset of neurologic symptoms related to the ipsilateral cerebral hemisphere. Selective carotid angiography determined preoperative total occlusion of the ICA.

Effects of aspirin and dipyridamole on expanded polytetrafluoroethylene graft patency.

A randomized, double-blind clinical trial was designed to assess the effect of aspirin (ASA) alone or in combination with dipyridamole (DIP) on the patency rates of expanded PTFE grafts placed in the infrainguinal position. Forty-nine patients were randomized into three groups who received three times daily either two placebos (17 patients), 325 mg ASA and placebo (16 patients), or 325 mg ASA and 75 mg DIP (16 patients). The patients were seen at 3-month intervals for 1 year, and coded medication bottles were dispensed and returned pills counted to assess patient compliance.

Doppler evaluation of the pedal arch.

The association of a patent pedal arch with early distal bypass patency has recently been emphasized. Unfortunately, in many patients information about the pedal arch can only be obtained with intraoperative angiography. An 8 mHz Doppler probe was used to noninvasively evaluate the pedal arch in 62 patients with various degrees of vascular disease.

Predicted hyperemic angiography: a technique of distal arteriography in the severely ischemic leg.

A technique of distal arteriography in the severely ischemic leg has been developed by modifying hyperemic angiography. The postischemic hyperemic response can be measured for a given patient and the time fo maximum glow predicted. A study of 35 patients with severe ischemia has shown the maximum hyperemic response time (MHRT) to vary greatly among patients.

Comparison of platelet adherence and aggregation in modified human umbilical vein and autogenous vein grafts.

The use of glutaraldehyde-tanned human umbilical vein as a vascular conduit has recently become popular. In previous studies in our laboratory, neointimal fibrous hyperplasia was responsible for poor long-term patency of this material in a canine model. The present study was undertaken to compare the platelet-adhering characteristics of autogenous vein and modified human umbilical vein.

Goretex and autogenous vein in the canine model.

Thirty Goretex grafts of 6 mm internal diameter, 30 mu fibril length, 30 mg/cc density and 0.5 mm wall thickness were placed as end-to-side bypass grafts in canine femoral arteries. Handling characteristics, patency and healing properties were compared with autogenous jugular veins which were anastomosed into the opposing femoral arteries.