Subclavian steal despite ipsilateral vertebral occlusion.

In the classic subclavian steal syndrome, vertebrobasilar insufficiency is caused by reverse flow in the vertebral artery ipsilateral to a subclavian stenosis or occlusion. We present two patients with vertebrobasilar insufficiency and ipsilateral vertebral and subclavian occlusive disease. The postulated mechanism of vertebrobasilar insufficiency is reverse flow in collateral neck vessels.

Long-term hemodynamic evaluation of lower extremity percutaneous transluminal angioplasty.

Percutaneous transluminal angioplasty (PTA) has provided an alternative method of treatment for occlusive disease of the lower extremities. However, the long-term durability of PTA compared with that of surgical reconstruction has not been adequately evaluated. This study was undertaken to assess the long-term hemodynamic results of PTA.

Peripheral vascular trauma from close-range shotgun injuries.

This report summarizes an eight-year experience (1976 to 1983) with 49 close-range shotgun blasts with associated major vascular injuries seen in a large urban hospital. Injuries to the upper extremity (40%), lower extremity (56%), and neck (4%) were seen. A high frequency of associated deep venous injury (82%), nerve injury (37%), fracture (33%), massive soft-tissue loss (43%), and compartmental hypertension (39%) was observed.

Ankle bypass: should we go the distance?

This report reviewed the results of 47 distal arterial reconstructions to or below the level of the malleolus. The operations were performed by the techniques of popliteal-to-distal bypass (20 procedures) and in situ bypass (27 procedures). Seventy-five percent of patients had gangrene of ischemic ulceration, and all procedures were performed for limb salvage.

Internal iliac artery revascularization in the treatment of vasculogenic impotence.

Five impotent men underwent internal iliac artery revascularization in conjunction with end-to-side aortobifemoral bypass after preoperative testing suggested a vasculogenic cause for impotence. All patients had abnormal preoperative penile/brachial arterial pressure indices (mean, 0.42 +/- 0.

The role of carotid duplex scanning in surgical decision making.

Eighty-one patients suspected of having cerebrovascular disease had 157 carotid arterial systems studied by both duplex ultrasonography and contrast arteriography to better define the role of carotid duplex scanning in the surgical decision-making process. These studies were reviewed in a blinded fashion in conjunction with history and physical examination data by two surgeons, one operating on only symptomatic lesions, the other operating on both symptomatic and asymptomatic lesions. Results were analyzed to ascertain if there was agreement regarding decisions for carotid endarterectomy based on scan findings compared with decisions based on arteriographic findings.

The natural history of isolated carotid siphon stenosis.

Between August 1978 and July 1983, 93 patients (71 with unilateral and 22 with bilateral isolated carotid siphon stenosis) were identified from a review of 885 consecutive cerebral arteriograms. This yielded 115 cerebral hemispheres at risk. At the time of arteriography, 93 hemispheres were asymptomatic regarding the hemisphere with siphon stenosis (group I), whereas 22 hemispheres in 22 patients had had neurologic events referable to the hemisphere with siphon stenosis (group II).

Prediction of improvement in ankle blood pressure following arterial bypass.

Percutaneous femoral artery pressures and lower extremity segmental Doppler-derived blood pressures in 116 lower extremities were analyzed to determine if postbypass ankle/brachial indices (ABIs) could be predicted based on preoperative pressures. Predicted ABIs were calculated by increasing the prebypass ABI by the same percentage that the extremity/brachial index at the distal end of the bypass would be increased, assuming a postbypass index of 1.0 at the distal graft.

Is femoral pulse palpation accurate in assessing the hemodynamic significance of aortoiliac occlusive disease?

Palpation of the common femoral artery pulse has been the mainstay in the clinical assessment of the significance of aortoiliac disease for deciding whether to perform a suprainguinal versus an infrainguinal bypass. This study was performed to assess the accuracy of clinical pulse palpation in comparison to intraarterial pressure measurements of 31 common femoral arteries in 21 patients. Pulse palpation was graded as to the presence (abnormal) or absence (normal) of hemodynamically significant aortoiliac occlusive disease while at rest.

Indirect assessment of carotid occlusive disease by ocular pneumoplethysmography. 500 mm Hg vacuum pressure measurements and ocular pulse timing.

The interpretation and diagnostic value of the ophthalmic artery pressure measurement and ocular pulse timing modes of the 500 mm Hg vacuum OPG-Gee ocular pneumoplethysmograph were evaluated in 65 patients who underwent aortic arch and cerebral arteriography. Data analysis revealed the OPG-Gee differential tracing which electronically compares and amplifies differences between the right and left eye pulse waveforms to be of little value. In predicting the presence of a greater than or equal to 50 percent diameter unilateral stenosis, an eye-eye pulse interval of greater than 15 msec was 82 percent accurate, a greater than or equal to 5 mm Hg ophthalmic artery pressure difference was 77 percent accurate and when combined these two criteria were 84 percent accurate.

Crossover femorofemoropopliteal sequential bypass for combined ipsilateral iliac and femoropopliteal occlusive disease.

We evaluated the effectiveness of crossover femorofemoropopliteal sequential bypass in 13 patients with combined ipsilateral iliac and femoropopliteal disease. Of them, eight underwent bypass grafting for limb salvage, and five, for disabling claudication. Four of the patients with claudication had relief of symptoms and significant increases in treadmill walking time.

Aortofemoral or femoropopliteal revascularization? A prospective evaluation of the papaverine test.

Proper selection of suprainguinal vs. infrainguinal arterial revascularization in patients with multilevel disease requires hemodynamic assessment. In such patients hemodynamic evaluation of the aortoiliac system cannot be made accurately with either arteriography or current noninvasive techniques.

Efficacy of prostaglandin E1 in the treatment of lower extremity ischemic ulcers secondary to peripheral vascular occlusive disease. Results of a prospective randomized, double-blind, multicenter clinical trial.

Most previous reports suggesting beneficial effects of prostaglandin E1 (PGE1) have been retrospective and uncontrolled. Therefore, this study was undertaken to assess the efficacy of PGE1 in the treatment of ischemic ulcers in patients with peripheral vascular occlusive disease (PVOD). One hundred twenty patients with one to three ischemic ulcers not healing for 3 weeks with standard care were randomized to receive either PGE1 (20 ng/kg/min) or a placebo for 72 hours through a central venous catheter.

Experience with latrogenic pediatric vascular injuries. Incidence, etiology, management, and results.

During a 32-month period, 79 extremities in 76 children (age 1 day-13 years, mean = 31 months) were evaluated with regard to iatrogenic vascular injuries. Prospectively, 42 children were studied pre- and post-cardiac catheterization. Ten of these children sustained vascular injuries (incidence = 24%).

Imaging ultrasound in the intraoperative diagnosis of vascular defects.

High-resolution real-time ultrasonography was employed during 267 vascular operations in order to diagnose vascular defects such as intimal flaps, strictures, and thrombi. These defects occur at operative areas (e.g.

Cardiovascular lymphoscintigraphy.

The technique of lymphoscintigraphy when applied to the heart and blood vessels correlates well with results of anatomic investigations of arterial and cardiac lymphatic vessels reported in the literature. Five dogs and eight rabbits underwent lymphoscintigraphy of the heart and aorta, as well as the iliac, femoral, and tibial arteries. After surgical exposure, approximately 500 microCi of 99mTc-labelled antimony sulfide was injected into the myocardium or the adventitial-medial plane of an artery.

The application of real-time ultrasound imaging during surgical procedures.

Operative ultrasound using real-time high resolution B-mode ultrasound scanning is a practical and useful diagnostic aid. At operations upon the biliary tract, pancreas and blood vessels, ultrasound had a favorable impact upon surgical management. When similar operative roentgenographic studies were available, operative ultrasound compared favorably with both operative cholangiography and arteriography.

Diverticulitis of the cecum.

Ten patients with diverticulitis of the cecum are reported upon herein. The disease is difficult to distinguish preoperatively from that of appendicitis and may be difficult to distinguish intraoperatively from carcinoma of the cecum. The diverticula are usually solitary and may be of the true or false variety.

Persistent sciatic artery. Clinical aspects and operative management.

Abnormal persistent of the embryonic axial blood supply to the leg, the sciatic artery, is a rare but often clinically important condition. The sciatic artery may vary from a small collateral in the upper thigh to a very large vessel that is the leg's sole arterial blood supply. The abnormal artery is prone to aneurysmal dilatation and atherosclerotic occlusion, and different patterns of anatomic development in the sciatic and femoral artery systems pose significant diagnostic and therapeutic problems.

Hemodynamic evaluation of the aortoiliac system based on pharmacologic vasodilatation.

Selection of the appropriate vascular reconstructive procedure in patients with multisegment disease requires the differentiation of aortoiliac from femoropopliteal occlusive disease and the detection of subcritical stenoses in the aortoiliac segment. Triplane arteriography and common femoral intra-arterial papaverine injection (30 mg) were done in 43 lower extremities in patients who subsequently had arterial bypass. The percent diameter stenosis was measured on the arteriograms and common femoral intra-arterial pressure was continuously monitored before and after papaverine injection.

The treatment of cerebral ischemia by external carotid artery revascularization.

Thirteen patients with internal carotid artery occlusion and symptomatic external carotid artery stenosis underwent external carotid artery revascularization by means of endarterectomy (n = 10) or subclavian artery--external carotid artery bypass (n = 3). All patients but one were followed up, for five to 46 months (mean, 20 months). There were no operative deaths or complications and no late strokes.

Early experience with popliteal to infrapopliteal bypass for limb salvage.

In an attempt to improve graft patency and limb salvage in patients with isolated tibial vessel and/or popliteal-tibial vessel occlusive disease, bypass grafts from the popliteal or distal superficial femoral artery to infrapopliteal arteries were used in patients requiring bypass for limb salvage. During a 2 1/2-year period, 23 patients with patent axial vessels and hemodynamically normal inflow to the level of the knee underwent such bypasses. Cumulative graft patency and limb salvage rates at 31 months were 84% and 70%, respectively.