Comparison of caval filters in the management of venous thromboembolism.

Over a seven-year period, 38 Mobin-Uddin MU and 33 Kim-Ray Greenfield KG vena cava filters were inserted in 71 patients with no substantial complications or deaths directly related to the surgical procedure. Thirteen of the 16 early deaths were due to progression of associated diseases. The remaining three deaths were caused by pulmonary emboli and occurred in each instance after insertion of a MU filter.

Revascularization of the ischemic kidney.

Although acute renal artery obstruction causes cessation of kidney function, the viability of the nephron is often maintained by collateral circulation. When renal artery blood flow is restored, filtration is resumed and the resulting acute tubular necrosis is gradually resolved as renal tubular cells regenerate. We have observed several different mechanisms of acute renal artery obstruction resulting in anuric renal failure: temporary suprarenal placement of an aortic clamp during absominal aneurysmectomy, resulting in bilateral renal artery occlusion; embolus, presumably of cardiac origin, to a solitary kidney; and thrombosis of the distal aorta extending to a level proximal to the renal arteries.

The reoperation of choice for aortofemoral graft occlusion.

Restoration of circulation following occlusion of an aortofemoral graft was attempted in 50 limbs in 38 patients. Progressive arteriosclerosis in the femoral vessels was the cause of graft limb thrombosis in most instances. Profundaplasty was employed in 47 limbs and femoral-popliteal bypass in two to provide effective runoff.

Vascular endoscopy: useful tool or interesting toy.

A prospective protocol was designed to evaluate the efficacy and practically of intraluminal endoscopy in vascular reconstructive procedures. The choledochoscope and the arthroscope which utilize the Hopkins Optical System, as well as other available fiberoptic endoscopy units, were evaluated in 91 vascular reconstructions, including 42 carotid endarterectomies, 24 femoral artery reconstructions, 13 popliteal artery anastomoses, seven aortic and iliac procedures, one renal reconstruction, and one tibial reconstruction. In three cases the internal surface of an occluded limb of an aortic graft was examined endoscopically following thrombectomy.

Vascular endoscopy --- an adjunct to carotid surgery.

Technical advances in optical instrumentation have made vascular endoscopy a potential method for intraoperative evaluation of carotid endarterectomy. A prospective protocol was designed to evaluate the efficacy and practicality of this technique using the Hopkins Optical System in 35 carotid endarterectomies. The external carotid artery was examined after completion of the endarterectomy.

Progression of popliteal aneurysmal disease following popliteal aneurysm resection with graft: a twenty year experience.

Multifocal occurrence of peripheral atherosclerotic aneurysm is well known. However, little attention has been directed to subsequent progressive aneurysmal development adjacent to sites of previously resected and grafted popliteal aneurysms. During a 20 year follow-up study of 79 patients with 115 popliteal aneurysms, we have observed the development of six atherosclerotic femoropopliteal aneurysms adjacent to the original aneurysm site in four patients, occurring 5 months to 10 years (average, 5 1/2 years) after the initial operation.