[Thrombolytic therapy in acute lower extremity ischemia]. / Trombolysebehandling ved akut underekstremitetsiskaemi.

During a period of four and a half years 37 lower extremities with acute ischaemia were treated with thrombolysis. Angiographically, 35 cases demonstrated no suitable arteries for distal reconstruction. In two cases vascular surgery was not performed because of cardiac incompensation. Two patients died within one month and limb salvage was 69%. During 22 months (3-48) of follow-up another six patients were amputated two to nine months later. The 18 salvaged lower extremities (49%) had an ankle-brachial pressure index of 0.63 (0.30-1.-09). Review of all angiograms revealed a demonstrable effect of thrombolytic therapy only in 13 (35%) cases. In conclusion, thrombolytic therapy should be considered in the case of acute lower extremity ischaemia unsuitable for reconstructive procedures. Even though the effect of thrombolytic therapy cannot be demonstrated on the angiogram, that should not necessarily deem the treatment to be a failure.

[Vascular surgery in patients with impaired renal function]. / Karkirurgisk behandling hos patienter med påvirket nyrefunktion.

The purpose of the study was to evaluate the effect of surgery for renal artery stenosis in patients with impaired renal function. The design was a retrospective investigation with follow-up. The material consisted of 42 such patients operated at Rigshospitalet between 1980 and 1990. Renal function and blood pressure status was evaluated preoperatively and at follow-up. The perioperative mortality was 5% (n = 2) and morbidity 21% (n = 9). At discharge from hospital renal function was maintained in 38 patients (90%), including three patients who at the time of operation were without diuresis and had been in dialysis for up to 28 days. Twenty-three patients were still alive at postoperative follow-up at a median of 66 months. The cumulative five-year survival was 62%, which was significantly lower than that of a sex- and age-matched population. Eleven patients developed terminal renal insufficiency during the follow-up period. The cumulative preservation of renal function was 77% after five years. In conclusion, reconstruction of the renal arteries in patients with declining renal function and renal artery stenosis or occlusion can save renal function such that dialysis may be avoided in most cases.

[Traumatic lesions of the axillary and brachial artery]. / Traumatiske laesioner af a. axillaris og a. brachialis.

During af six year period 16 patients were treated for an axillary or brachial artery trauma. The vascular injury was caused by fracture in nine cases, contusion in four and penetrating injury in three. Concomitant nerve or tendon lesion occurred in five cases. Five of the 16 events were industrial accidents. Only one case was due to violence. Four patients appeared to be intoxicated with alcohol. Fifteen patients were treated surgically, 12 with vascular reconstruction. One patient was treated conservatively. At the time of discharge all extremities were assessed as having normal arterial supply. At follow-up at median 28 months all extremities were preserved. However, two-thirds had minimal to disabling sequels. Four out of 10 who were professionally active before the trauma had lost this ability.

[Surgical treatment of renovascular hypertension caused by renal artery stenosis. A retrospective study]. / Kirurgisk behandling af renovaskulaer hypertension forårsaget af nyrearteriestenose. En retrospektiv opgørelse.

During a 10 year period 58 patients with renovascular hypertension due to renal artery stenosis were treated surgically. A retrospective analysis of the results was carried out. No perioperative mortalities occurred. Ten percent of the patients developed hypertension again after an average of 27 months. At follow-up (median 65 months), 85% of the patients had normal blood pressure or either no, modest or considerably reduced anti-hypertensive medication. It is concluded that surgical treatment of renovascular hypertension is a safe and effective procedure.

[Acetylsalicylic acid treatment after peripheral vascular surgery]. / Acetylsalicylsyrebehandling efter perifer karkirurgi.

Antiplatelet drugs (acetylsalicylic acid) have been widely used in arteriosclerotic patients during recent years. We have reviewed the literature to find out if this treatment also is indicated in patients operated with reconstructive vascular surgery for lower limb ischemia. It is concluded, that all patients should receive life-long treatment with acetylsalicylic acid 300-500 mg per day following peripheral vascular surgery. This will improve the patency rate of certain vascular procedures, and in all patients it reduces the incidence of cerebral stroke and the risk of myocardial infarction in the years following peripheral vascular surgery.

[Intravagal paragangliomas]. / Intravagale paragangliomer.

Two patients with vascular tumors adjacent to the carotid branch of the vagus nerve are presented. Contrary to expectations, the tumours proved to be intravagal paragangliomata. Both were treated surgically.

[A case of perforation of a blind loop secondary to ileocolic side-to-side anastomosis]. / Et tilfaelde af perforation af blind loop sekundaert til ileocolisk side-til-side anastomose.

A rare late complication of side-to-side anastomosis; perforation of a blind loop with subsequent localized inflammation of the abdominal wall is presented. Operative intervention with resection of the blind loop and the establishment of an end-to-end anastomosis is recommended.