CT guided periaortic fluid aspiration diagnosing aortic graft infection.

CT guided diagnostic aspiration was performed on a patient suspected of aortic graft infection. The positive aspiration prompted aggressive successful surgical intervention.

Intraaortic balloon entrapment: a complication of balloon perforation.

A patient in whom perforation of a percutaneously inserted intraaortic balloon resulted in a clot formation inside the balloon is described. The balloon could not be withdrawn percutaneously and was lodged in the femoral artery. It was removed surgically, and the artery was repaired.

Practice and theory of "delayed" embolectomy. A 22-year perspective.

A study was made of delayed embolectomy in 45 patients (55 limbs). In 5 patients (11%) the cause of arterial embolization was rheumatic heart disease, and 40 patients (89%) suffered from atherosclerotic cardiovascular disease. The study was divided into 3 phases: I (1960-1964), II (1965-1974) and III (1975-1981). In phases II and III surgery was carried out using the Fogarty catheter technique. In 5 patients the embolus was located in the upper extremity. Seven patients died and 8 major amputations were performed within 30 days of surgery. Use of the Fogarty catheter technique and persistent anticoagulant therapy effected 71.8% limb salvage in phase II and 91.6% limb salvage in phase III. Successful revascularization was achieved in 70.9% of the limbs in which peripheral emboli had occurred on an average of 2.7 days prior to surgical intervention. A theoretical basis for the late development of the acute embolic onset is presented.

Extrathoracic approach in surgical treatment of subclavian steal.

Between 1979 and 1985 11 selected patients underwent axilloaxillary and carotid-subclavian bypass grafting [dacron or Gore-Tex (USA), 8 mm inner diameter]. Nine patients had lesions in the left subclavian artery and two patients presented with innominate artery obstruction with subclavian-carotid recovery phenomenon. All patients were symptomatic before surgery, and all were relieved of both cerebrovascular and upper extremity ischemic symptoms following surgery. Early graft patency has been excellent. There has been no mortality or serious postoperative complications. Two patients developed late graft thrombosis with recurrent ischemia of the left upper extremity, but there were no neurological symptoms. There has been a follow-up period of up to 6.5 years (mean 38.4 months.) It would appear that the appropriate extrathoracic route of revascularization is the procedure of choice for symptomatic patients with subclavian steal and subclavian-carotid recovery phenomenon.

Percutaneous chemical lumbar sympathectomy with alcohol with computed tomography control.

Percutaneous chemical lumbar sympathectomy with alcohol (PCLSA) using computed tomography (CT) control was performed in 8 patients suffering from advanced peripheral arterial occlusive disease. PCLSA under CT guidance was found to be a simple and safe procedure. The use of CT control added precision in the guidance of needle placement. Positive results were obtained in all patients, without significant morbidity. PCLSA may be an alternative to surgical sympathectomy.

Non invasive testing in carotid artery occlusive disease: the value of direct Doppler ultrasonography.

Non invasive examination of carotid artery occlusive disease, as performed in our vascular laboratory, was compared to angiographic and operative findings in 65 patients (74 arteries). The sensitivity of carotid phonoangiography alone in detecting carotid artery stenosis was 73%. Ophthalmic flow direction was reversed in only 32% of stenosed arteries. Resistance index of directional Doppler sonography was high in only 15% of stenosed arteries. The most reliable part of the whole examination proved to be the direct "auscultation" of the carotid vessels in the neck. The overall sensitivity and specificity of this test was 88% and 64%, respectively; sensitivity being 94% for stenoses of over 50% in diameter and 55% for stenoses less than 50% in diameter. The major drawback of the test was its subjectiveness.

Transluminal dilatation of the subclavian artery.

Transluminal dilatation of seven left subclavian arteries and one right subclavian artery was attempted in seven patients. Dilatation was successful in four left subclavian arteries and the single right subclavian artery treated. Five of the patients suffered from cerebral symptoms as well as ischemia of the upper limb, one had only cerebral symptoms and another had only arm claudication. All patients also had significantly reduced systolic blood pressures in the brachial artery. Standard techniques for percutaneous transluminal angioplasty (PTA) were employed, using the femoral route six times and the axillary route four times. No complications occurred. All patients were permanently given a maintenance dose of antiplatelet treatment with dipyridamole 75 mg tds after PTA. Follow-up of up to 36 months, indicates that angioplasty can be accomplished in the stenosed subclavian artery with relatively little hazard. Patients with hemodynamically significant stenoses should be considered for PTA if their symptoms and signs warrant such therapy.

Pulmonary artery aneurysm presenting as a peripheral coin lesion--the danger of needle biopsy.

A peripheral pulmonary artery aneurysm appeared as a solitary, smooth and discrete coin lesion in the lung. The aneurysm was surgically resected. Various etiologies possibly responsible for this entity are discussed. The complications of transthoracic needle aspiration biopsy are reviewed, with emphasis on the hazards of puncturing a vascular lesion, as well as suggested steps to avoid this complication.

The use of a balloon catheter in the treatment of an iatrogenic pseudo-aneurysm of the subclavian artery.

The use of an angiographic balloon catheter to achieve proximal control of the left subclavian artery as an adjunct to surgery is described. By this application of interventional radiology combined with surgery, successful treatment of a pseudo-aneurysm of the subclavian artery in a gravely ill patient was made possible without resort to thoracotomy.

Role of the vascular laboratory in the diagnosis of aortic arch occlusive disease: Screening of 2000 patients.

A significant difference in bilateral systolic brachial artery pressures and the presence of systolic bruit over a subclavian artery suggests occlusive disease in the innominate or subclavian arteries. Two thousand patients with these signs underwent ultrasonography of the carotid, subclavian, and brachial arteries in our laboratory. Doppler recordings of a vertebral artery, with hyperemia testing of the ipsilateral arm, identified those with a subclavian steal syndrome. In each case, angiography confirmed the laboratory diagnosis. The effectiveness of corrective surgery was evaluated noninvasively. Illustrative cases are presented and discussed.

Effect of manual lymphdrainage massage on blood components and urinary neurohormones in chronic lymphedema.

In an earlier paper we have shown that manual lymph drainage massage of edematous limbs can result in the excretion of up to 1 liter urine derived from reabsorption and transport from the interstitial fluid, simultaneously with significant changes in the excretion of urinary neurohormones. These findings indicated that histamine and serotonin were released from the edematous tissue and that circulation improved through increased output of adrenaline and noradrenaline. The results achieved led us to assume that similar changes may have occurred in the blood during treatment, and induced us to study the effect of manual lymphdrainage on various blood constituents and urinary neurohormones.

Detection of accidental leg ischemia during aortoiliac reconstruction.

After surgery of the aorta and iliac arteries, perioperative information concerning the circulatory status of the legs is vital. In a consecutive series of 71 patients, segmental air plethysmography was used to monitor simultaneously pulse volumes in both legs. Accidental ischemia was detected in four patients, and immediate corrective measures were undertaken. Compared with other methods, plethysmography proved reliable and easy to use.

Arterial combat injuries of the upper extremity.

The results of treatment of 101 combat injuries of the upper extremities are reported. There were 84 acute injuries and 17 late complications. There was a high incidence of associated fractures (35%) and nerve lesions (51%). Over half the injuries were repaired by saphenous vein graft replacement. There were seven early amputations related to a long delay before treatment, extensive tissue damage, and sepsis with delayed hemorrhage. There were no late amputations, but residual neurologic damage gave a less than perfect result in 32 extremities. Two injuries resulted in Volkmann's contracture. Fracture specific to the management of upper-extremity arterial injuries are outlined.