| 1. |
- Basu, Samar, et al.
(författare)
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Biomarkers of free radical injury during spinal cord ischemia
- 2001
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Ingår i: FEBS Letters. - 0014-5793 .- 1873-3468. ; 508:1, s. 36-38
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Tidskriftsartikel (refereegranskat)abstract
- Plasma and urinary levels of 8-iso-PGF(2alpha) and 15-keto-dihydro-PGF(2alpha) were analysed at baseline and during the ischemia-reperfusion period in experimental spinal cord ischemia. A significant and immediate increase of 8-iso-PGF(2alpha) in plasma at the start and up to 60 min, and in the urine at 90-150 min following ischemia indicate an association of oxidative injury. The inflammatory response indicator 15-keto-dihydro-PGF(2alpha) in plasma increased significantly at the start and up to 60 min after ischemia. No such increase was seen in animals with no spinal cord ischemia. Thus, free radical mediated and cyclooxygenase catalysed products of arachidonic acid are increased during spinal cord ischemia as a consequence of oxidative injury and inflammation.
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| 2. |
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| 3. |
- Bergqvist, David, et al.
(författare)
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Akupunktur kan ge kärlskador
- 1998
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 95:3, s. 180-181
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 4. |
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| 5. |
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| 6. |
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| 7. |
- Bergqvist, David, et al.
(författare)
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Is balloon angioplasty below the knee joint wise?
- 1998
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Ingår i: Indications in Vascular and Endovascular Surgery. - London : WB Saunders. - 0702024457 - 9780702024450 ; , s. 353-365
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 8. |
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| 9. |
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| 10. |
- Bergqvist, David, et al.
(författare)
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Klinisk värdering av kritisk ischemi skall alltid göras före amputation
- 1999
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 96:7, s. 727-729
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Patients with critical limb ischemia (rest pain and/or ulcer/gangrene, together with low ankle pressure) are at risk of amputation, and should therefore undergo arterial reconstruction if that is at all technically possible. Thorough clinical investigation will usually distinguish patients in need of further evaluation by a vascular surgeon. No amputation should be undertaken without such evaluation. Diabetic patients belong to a special category, in that neuropathy makes it difficult to evaluate pain, and ankle pressure is often falsely high due to medial arterios sclerosis.
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| 11. |
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| 12. |
- Bergqvist, David, et al.
(författare)
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Paediatric arterial trauma
- 1998
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Ingår i: European Journal of Surgery. - : Oxford University Press (OUP). - 1102-4151 .- 1741-9271. ; 164:10, s. 723-731
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Tidskriftsartikel (refereegranskat)
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| 13. |
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| 14. |
- Bergqvist, David, et al.
(författare)
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Secondary aortoenteric fistula : changes from 1973 to 1993
- 1996
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1078-5884 .- 1532-2165. ; 11:4, s. 425-428
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate a series of patients with secondary aortoenteric fistulas and compare it with a previous series (1985-93 vs. 1973-84). DESIGN: Retrospective study of medical records. SETTING: Sixteen vascular surgical centers in Sweden. PATIENTS: Twenty-seven patients were identified making an overall incidence of 0.5% of all aortoiliac operations. Among aneurysm patients the incidence was significantly lower than in the previous series. One patient record could not be identified. Fourteen primary operations were for aortic aneurysm, 12 for occlusive disease and one was an aortorenal vein bypass. RESULTS: Symptoms of the fistula occurred after a median interval of 90 months which is significantly later than the previous series (32 months; p<0.05). The commonest presentation was bleeding followed by septis. The median diagnostic delay was 10.5 days, which was significantly shorter than in the previous series. Most fistulas involved the duodenum (88%). One patient died before surgery. The postoperative mortality was 28%, significantly lower than in the previous series (58%) (p<0.05). At the end of follow up (median 43 months) significantly more patients were alive than in the previous series (42% vs 18%) (p<0.05). CONCLUSION: Over a 21 year period there seems to have been a decrease in the frequency of secondary aortoenteric fistulas after aneurysm surgery, a longer interval before they occur, a shorter diagnostic delay, and a better survival.
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| 15. |
- Boström, Annika, et al.
(författare)
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Duplex scanning as the sole preoperative imaging method for infrainguinal arterial surgery
- 2002
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 23:2, s. 140-145
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: to evaluate preoperative duplex as the sole investigation prior to lower limb reconstruction. Design retrospective analysis. MATERIALS AND METHODS: between January 1995 and December 1999, 157 of 329 surgical interventions for chronic infrainguinal arterial or aneurysmal disease were performed without preoperative angiography. RESULTS: in patients undergoing femoral artery endarterectomy, the extent of the stenosis and the status of the distal deep femoral artery were correctly diagnosed with duplex scanning in all but one patient. Duplex scan findings in patients undergoing infrainguinal bypass procedures were in agreement with the findings obtained from on-table angiography in regard to the selection of optimal outflow anastomotic sites in 123 (98%). Duplex scanning correctly evaluated the status of runoff in 113 (90%). There were no significant differences in 30-day occlusion rate and patency at 12 months between reconstructions performed with and without preoperative angiography. CONCLUSION: in patients with conclusive duplex scan findings there is no need to perform angiography prior to lower limb reconstruction.
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| 16. |
- Boström, Annika, et al.
(författare)
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Repeat surgery without preoperative angiography in limbs with patent infrainguinal bypass grafts
- 2002
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : SAGE Publications. - 1078-5884 .- 1532-2165. ; 36:5, s. 343-350
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to assess the feasibility and results of repeat surgery without preoperative angiography in limbs with patent infrainguinal bypass grafts. Between January 1995 and December 1999, 73 surgical interventions were performed for correction of inflow, graft, or runoff-related lesions in limbs with patent infrainguinal bypass grafts. Fifty-six of the 73 cases were operated on based on the findings obtained from duplex scanning alone. There were 53 vein and 3 prosthetic grafts in the series. The indications for intervention without angiography were stenotic or occlusive lesions in 35, graft aneurysm in 7, and arteriovenous fistulae in 14. There were no deviations from the preoperatively planned surgical strategy in patients undergoing surgery without preoperative angiography. Cumulative life table primary, (stenosis free) and primary-assisted patency rates, at 12 months following graft revisions (excluding arteriovenous fistulae ligatures) without preoperative angiography, were 64% and 85%, respectively. The corresponding figures for revisions performed with preoperative angiography were 58% and 84%, respectively. There were no significant differences between patients undergoing surgery with or without preoperative diagnostic angiography with regard to patency rates. Surgical interventions for correction of infrainguinal graft-related stenotic or aneurysmal lesions can be safely performed based on findings obtained from duplex scanning.
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| 17. |
- Boström Ardin, Annika, et al.
(författare)
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Selection of patients with infrainguinal arterial occlusive disease for percutaneous transluminal angioplasty with duplex scanning
- 2002
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Ingår i: Acta Radiologica. - 0284-1851 .- 1600-0455. ; 43:4, s. 391-395
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To evaluate the role of duplex scanning in the selection of patients with infrainguinal arterial occlusive disease for percutaneous transluminal angioplasty (PTA). MATERIAL AND METHODS: From January 1995 through May 2000, 702 patients (952 limbs), with chronic lower extremity ischemia due to infrainguinal atherosclerotic disease diagnosed by duplex scanning, were retrospectively studied. Diagnostic angiography (130 limbs) or infrainguinal PTA (108 limbs) was performed in 238 limbs. Two investigators retrospectively analyzed the duplex examinations and angiographies in a blinded manner and used similar criteria for the interpretation of lesions suitable or not suitable for PTA. RESULTS: The superficial femoral, popliteal and crural artery lesions were correctly selected for PTA in 85%, 66% and 32%, respectively. The accuracy, sensitivity, specificity, negative predictive value and positive predictive value of duplex scanning to appropriately categorize femoropopliteal lesions as suitable or unsuitable for PTA were 89%, 83%, 92%, 94% and 78%, respectively. The accuracy of duplex scanning for predicting the performance of infrainguinal PTA was 83%. CONCLUSION: Duplex scanning has an important impact on the selection of treatment modalities in limbs with infrainguinal arterial occlusive disease. Femoropopliteal lesions can be reliably selected to PTA according to duplex scan findings.
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| 18. |
- Boström Ardin, Annika, et al.
(författare)
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Surgical reconstruction without preoperative angiography in patients with aortoiliac occlusive disease
- 2002
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Ingår i: Annals of Vascular Surgery. - : Elsevier BV. - 0890-5096 .- 1615-5947. ; 16:3, s. 273-278
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to evaluate the feasibility of performing surgical reconstructions in patients with aortoiliac occlusive disease with findings obtained solely from duplex scanning. Between January 1995 through December 1999, among 112 patients who underwent surgical intervention due to aortoiliac occlusive disease, 44 were operated on with findings obtained solely from preoperative duplex scanning. Deviations from preoperatively planned surgical interventions according to duplex scan findings and the outcome were analyzed. Our results showed that surgical reconstructions for treatment of aortoiliac occlusive disease can be safely performed by using duplex scanning as the sole preoperative diagnostic modality in patients with conclusive duplex scan findings.
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| 19. |
- Christiansson, Lennart, et al.
(författare)
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A new method of intrathecal PO2, PCO2, and pH measurements for continuous monitoring of spinal cord ischemia during thoracic aortic clamping in pigs
- 2000
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Ingår i: Surgery. - : Elsevier BV. - 0039-6060 .- 1532-7361. ; 127:5, s. 571-576
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Impaired spinal cord circulation during thoracic aortic clamping may result in paraplegia. Reliable and fast responding methods for intraoperative monitoring are needed to facilitate the evaluation of protective measures and efficiency of revascularization.METHODS: In 11 pigs, a multiparameter PO2, PCO2, and pH sensor (Paratrend 7, Biomedical Sensors Ltd, United Kingdom) was introduced into the intrathecal space for continuous monitoring of cerebrospinal fluid (CSF) oxygenation during thoracic aortic cross-clamping (AXC) distal to the left subclavian artery. A laser-Doppler probe was inserted into the epidural space for simultaneous measurements of spinal cord flux. Registrations were made before and 30 minutes after clamping and 30 and 60 minutes after declamping. The same measuring points were used for systemic hemodynamic and metabolic data acquisition.RESULTS: The mean CSF PO2 readings of 41 mm Hg (5.5 kPa) at baseline decreased within 3 minutes to 5 mm Hg (0.7 kPa) during AXC (P < .01). Spinal cord flux measurement responded immediately in the same way to AXC. Both methods indicated normalization of circulation during declamping. Significant (P < .01) changes were also observed in the CSF metabolic parameters PCO2 and pH.CONCLUSIONS: In this experimental model of spinal ischemia by AXC, online monitoring of intrathecal PO2, PCO2, and pH showed significant changes and correlated well with epidural laser-Doppler flowmetry (P < .01).
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| 20. |
- Christiansson, Lennart, et al.
(författare)
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Aspects of the spinal cord circulation as assessed by intrathecal oxygen tension monitoring during various arterial interruptions in the pig
- 2001
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Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier BV. - 0022-5223 .- 1097-685X. ; 121:4, s. 762-772
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We sought to study the effect of various modes of interruption of the spinal cord blood supply on intrathecal oxygenation.METHODS: In 24 pigs intrathecal PO (2), PCO (2), and pH were continuously monitored with a multiparameter catheter (Paratrend 7, Biomedical Sensors; Diametrics Medical, Inc, St Paul, Minn) during and after aortic crossclamping or selective interruption of segmental arteries and proximal collateral circulation.RESULTS: Proximal aortic clamping (n = 6) produced complete ischemia, whereas a second clamp close to the celiac trunk (n = 4) partly protected against spinal cord ischemia. This is explained by prevention of the steal phenomenon in the excluded part of the aorta. Adding clamps to the subclavian arteries (n = 6) created complete spinal ischemia as the collateral circulation was interrupted. In another group (n = 4) all segmental arteries below T5 were occluded with no reaction in the intrathecal variables. Additional selective clamping of supreme intercostal arteries (n = 4) showed the relative importance of the subclavian and vertebral collateral pathways.CONCLUSIONS: Continuous intrathecal PO (2) was monitored during various modes of interruption of the spinal cord blood supply. This provided insight into the ischemia mechanisms and relative importance of the segmental contribution and proximal collateral pathways of the spinal cord circulation in pigs. A short literature review is given, and aspects of comparative anatomy are discussed.
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| 21. |
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| 22. |
- Christiansson, Lennart, et al.
(författare)
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Increased FiO2 improves intrathecal oxygenation during thoracic aortic cross-clamping in pigs
- 2001
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Ingår i: Scandinavian Cardiovascular Journal. - 1401-7431 .- 1651-2006. ; 35:2, s. 147-150
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate the effect of 100% oxygen ventilation on cerebrospinal fluid (CSF) oxygenation in 11 pigs during thoracic aortic cross-clamping.DESIGN: An aorto-aortic shunt was used for control of central hemodynamics and study of hypoperfusion by exsanguination. CSF PO2, PCO2 and pH were continuously monitored before and during clamping. The changes in hemodynamic parameters and intrathecal gas tensions in response to variations in proximal mean aortic pressure and fraction of inspired oxygen (FiO2) were recorded.RESULTS: Baseline CSF PO2 decreased from 4.8 +/- 1.9 to 2.6 +/- 2.2 kPa following aortic occlusion. Increasing FiO2 to 1.0 resulted in a significant increase in CSF PO2 to 4.1 +/- 3.0 with a return to 2.7 +/- 2.1 kPa after reducing FiO2 to 0.4 again. The same variations in FiO2 did not induce any significant changes in CSF PO2 during hypotension.CONCLUSION: Increased FiO2 during experimental thoracic aortic cross-clamping with stable proximal arterial pressure helps to maintain CSF PO2, whereas severe hypotension could not be compensated for by hyperoxemia.
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| 23. |
- Christiansson, Lennart, et al.
(författare)
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Relationship between intrathecal oxygen tension and ultrastructural changes in the spinal cord during experimental aortic clamping
- 2000
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 19:4, s. 413-420
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate spinal cord ultrastructure related to cerebrospinal fluid (CSF) oxygenation.DESIGN: experimental aortic occlusion model with intrathecal oxygen tension monitoring.MATERIALS AND METHODS: Two groups of pigs underwent proximal (P) or double (D) aortic occlusion for 30 min followed by 1 h of reperfusion. In a third group (I) segmental arteries distal to T3 were clamped for 90 min. A thin pO(2), pCO(2) and pH sensor was placed intrathecally for continuous monitoring of CSF. Spinal cord segments were studied by electron microscopy (EM).RESULTS: In group P, CSF-pO(2)rapidly decreased during clamping and major changes in pH and pCO(2)were seen. EM demonstrated neuronal degeneration with loss of cellular integrity and severe affection of organelles. In the group D, CSF oxygenation decreased to about half, but with only moderate changes in the metabolic parameters. Group I showed no significant changes in CSF measurements. The latter groups were similar at EM, showing only mild mitochondrial changes.CONCLUSIONS: The level of CSF oxygenation during aortic cross-clamping or segmental artery interruption seems to correlate with ultrastructural changes in the spinal cord. This online intrathecal monitoring technique may provide valuable information on spinal cord circulation during thoracoabdominal aortic surgery.
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| 24. |
- Demirer, S., et al.
(författare)
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Haemostasis in patients with Behcet's disease
- 2000
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 19:6, s. 570-574
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Tidskriftsartikel (refereegranskat)abstract
- AIM: to determine whether Behçet's disease affects haemostatic function. SETTING: University Hospital, Turkey. PATIENTS: one hundred and twenty-seven consecutive patients with Behçet's disease, 34 of whom with a history of vascular involvement. METHODS: prothrombin fragment 1+2 tissue plasminogen activator, protein S and C, antithrombin, fibrinogen, von Willebrand factor, thrombomodulin and prothrombin time (PT) were measured in patient plasma. RESULTS: soluble thrombomodulin was significantly lower and von Willebrand factor (vWF) and tissue plasminogen activator (tPA) significantly higher in Behçet's patients. Patients with vascular involvement showed the highest levels of vWF and tPA. There was no activation of coagulation, not even in patients with an active disease at the time of sampling. CONCLUSION: there were indirect signs of endothelial activity or damage, particularly in patients with vascular involvement. Coagulation was not activated.
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| 25. |
- Eklöf, Hampus, et al.
(författare)
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2D inflow MR angiography in severe chronic leg ischemia
- 1998
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Ingår i: Acta Radiologica. - 0284-1851 .- 1600-0455. ; 39:6, s. 663-668
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to compare 2D inflow MR angiography (MRA) with selective X-ray angiography (XRA) in patients with severe chronic leg ischemia. MATERIAL AND METHODS: In a blinded prospective study, 2D inflow MRA and XRA were compared with regard to evaluation of the arteries distal to the knee in 24 patients (median age 72 years) with severe ischemia; 23 of them had either rest pain or tissue loss. Statistics were calculated with XRA as the reference method. RESULTS: The interpretations of 2D inflow MRA and XRA showed moderate agreement in the calf arteries but poor agreement in the foot arteries. Of the discrepancies, two-thirds were observer-related and only one-third method-related. Of all the comparable arteries, 9% showed method-related differences between the two methods. An assessment of MRA using only maximum intensity projections (MIP) resulted in 19% of findings being judged inconclusive whereas all the arteries could be classified when the cross-sectional images were studied on the viewing console. CONCLUSION: The agreement between MRA and XRA was good in the calf but questionable in the foot.
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| 26. |
- Eklöf, Hampus, et al.
(författare)
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Renal artery stenosis evaluated with magnetic resonance angiography using intraarterial pressure gradient as the standard of reference : A multireader study
- 2005
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Ingår i: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 46:8, s. 802-809
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate 3D-Gd-magnetic resonance angiography (MRA) in detecting hemodynamically significant renal artery stenosis (RAS). MATERIAL AND METHODS: Thirty patients evaluated for atherosclerotic RAS by MRA and digital subtraction angiography (DSA) were retrospectively included. Standard of reference for hemodynamically significant RAS was a transstenotic gradient of 15 mmHg. DSA visualized 60 main renal arteries and 9 accessory arteries. Pressure gradient measurement (PGM) was available from 61 arteries. Three radiologists evaluated all examinations independently in a blinded fashion. RESULTS: RAS was present in 26 arteries. On MRA, each reader identified 4 of 9 accessory renal arteries, a detection rate of 44%. The three readers correctly classified 22/25/22 of the 26 vessels with a significant gradient as > or =60% RAS and 31/25/32 of the 35 with no significant gradient as < 60% RAS on MRA. Interobserver agreement was substantial. MRA image quality was adequate for RAS evaluations in all patients. ROC curves indicated that MRA is an adequate method for evaluating RAS. When screening for RAS, a 50% diameter reduction cut-off is better than 60%. RAS with 40-80% diameter reductions accounted for 65% of discrepancies. CONCLUSION: MRA is an adequate method for evaluating RAS limited mainly by poor detection rate for accessory renal arteries.
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| 27. |
- Hellberg, Anders, et al.
(författare)
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A prolonged spinal cord ischaemia model in pigs. Passive shunting offers stable central haemodynamics during aortic occlusion
- 2000
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 19:3, s. 318-323
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: to evaluate the effect of a modified aortic shunt on central haemodynamic variables during experimental thoracic aortic occlusion in a prolonged spinal cord ischaemia model.MATERIAL AND METHODS: central haemodynamic variables were evaluated during aortic cross-clamping. In the shunt group (n=11), after the placement of proximal and distal aortic clamps, distal aortic perfusion was restored through an aortoiliac shunt via the left subclavian artery. In the no-shunt group (n=11), spinal cord ischaemia was achieved with only proximal aortic cross-clamping. The clamping time was 60 minutes in the shunt group and 30 minutes in the no-shunt group.RESULTS: in the no-shunt group, all animals needed inotropic support, vasodilators and buffers during the experiment. None of these drugs were needed in the shunt group. In the no-shunt group, cross-clamping caused a significant increase in mean arterial pressure and heart rate compared to baseline values. These variables were stable in the shunt group during aortic occlusion. In the reperfusion period cardiac output, heart rate and arterial pCO(2)were significantly higher in the no-shunt than in the shunt group.CONCLUSION: the present experimental spinal cord ischaemia model, using double aortic cross-clamping with shunt, offers improved central haemodynamics. This enables the study of prolonged selective spinal cord ischaemia without interaction from vasoactive drugs or systemic reperfusion.
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| 28. |
- Hellberg, Anders, et al.
(författare)
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Influence of low proximal aortic pressure on spinal cord oxygenation in experimental thoracic aortic occlusion
- 2001
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Ingår i: Journal of Cardiovascular Surgery. - 0021-9509 .- 1827-191X. ; 42:2, s. 227-231
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To evaluate the effect of low proximal aortic pressure on cerebrospinal fluid (CSF) oxygenation in an experimental thoracic occlusion model. METHODS: In nine pigs, continuous intrathecal pO(2), pCO(2) and pH monitoring was used during double descending thoracic aortic clamping following insertion of an aorto-aortic shunt. In five pigs, the shunt was connected to a citrated bag adjusted at approximately 40-45 cm above the heart for partial exsanguination in order to decrease mean proximal aortic pressure (MPAP) to below 50 mmHg. In four animals, sodium nitroprusside infusion was used for this purpose. RESULTS: Intrathecal pO(2) demonstrated a significant decrease from 4.9+/-2.1 to 2.9+/-2.4 kPa after 10 minutes of aortic cross-clamping. Lowering proximal aortic pressure caused a further significant decrease to 1.2+/-1.7 kPa (p<0.05). In seven pigs (5 in the exsanguination and 2 in the vasodilator group), restoration of mean proximal aortic pressure to 94.0+/-27.7 caused a recovery of CSF pO(2) from 1.2+/-1.9 to 2.8+/-3.0 (p<0.05). CONCLUSIONS: The results of this study demonstrate that MPAP which provides spinal cord perfusion through subclavian-vertebral arteries are crucial for maintenance of spinal cord oxygenation during thoracic aortic occlusion in this pig model.
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| 29. |
- Hellberg, Anders, et al.
(författare)
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Influence of segmental spinal cord perfusion on intrathecal oxygen tension during experimental thoracic aortic crossclamping
- 2000
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Ingår i: Journal of Vascular Surgery. - 0741-5214. ; 31:1 Pt 1, s. 164-170
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this study was to evaluate the possibility of identifying alterations in blood supply to the spinal cord during thoracic aortic crossclamping.METHODS: In 17 pigs, a multiparameter PO(2), PCO(2,) and pH sensor was introduced into the intrathecal space for continuous monitoring of cerebrospinal fluid (CSF) oxygenation during aortic crossclamping. An epidural laser Doppler probe was used to measure spinal cord flux. After insertion of an aortic shunt from the left subclavian to the left iliac artery and interruption of the right subclavian and lumbar arteries (L2-L5), the thoracic aorta just distal to the left subclavian artery was clamped for 60 minutes. By placement of the distal aortic crossclamping below the level of L1 in group A (n = 9 animals), perfusion of only the abdominal visceral arteries was maintained. In group B (n = 8 animals), the distal aortic crossclamping was above the level of T12, and thus some spinal cord perfusion was maintained through the aortic shunt.RESULTS: The significant decrease in CSF PO(2) was observed within 3 minutes after the placement of the proximal aortic crossclamping and was normalized in all animals after establishment of the shunt flow. In group A, distal aortic crossclamping caused a decrease in CSF PO(2) with at least 50% of the preclamping values within 3 minutes. The mean CSF PO(2) of 2.99 +/- 0.70 kPa at 60 minutes of distal aortic crossclamping in group B was significantly higher than in group A (0.11 +/- 0.11 kPa; P <. 001). In group A, PCO(2) measurements showed no significant changes in 3 minutes after distal aortic crossclamping but revealed significantly higher values at 30 and 60 minutes compared with group B. Spinal cord flux values showed similar changes as CSF PO(2) during the whole experiment in both groups.CONCLUSION: In this experimental model of aortic crossclamping, continuous CSF oxygen tension monitoring allows rapid detection of alterations in spinal cord circulation.
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| 30. |
- Hellberg, Anders, et al.
(författare)
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Monitoring of intrathecal oxygen tension during experimental aortic occlusion predicts ultrastructural changes in the spinal cord
- 2001
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Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier BV. - 0022-5223 .- 1097-685X. ; 121:2, s. 316-323
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the correlation between intrathecal PO2 and ultrastructural changes in the spinal cord during thoracic aortic occlusion in pigs. MATERIAL AND METHODS: In 18 pigs, online intrathecal oxygenation was monitored by a multiparameter Paratrend catheter (Biomedical Sensors, High Wycombe, United Kingdom) during 60 minutes' clamping of the proximal and distal descending thoracic aorta. The animals were randomly divided into 2 groups (A and B) depending on the level of distal aortic clamping. Distal aortic perfusion was restored through an aorto-iliac shunt, which also maintained low thoracic segmental perfusion of the spinal cord in group B. Perfusion-fixation technique was used before harvesting the spinal cord specimens, which later were evaluated with light and electron microscopy by an independent observer. Intrathecal parameters were interpreted as normal if PO2 was more than 0.8 kPa and PCO2 was less than 12 kPa, as intermediate ischemia if PO2 was 0.8 or less or PCO (2) was more than 12 kPa, and as absolute ischemia if PO2 was 0.8 or less and PCO2 was more than 12 kPa. RESULTS: Among 6 animals with ultrastructural changes of absolute spinal cord ischemia-reperfusion injury, 5 also had absolute ischemia according to variables derived by the Paratrend catheter. The 2 methods were in agreement in 3 of 5 animals with intermediate ischemia-reperfusion changes and in 5 of 6 animals with normal findings. The accuracy of cerebrospinal fluid PO2 and PCO2 to predict electron microscopy-verified intermediate or absolute ischemia-reperfusion injury was 94%. CONCLUSIONS: Monitoring of intrathecal PO2 after clamping of the descending aorta correlated with ultrastructural changes in the spinal cord in this pig model.
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| 31. |
- Hellman, Per, et al.
(författare)
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Surgical strategy for large or malignant endocrine pancreatic tumors
- 2000
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 24:11, s. 1353-1360
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Tidskriftsartikel (refereegranskat)abstract
- Endocrine pancreatic tumors (EPTs) are rare but have a remarkably better prognosis than adenocarcinoma of the pancreas. Patients with EPTs benefit from surgical and medical therapy, which may alleviate symptoms due to hormonal excess and increase survival. Patients with large or malignant EPTs with infiltrative disease may suffer from local complications, including gastrointestinal bleeding and obstruction and involvement of the superior mesenteric (SMV) and portal (PV) veins. Among 31 patients with operable and large or malignant EPTs, 7 had hormone-producing syndromes (insulin, glucagon), and 24 had clinically nonfunctioning EPTs. Surgery in these patients included vascular reconstruction of the SMV/PV (n = 4), resection of infiltrated adjacent organs (n = 5; stomach, transverse colon), or resection of concomitant liver metastases (n = 3). Four patients with conspicuously large insulinomas, and three with glucagonoma were successfully operated on with alleviation of hormonal symptoms. Among the 24 nonfunctioning EPTs, 5 patients had been explored earlier and their tumors judged inoperable due to locally invasive disease or misdiagnosis as pancreatic adenocarcinoma. The operations were performed with no mortality and low morbidity. We conclude that large and malignant EPTs with limited spread of disease may benefit from a combination of medical and surgical therapy.
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| 32. |
- Hierton, T., et al.
(författare)
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Long term follow-up of autologous vein grafts. 40 years after reconstruction for cystic adventitial disease
- 1995
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Ingår i: VASA. - 0301-1526 .- 1664-2872. ; 24:3, s. 250-252
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Tidskriftsartikel (refereegranskat)abstract
- Long term follow-up (38-41 years postoperatively) has been undertaken in three patients who were initially operated on with autologous reversed vein grafts due to cystic adventitial disease of the popliteal artery. The patients were evaluated clinically as well as with colour coded ultrasonography and phase-locked echo-tracking ultrasonography. One vein graft was occluded, the others were patent, without dilatation and with a compliance similar to that in the femoral artery. Autologous vein grafts below the groin are very durable.
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| 33. |
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| 34. |
- Karacagil, Sadettin, et al.
(författare)
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A modified technique of ultrasonic triplex scanning of the lower extremity arteries
- 1996
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Ingår i: Upsala Journal of Medical Sciences. - 0300-9734 .- 2000-1967. ; 101:1, s. 113-120
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Tidskriftsartikel (refereegranskat)abstract
- This study was undertaken to evaluate the utility of a modified technique of triplex scanning of the lower extremity arteries in 20 subjects without any clinical signs of arterial disease. The distal aorta and iliac arteries were examined with the subject in supine position and lying slightly on the opposite side. By moderate compression of the probe towards the psoas muscle and directing it over the iliac arteries with slight medial retraction of the abdomen, satisfactory visualization of the common and external arteries with 7.5 MHz high resolution imaging and a 5.6 MHz doppler probe were obtained in 56 of 80 segments (70%). In obese individuals it was necessary to use 5 MHz probe for satisfactory scanning of the aortic bifurcation and common iliac arteries. The distal superficial femoral, popliteal and tibioperoneal trunk segments were examined with the patient prone and the knee slightly flexed. Peak systolic, early diastolic reverse and late diastolic forward flow velocities were studied together with measurement of the arterial diemeters, which demonstrated wide variations. This study suggests that satisfactory scanning of the iliac and femoropopliteal arteries with the described technique can be achieved in the majority of subjects with a superficial high resolution probe. The combination of 7.5 MHz two-dimensional imaging with a 5.6 MHz pulsed wave Doppler probe offers optimal information of these arteries in nonobese individuals.
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| 35. |
- Karacagil, Sadettin, et al.
(författare)
-
Anastomotic rupture at the site of polytetrafluoroethylene (PTFE) and distal vein cuff of femoropopliteal bypass : Two case reports
- 2000
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Ingår i: Upsala Journal of Medical Sciences. - 0300-9734 .- 2000-1967. ; 105:3, s. 245-248
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Tidskriftsartikel (refereegranskat)abstract
- Two female patients, 63 and 78 years of age, underwent femoropopliteal bypass with polytetrafluoroethylene (PTFE) graft and distal vein cuff. They developed graft occlusion due to false aneurysm at the site of vein cuff during one and eight weeks after surgery, respectively. Improper suture technique or weak vein wall might lead to suture disruption leading to false aneurysm as presented in this article.
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| 36. |
- Karacagil, Sadettin, et al.
(författare)
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Comparative analysis of patency, limb salvage and survival in diabetic and non-diabetic patients undergoing infrainguinal bypass surgery
- 1995
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Ingår i: Diabetic Medicine. - 0742-3071 .- 1464-5491. ; 12:6, s. 537-541
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Tidskriftsartikel (refereegranskat)abstract
- In 92 diabetic and 175 non-diabetic patients undergoing 336 femoropopliteal or femorodistal bypass procedures, 1- and 3-year cumulative life-table patency, limb salvage, and survival rates were comparatively analysed. The peroperative mortality rate was significantly higher in diabetic patients (5% compared to 1.4%, p < 0.001). The cumulative graft patency rates were 61% at 12 months and 46% at 36 months in diabetic patients compared to 64 and 52% in non-diabetic patients. Significantly better patency rates were observed in limbs with good runoff compared to limbs with poor runoff in both groups. The limb salvage rates at 3 years were 70% in diabetic patients and 62% in non-diabetic patients. The survival rate at 3 years was significantly lower in diabetic patients, 62% compared to 86% in non-diabetic patients. Diabetic patients with poor runoff demonstrated a significantly lower survival rate after 36 months compared to diabetic patients with good runoff (48% and 74%, respectively). The results of this study demonstrate that the early and intermediate patency and limb salvage rates are similar in diabetic and non-diabetic patients. On the other hand the survival rate in diabetic patients, especially in those with poor distal runoff, is significantly lower than non-diabetic patients.
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| 37. |
- Karacagil, Sadettin, et al.
(författare)
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Composite polytetrafluoroethylene/vein bypass grafts : conventional distal vein segment of vein cuff?
- 1996
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1078-5884 .- 1532-2165. ; 12:3, s. 337-371
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To determine the current status of PTFE vein composite grafts, we reviewed our experience with 205 composite reconstructions and compared the results of conventional distal vein segment to that of distal vein cuff. DESIGN: Retrospective review. SETTING: Department of Surgery, University Hospital. PATIENTS AND METHODS: The series included 85 women and 102 men with a median age of 70. The indications for surgery were claudication in 30, rest pain in 71 and ulcer/gangrene in 103. The site of the distal anastomosis was the popliteal artery in 111 and crural artery in 94. The graft consisted of a proximal PTFE graft anastomosed to a distal segment of reversed saphenous vein in 169 or to a modified distal Miller cuff in 36 operations after 1992. RESULTS: Cumulative life table primary patency rates for the whole series at 12, 24 and 36 months were 39%, 32% and 25% respectively. Limbs with good run-off demonstrated significantly better patency rates compared to limbs with poor run-off (55% and 17% at 12 months, 35% and 11% at 36 months, p = 0.04). The patency rate of femorocrural grafts with poor run-off was only 4% at 12 months. The overall limb salvage rates at 12 and 36 months were 63% and 55%, respectively. Similar results were obtained in limbs with distal reversed vein segment and distal vein cuff. CONCLUSION: The results of this study suggest that for infrainguinal bypass grafting where the saphenous vein is unavailable, a composite PTFE-vein graft might be an acceptable alternative in limbs with good run-off. Although not a randomised study, the results using a distal reversed vein segment of a cuff were similar.
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| 38. |
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| 39. |
- Karacagil, Sadettin, et al.
(författare)
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Duplexundersökning av arteriella kärlgraft
- 2002
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Ingår i: Klinisk fysiologisk kärldiagnostik. - Lund : Studentlitteratur. - 9144021895 ; , s. 92-99
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 40. |
- Karacagil, Sadettin, et al.
(författare)
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Duplexundersökning av artärer i buken
- 2002
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Ingår i: Klinisk fysiologisk kärldiagnostik. - Lund : Studentlitteratur. - 9144021895 ; , s. 115-122
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 41. |
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| 42. |
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| 43. |
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| 44. |
- Karacagil, Sadettin, et al.
(författare)
-
Influence of twist on vein and PTFE graft hemodynamics : an ex vivo experimental study
- 1997
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Ingår i: Panminerva Medica (Testo stampato). - 0031-0808 .- 1827-1898. ; 39:2, s. 95-99
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In an ex vivo infusion model, the effect of different factors affecting the critical level of twist in vein and PTFE grafts was analysed. SETTING: University Hospital, Department of Surgery. EXPERIMENTAL DESIGN: Saline perfusion of grafts with various diameter and length under constant high (90 ml/min) and low (50 ml/min) flow rates against various peripheral resistance was performed. MEASURES: The pressure changes in the grafts were measured at increasing increments of twisting. RESULTS: The critical level of twist appears to be dependent on the diameter, length, stretching, status of peripheral resistance, amount of volume flow and the type of graft material, varying between 90 to more than 360 degrees. In vein grafts critical twisting appeared earlier with a decrease in diameter, shortening in length, high peripheral resistance, high flow rate and stretching. PTFE grafts especially with external spiral support were resistant to twist. CONCLUSIONS: These data suggest that the critical level of graft twist is dependent upon multiple factors and moderate or even high grade twist with especially externally supported PTFE grafts regardless of length and long mobilized vein grafts do not lead to hemodynamic changes. On the other hand total cessation of flow occurs at lower degrees of twist in stretched, short vein grafts.
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| 45. |
- Karacagil, Sadettin, et al.
(författare)
-
Lower extremity arterial reconstructions based on duplex scanning without preoperative angiography
- 1998
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Ingår i: Journal of Vascular Surgery. - 0741-5214 .- 1097-6809. ; 4:3, s. 99-102
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract The high accuracy of duplex scanning in the diagnosis of lower limb arterial insufficiency has prompted us to perform aortoiliac and infrainguinal reconstructions (n = 77) in a selected group of patients with atherosclerotic occlusive disease of the lower extremity as well as graft revisions. Duplex findings were in agreement with operative findings in all patients in regard to the selection of the proximal and distal sites of the bypass procedures. In conclusion, we recommend with caution that, in patients with satisfactory duplex examination, vascular surgical reconstructions for lower limb ischaemia can be safely performed without preoperative angiography.
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| 46. |
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| 47. |
- Karacagil, Sadettin, et al.
(författare)
-
Outcome of infrainguinal arterial bypass grafting in limbs with postthrombotic syndrome
- 1996
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Ingår i: Clinical and applied thrombosis/hemostasis. - : SAGE Publications. - 1076-0296 .- 1938-2723. ; 2:3, s. 192-195
-
Tidskriftsartikel (refereegranskat)abstract
- From among 336 infrainguinal bypass proce dures performed for treatment of atherosclerotic occlu sive disease, 27 patients with histories of deep venous thrombosis (DVT) were retrospectively analyzed with re gard to patency and limb salvage rates. In 25 patients, venous diagnosis was verified by antegrade phlebogra phy, which demonstrated postthrombotic changes in the deep venous system. Indications for infrainguinal bypass surgery were severe claudication (six patients), rest pain (nine patients), and nonhealing ulcer or gangrene (12 pa tients). Sixteen autologous saphenous vein grafts, six composite (PTFE-vein), and five prosthetic grafts were used. All 11 femorodistal bypass grafts occluded within 6 months compared to an 82% patency rate of femo ropopliteal bypasses. Among 16 femoropopliteal by passes, only one patient with poor runoff underwent lower leg amputation after bypass failure. On the other hand, all 11 patients with distal bypass underwent major amputation during the first 7 months. The dismal outcome of patients with previous DVT undergoing femorodistal bypass procedures in this small population might be due to the deleterious effect of venous outflow impairment on already limited distal runoff status due to severe athero sclerotic changes.
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| 48. |
- Karacagil, Sadettin, et al.
(författare)
-
Patterns of atherosclerotic occlusive disease of lower leg and pedal arteries in hypertensive patients undergoing infrainguinal bypass procedures
- 1995
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 15:1, s. 57-60
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyse the atherosclerotic involvement of lower leg and foot arteries in patients undergoing infrainguinal bypass grafting. SETTING: Department of Surgery, University Hospital. PATIENTS: Among 282 limbs (267 patients), fifty limbs belonged to hypertensive nondiabetics (Group A), 39 to hypertensive diabetics (Group B), 129 to normotensive nondiabetics (Group C) and 64 to normotensive diabetics (Group D). INTERVENTIONS: Femoropopliteal or femorodistal bypass procedures. MEASURES: Intraoperative postreconstruction serial angiography of the lower leg and foot arteries. RESULTS: Occlusion rate of two or three lower leg arteries was significantly higher among diabetics (Group B 77% and Group D 73%, respectively) compared to nondiabetics (Group A 56% and Group D 51%, respectively). It was similar in diabetic patients with or without hypertension. The incidence of having both foot arches (dorsal and plantar arch) intact was significantly higher in nondiabetic patients with hypertension (Group A). Only 5.8% of these patients demonstrated both deficient or occluded foot arches compared to 18% in Group B and 31% in Group C and 20% in Group D. CONCLUSION: Hypertension does not seem to contribute to the extent and severity of lower leg and foot vessel involvement in patients undergoing infrainguinal bypass surgery.
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| 49. |
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| 50. |
- Karacagil, Sadettin, et al.
(författare)
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Spontaneous internal carotid artery dissection : Review
- 1996
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Ingår i: International angiology : a journal of the International Union of Angiology. - 0392-9590. ; 15:4, s. 291-294
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Tidskriftsartikel (refereegranskat)abstract
- Spontaneous ICA dissection is an increasingly recognized cause of stroke especially in young adults. The most frequently reported site of involvement is the cervical part of the internal carotid artery (ICA). Although several primary arteriopathies have been related to the development of spontaneous ICA dissection the cause is not clear in most cases. The clinical picture varies from mild cerebral and/or cranial nerve dysfunction to a completed stroke. Angiography has been considered as gold standard in establishing diagnosis. Recently, duplex scanning has emerged as a powerful noninvasive diagnostic tool only in the initial assessment but in the serial follow-up of patients. Early diagnosis is essential as these lesions require anticoagulant treatment. Immediate heparinization is instituted after diagnosis, followed by oral anti-coagulation for at least six months. Surgical treatment is warranted in only few cases. Complete resolutions of the dissection is seen in at least 50% of cases. The risk of recurrent stroke remains low in patients discharged alive after spontaneous ICA dissection.
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