Vascular surgery最新文献

英文中文

Thrombolytic treatment of venous thromboembolism. 静脉血栓栓塞的溶栓治疗。

Vascular surgery

Pub Date : 1977-11-01 DOI: 10.1177/153857447701100601

V Gurewich

From the Vascular Laboratory, St. Elizabeth’s Hospital, Boston, Massachusetts. The objective of thrombolytic therapy is to accelerate the rate of clot lysis or to induce it when natural activation of the lytic system is inadequate. In deep vein thrombosis involving the lower extremities, reduction in the incidence of venous insufficiency is the major goal. Complete lysis of venous thrombi has been reported in 40%’ to 60%3 of streptokinase-treated patients, compared to about 10% of those treated with heparin. When thromboembolic occlusion involves other sites, such as the hepatic or renal veins or the pulmonary arteries, thrombolytic therapy may improve vital organ function or may even be life-saving. However it should be emphasized that the long-term clinical benefits of streptokinase or urokinase have not been proven. What has been demonstrated in clinical trials is that thrombolytic therapy is more effective than heparin in dissolving venous thrombi-1--5 and that these drugs significantly accelerate the rate of lysis of pulmonary emboli compared to heparin. 6

引用次数: 3

Experience with fibrinolytic therapy of vascular occlusive disease. 有血管闭塞性疾病的纤溶治疗经验。

Vascular surgery

Pub Date : 1977-11-01 DOI: 10.1177/153857447701100605

W L Warner

1. There may well be a place for streptokinase therapy in selected patients with chronic arterial occlusion, but the emphasis should be on developing information on selection criteria. 2. Efficacy and safety have been established for the use of streptokinase in occluded AV cannulae, but this may be more of historical than contemporary importance. 3. Although more investigation is required to define the role of lytic therapy in retinal vascular occlusion and in the hemolytic uremic syndrome, the preliminary results are encouraging and merit further attention.

1. 在某些慢性动脉闭塞患者中，链激酶治疗可能会有一定的应用，但重点应放在发展选择标准的信息上。2. 链激酶治疗闭塞的房室插管的有效性和安全性已得到证实，但这可能具有历史意义而非当代意义。3.虽然需要更多的研究来确定溶血疗法在视网膜血管闭塞和溶血性尿毒症综合征中的作用，但初步结果令人鼓舞，值得进一步关注。

引用次数: 1

Heparin and vascular endothelium. 肝素与血管内皮。

Vascular surgery

Pub Date : 1977-11-01 DOI: 10.1177/153857447701100602

H Engelberg

From the Cedars-Sinai Medical Center, Los Angeles, California. Research evidence has accummulated to indicate that endogenous heparin functions in the repair of injured vascular endothelium and that the fixation of injected exogenous heparin at the endothelial surface, and the many beneficial effects of heparin at this site, would minimize the harmful effects of atherogenic and thrombotic factors. This subject has both physiologic and clinical significance. Physiologically it is pertinent that in various species there are numerous mast cells immedi-

引用次数: 5

Considerations on venous thrombectomy. 静脉血栓切除术的注意事项。

Vascular surgery

Pub Date : 1977-11-01 DOI: 10.1177/153857447701100609

A Senn, B Nachbur

From the Clinic of Thoracic and Cardiovascular Surgery, University of Bern, Bern, Switzerland. We are all aware of the problems that arise from deep venous thrombosis: pulmonary embolism, invalidating postphlebitic syndromes a real social problem in the chronic stage, and loss of life and limb in the acute phase. Prevention of thrombosis is to be aimed at by all means. When venous thrombosis is established, all the therapeutic measures have to be applied: anticoagulation, elevation, and bandaging to avoid the above-mentioned complications. But the conservative methods alone cannot achieve the real goal of therapy. That goal is to reopen the main venous channels and thus to restore unimpeded venous backflow. Disobliteration of the obstructed veins can only be achieved by fibrinolysis or surgical thrombectomy, and therefore we favor

引用次数: 1

Selecting the therapeutic alternative for rehabilitating patients with occlusive arterial disease. 动脉闭塞性疾病患者康复治疗方案的选择。

Vascular surgery

Pub Date : 1977-09-01 DOI: 10.1177/153857447701100507

L W Friedmann

From the Department of Rehabilitative Medicine, Nassau County Medical Center, East Meadow, New York Choosing a therapeutic plan for a patient with occlusive arterial disease is clearly one of the vital functions of the physician and surgeon. That decision and the care which flows from it are the reasons the patient consults us. He does not consult us for the diagnosis, or to participate in our research or training programs. The criteria upon which our decision must be based depend first upon the complaints of the patient, then upon the patient’s general health, the state of the medical and surgical art, and the patient’s wishes concerning the disposition of his life and body. The decision must be based not upon what we are technically capable of doing and have a personal interest in doing, but on what we ought to do. An example of the latter deciding whether to reimplant a limb after severance by trauma. In most cases, even though we now have the techniques and the technical skill to perform the reimplantation, it is my experience that to do so is usually not in the patient’s best interests. There are four criteria by which to judge success in medical treatment.

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引用次数: 1

What constitutes proper evaluation for the patient with intermittent claudication? 如何对间歇性跛行患者进行适当的评估?

Vascular surgery

Pub Date : 1977-09-01 DOI: 10.1177/153857447701100502

R Lennihan, M Mackereth

Intermittent claudication is a well-recognized clinical entity with characteristic complaints and findings. The patient describes exertional leg discomfort brought on by a short walk. Calf, thigh, or hip muscles may be involved. The pain subsides during a brief rest and the individual can walk again. Peripheral pulses are reduced or absent, but otherwise the leg seems quite normal. On the basis of these simple features, a physician can readily establish the diagnosis of arterial insufficiency which for all practical purposes is due to atherosclerosis. Atherosclerosis itself is a manifestation of aging with involvement that may appear localized. Yet the disease process is often generalized with coronary, cerebral, or hypertensive manifestations. What, then, constitutes a proper evaluation for the patient with intermit-

引用次数: 0

Surgical treatment of vertebral artery insufficiency in patients with diagnosis of multiple sclerosis. 诊断为多发性硬化症的患者椎动脉功能不全的手术治疗。

Vascular surgery

Pub Date : 1977-09-01 DOI: 10.1177/153857447701100508

S A Hurvitz

Nine patients with signs and symptoms of vertebral-basilar artery insufficiency and with the diagnosis of multiple sclerosis experienced partial restoration of lost neurologic function with the revascularization of ischemic tissue of the hindbrain by an operation to correct partial extraluminal obstruction of the proximal segment of the first part of the vertebral artery. The selection of patients is dependent on preoperative angiography of the aortic arch with visualization of the vessels of the neck, the vertebral and the carotid arteries. There was no mortality and no significant morbidity among these patients.

本文报道9例以椎基底动脉供血不足为症状和体征并诊断为多发性硬化症的患者，通过手术矫正椎动脉第一部分近段部分腔外梗阻，实现后脑缺血组织血运重建，从而部分恢复失去的神经功能。患者的选择取决于术前主动脉弓血管造影以及颈部血管、椎动脉和颈动脉的可视化。在这些患者中没有死亡率和显著发病率。

引用次数: 4

Aortic and iliac graft fistulae. 主动脉和髂移植物瘘管。

Vascular surgery

Pub Date : 1977-09-01 DOI: 10.1177/153857447701100503

D C Jackson, W M Thompson, I S Johnsrude

Sixteen patients with aortic and iliac graft fistulae were diagnosed from a series of over 886 abdominal aortic reconstructive operations. A preoperative diagnosis was established in 12, eleven by radiographic studies. Angiography and barium intestinal studies were the most helpful. The two most important features in diagnosis are a high index of suspicion and an aggressive radiographic approach.

在886次腹主动脉重建手术中诊断出16例主动脉和髂移植物瘘。术前诊断12例，11例通过影像学检查确定。血管造影和肠钡餐检查是最有帮助的。诊断的两个最重要的特征是高度的怀疑指数和积极的放射学方法。

引用次数: 6

Tube graft replacement of the suprarenal aorta with implantation of the superior mesenteric artery. 用肠系膜上动脉植入术置换肾上主动脉。

Vascular surgery

Pub Date : 1977-09-01 DOI: 10.1177/153857447701100505

P A Rubio, F J Reul

The superior mesenteric artery was successfully implanted to a tube graft replacement of the suprarenal abdominal aorta after a gunshot wound. Although injuries to the abdominal aorta carry a high mortality, adequate management and prompt operation can reduce the mortality rate. In cases like this one the ingenuity of the surgeon is at stake, because arterial anastomoses are not always possible to their natural origin. Death from aortic injuries is most commonly caused by hemorrhage and exsanguination, so appropriate measures must be taken as soon as the diagnosis is made to avoid this possibility. Also, patients should not be hypotensive for any long time, so transfusion should be timed carefully, especially when the aortic clamps are being removed.

在枪伤后，肠系膜上动脉被成功地植入到肾上腹主动脉的移植管中。虽然腹主动脉损伤死亡率很高，但适当的处理和及时的手术可以降低死亡率。在这种情况下，外科医生的聪明才智就会受到威胁，因为动脉吻合术并不总是能够回到其自然起源。主动脉损伤导致的死亡最常见的原因是出血和失血，因此诊断后必须立即采取适当措施以避免这种可能性。此外，患者不应长期处于低血压状态，因此输血的时机应谨慎，特别是在移除主动脉夹的时候。

引用次数: 1

Cystic adventitial disease of the popliteal artery. 腘动脉囊性外膜病。

Vascular surgery

Pub Date : 1977-09-01 DOI: 10.1177/153857447701100504

J Lau, H S Kim, R Carcia-Rinaldi

A 35-year-old man was admitted to the Ben Taub General Hospital for evaluation of increasing claudication of the right leg. His symptoms had begun a year before admission and had progressed to the point where he required crutches to walk. He had no history of trauma to his right leg, denied claudication of all other extremities, and had no symptoms of cardiac disease or cerebrovascular insufficiency. Physical examination was normal except for absent popliteal and distal pedal pulses in the right leg. The right foot was cooler than the left. Translumbar aortography revealed a normal aorta and iliac arteries. The

引用次数: 6

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