European journal of vascular surgery最新文献

Objectives:

To analyse the effect of an aggressive vascular reconstruction policy on the outcome of critical leg ischaemia in a defined population.

Design:

A retrospective survey of surgical in-hospital patient data related to population data in the study region over 22 years (1970–1991).

Setting:

Vasa Central Hospital district in Western Finland. The area is served by one Central Hospital and two District Hospitals.

Materials:

The population of 165 000 at the beginning of the study and 178 000 at the end of the study needing 977 interventions for chronic critical leg ischaemia (CLI), 397 for acute ischaemia and 313 for noncritical leg ischaemia.

Chief outcome measures:

Total and age-group related major amputation rates, mortality, rates of arterial interventions, limb salvage rate.

Main results:

The population > 65 years of age increased by 50% from 1970 to 1991. Major amputation rates increased 2.5 times from 1970 to 1981. The mean age at amputation increased from 71 to 78 years and at reconstruction from 68 to 74 years. The increase in numbers of reconstructions for CLI by 100% from 1980 onwards was associated with a reduction in amputation rate by 60% from 1983 to 1991. The 1- and 5-year survival rate after amputation was 55 and 20% and after reconstruction 83 and 45%. After reconstruction 1-, 3- and 5-year limb salvage rates were 83, 78 and 77% and limb salvage until death was 74%.

Conclusions:

With an aggressive reconstruction policy in CLI it is possible to reduce amputation rates with a reasonable mortality and morbidity even in patients in the 8th and 9th decade of life.

Percutaneous intentional extraluminal recanalisation (PIER) of the femoropopliteal artery is a new catheter technique to overcome long chronic occlusions. This technique was applied to 40 long chronic occlusions of the femoropopliteal segment. The mean length of the superficial femoral artery (SFA) occlusions was 16.9 cm, the mean length of the popliteal occlusions was 11.8 cm and the mean length of the femoropopliteal occlusions was 27.6 cm. Primary recanalisation success was 85%. Patency showed a significant correlation with poor initial angiographic result (p < 0.05). Life-time table analysis of the successful group demonstrated a primary clinical patency of 59% at 1 and 2 years and a secondary clinical patency of 71% at 1 year and 65% at 2 years. There were no serious complications related to this technique. PIER technique is simple and cost-effective, and shows a good initial success-rate with a promising 2 years clinical patency. This technique might be of importance for patients with a critical lower leg ischaemia, when there are contraindications for primary bypass surgery either from a technical or a general point of view.

Objectives:

To assess, in vivo, the loss of endothelial cells seeded in a Dacron graft at low, restricted arterial flow and at normal unrestricted flow.

Design and setting:

Laboratory animal study.

Materials:

Indium-111-oxine labelled endothelial cells were seeded in externally supported, preclotted Dacron grafts, inserted as interposition grafts in the carotid arteries of nine sheep. Activity (radioactivity) was measured, flow established, on one side unrestricted 120–180 ml/minute, and on the other restricted to 50 ml/minute by a distal clamp.

Outcome measures:

The reduction in activity over the grafts was measured for 2 hours.

Results:

There was an immediate loss of activity to around 80% and thereafter a lower rate of cell loss to around 50%. No difference could be demonstrated in the loss from low flow compared to high flow grafts. All grafts were patent. There was no difference in thrombus weights.

Conclusion:

No difference could be demonstrated in seeded endothelial cell loss from a Dacron graft in vivo at low flow (50 ml/minute) compared with unrestricted flow (120–180 ml/minute).

Endothelin-1 (ET-1) is a potent vasoconstrictive polypeptide produced from vascular endothelial cells. The effects of ischaemia, reperfusion, and exsanguination on plasma ET-1 levels were studied and compared in the mongrel dog after infrarenal aortic cross clamping. Ischaemia produced a trend toward increased ET-1 serum levels (p < 0.07 with Bonferroni correction) that did not reach significance. Plasma ET-1 levels were significantly increased during reperfusion and even further elevations were found following exsanguination. We found a 2–3 fold increase in ET-1 levels following reperfusion (Initial 3.19 ± 0.27 pg/ml vs. Reperfusion maximum 6.32 ± 0.72 pg/ml, Bonferroni p < 0.01). Haemorrhagic shock was associated with a 3–4 fold increase in ET-1 levels (Initial 3.19 ± 0.27 pg/ml vs. Exsanguination maximum 8.37 ± 0.97 pg/ ml Bonferroni p < 0.001). These data reveal that ET-1 is released during reperfusion and exsanguination and may mediate remote vascular events associated with infrarenal aortic cross clamping and acute blood loss.