J. Tautenhahn

Ruptured infrarenal aortic aneurysm--a critical evaluation.

Background: Objective evaluation of the management of patients with ruptured infrarenal aortic aneurysm in emergency situations has been described rarely. Patients and methods: Fifty-two consecutive patients with ruptured infrarenal aortic aneurysm (mean age, 70.3 years; range, 56–89 years; SD 7.8) were admitted between January 1993 and March 1998. Emergency protocols, final reports, and follow-up data were analyzed retrospectively. APACHE II scores at admission and fifth postoperative day were assessed. Results: The time between the appearance of first symptoms and the referral of patients to the hospital was more than 5 hours in 37 patients (71%). Thirty-eight patients (71%) had signs of shock at time of admission. Ultrasound was performed in 81% of patients as the first diagnostic procedure. The most frequent site of aortic rupture was the left retroperitoneum (87%). Intraoperatively, acute left ventricular failure occurred in four patients, and cardiac arrest in two others. The postoperative course wa...BACKGROUND Objective evaluation of the management of patients with ruptured infrarenal aortic aneurysm in emergency situations has been described rarely. PATIENTS AND METHODS Fifty-two consecutive patients with ruptured infrarenal aortic aneurysm (mean age, 70.3 years; range, 56-89 years; SD 7.8) were admitted between January 1993 and March 1998. Emergency protocols, final reports, and follow-up data were analyzed retrospectively. APACHE II scores at admission and fifth postoperative day were assessed. RESULTS The time between the appearance of first symptoms and the referral of patients to the hospital was more than 5 hours in 37 patients (71%). Thirty-eight patients (71%) had signs of shock at time of admission. Ultrasound was performed in 81% of patients as the first diagnostic procedure. The most frequent site of aortic rupture was the left retroperitoneum (87%). Intraoperatively, acute left ventricular failure occurred in four patients, and cardiac arrest in two others. The postoperative course was complicated significantly in 34 patients. The overall mortality rate was 36.5% (n = 19). In 35 patients, APACHE II score was assessed, showing a probability of death of more than 40% in five patients and lower than 30% in 17 others. No patient showing probability of death of above 75% at the fifth postoperative day survived (n = 7). CONCLUSIONS Ruptured aortic aneurysm demands surgical intervention. Clinical outcome is also influenced by preclinical and anesthetic management. The severity of disease as well as the patients prognosis can be approximated using APACHE II score. Treatment results of heterogeneous patient groups can be compared.

Diagnosis and management of trauma and iatrogenic induced arteriovenous fistulas in the neck.

Trauma-induced arteriovenous (av) communications in the cervical region involving the external carotid artery and the jugular vein are exceptionally rare. Moreover, an iatrogenic av fistula between the vertebral artery and the vein after insertion of a venous catheter into the internal jugular vein is described. The discussion includes the clinical presentation, diagnosis and management of such rare av fistulas.Trauma-induced arteriovenous (av) communications in the cervical region involving the external carotid artery and the jugular vein are exceptionally rare. Moreover, an iatrogenic av fistula between the vertebral artery and the vein after insertion of a venous catheter into the internal jugular vein is described. The discussion includes the clinical presentation, diagnosis and management of such rare av fistulas.

Simultaneous treatment of Salmonella typhimurium-induced symptomatic abdominal aortic aneurysm with associated spondylitis

Bacterially infected aneurysms associated with local spondylitis, while representing a potentially fatal clinical picture, are an operative challenge for vascular surgeons and orthopaedic surgeons alike. In this context, the concurrent occurrence of an infection with Salmonella typhimurium as a causative agent is a rare observation. The case report gives an outline of the simultaneous vascular and orthopaedic surgical procedure. The subrenal mycotic aneurysm was removed in a first step. The continuity of the aorta was restored centrally through an autogenic aortic graft with caudal anastomosis to a dacron vascular prosthetic tube. Initially, the latter was chosen of excessive length so as to facilitate the orthopaedic surgeons approach. Upon completion of stabilising surgery of the vertebral column, the dacron tube was reduced in length as necessary and the surgical area was enclosed with an omentum majus plastic mesh. No complications were noted during the 18-month follow-up period.Simultaneous treatment of Salmonella typhimurium-induced symptomatic abdominal aortic aneurysm with associated spondylitis. Bacterially infected aneurysms associated with local spondylitis, while representing a potentially fatal clinical picture, are an operative challenge for vascular surgeons and orthopaedic surgeons alike. In this context, the concurrent occurrence of an infection with Salmonella typhimurium as a causative agent is a rare observation. The case report gives an outline of the simultaneous vascular and orthopaedic surgical procedure. The subrenal mycotic aneurysm was removed in a first step. The continuity of the aorta was restored centrally through an autogenic aortic graft with caudal anastomosis to a dacron vascular prosthetic tube. Initially, the latter was chosen of excessive length so as to facilitate the orthopaedic surgeons approach. Upon completion of stabilising surgery of the vertebral column, the dacron tube was reduced in length as necessary and the surgical area was enclosed with an omentum majus plastic mesh. No complications were noted during the 18-month follow-up period.

Zur Problematik des akuten arteriellen Verschlusses als Folge einer heparininduzierten Thrombozytopenie

Ein heparininduzierter GefasBverschluss ist eine seltene aber schwere Nebenwirkung der Heparingabe. Dieser Zusammenhang wurde initial bei 10 von 13 Patienten in dem von uns untersuchten Krankengut verkannt. Obwohl bereits Komplikationen eingetreten waren, wurde die Heparindosis in diesen Fallen weiter erhoht. Neben einem klinisch begrundeten Verdacht basiert die Diagnose auf regelmaBigen Kontrollen der Thrombozytenzahlen. Zur Sicherung des Verdachts konnen der Aggregationstest, der Serotonin Freisetzungstest, der heparininduzierte Plattchenaktivierungs (HIPA)-Test und der Plattchenfaktor IV/ Heparin-Immunassay (ELISA) verwendet werden. Bei einem unserer Patienten zeigte der HIPA-Test ein falsch negatives Ergebnis. Eine positive Kreuzreaktion mit niedermolekularen Heparinen fanden wir in allen Untersuchungen. Auch bei sechs Kranken (46 %) bestand eine positive Kreuzreaktion mit dem Heparinoid Danaproid-Natrium (Orgaran). Neben der gefaschirurgischen Revaskularisation wurde bei funf Patienten die medikamentose Antikoagulation mit Hirudin oder Danaproid-Natrium durchgefiihrt. Insgesamt verstarben drei Patienten und zwei weitere mussten amputiert werden.

Die akute Aortendissektion — eine seltene Ursache der kompletten Ischämie des Armes

Die akute Armischamie als einziges klinisches Zeichen fur eine Aortendissektion Typ Stanford Aist sehr selten. Ohne die typischenSymptome kann diese leicht ubersehen werden. Anhand eines Fallbeispieles berichten wir uber das abweichende chirurgische Procedere einer erst intraoperativen Diagnosestellung. 1m Einzelfall ist daher bei einem frustranen Embolektomieversuch mit intraoperativ auffalligem „federnden“ Widerstand des Fogarty-Katheters an eine dissektionsbedingte Ischamie zu denken.

Ergotismus,eine seltene Ursache des arteriellen Gefäßverschlusses der unteren Extremitäten

Der Ergotismus ist eine seltene Ursache fur die arterielle Minderdurchblutung der unteren Extremitat. Wir berichten kasuistisch uber dieses Krankheitsbild hervorgerufen durch den chronischen Abusus ergotaminhaltiger Praparate im Rahmen einer Migranebehandlung.

Die einzeitige Behandlung eines durch Salmonella typhimurium induzierten symptomatischen Bauchaortenaneurymas mit Spondylitis@@@Simultaneous treatment of Salmonella typhimurium-induced symptomatic abdominal aortic aneurysm with associated spondylitis

Bacterially infected aneurysms associated with local spondylitis, while representing a potentially fatal clinical picture, are an operative challenge for vascular surgeons and orthopaedic surgeons alike. In this context, the concurrent occurrence of an infection with Salmonella typhimurium as a causative agent is a rare observation. The case report gives an outline of the simultaneous vascular and orthopaedic surgical procedure. The subrenal mycotic aneurysm was removed in a first step. The continuity of the aorta was restored centrally through an autogenic aortic graft with caudal anastomosis to a dacron vascular prosthetic tube. Initially, the latter was chosen of excessive length so as to facilitate the orthopaedic surgeons approach. Upon completion of stabilising surgery of the vertebral column, the dacron tube was reduced in length as necessary and the surgical area was enclosed with an omentum majus plastic mesh. No complications were noted during the 18-month follow-up period.Simultaneous treatment of Salmonella typhimurium-induced symptomatic abdominal aortic aneurysm with associated spondylitis. Bacterially infected aneurysms associated with local spondylitis, while representing a potentially fatal clinical picture, are an operative challenge for vascular surgeons and orthopaedic surgeons alike. In this context, the concurrent occurrence of an infection with Salmonella typhimurium as a causative agent is a rare observation. The case report gives an outline of the simultaneous vascular and orthopaedic surgical procedure. The subrenal mycotic aneurysm was removed in a first step. The continuity of the aorta was restored centrally through an autogenic aortic graft with caudal anastomosis to a dacron vascular prosthetic tube. Initially, the latter was chosen of excessive length so as to facilitate the orthopaedic surgeons approach. Upon completion of stabilising surgery of the vertebral column, the dacron tube was reduced in length as necessary and the surgical area was enclosed with an omentum majus plastic mesh. No complications were noted during the 18-month follow-up period.

Iatrogene Gefäßläsionen als Folge therapeutischer bzw. invasiv-diagnostischer Maßnahmen

When studying the etiology of trauma-induced injury, it is apparent that there is an increasing incidence of iatrogenic vascular lesions. One reason for this phenomenon is that many vascular procedures, including invasive catheteral procedures, minimally invasive interventions and osteosynthetic operations, are being performed more frequently. In such emergent clinical situations, prompt and appropiate diagnostic evaluation and reconstruction of affected vessels are required for a successful outcome.

Ein neues Therapiekonzept bei der Behandlung der peripheren arteriellen Verschlußkrankheit durch Übernahme der Kathetertechniken in den Operationssaal

Die perkutanen und endovascularen Kathetertechniken sind etablierte Behandlungsverfahren und konnen alternativ oder erganzend zu konventionellen gefaschir. OP-Techniken eingesetzt werden. Die modernen fahrbaren DSA-Anlagen erlauben eine qualitativ hochwertige bildgebende Diagnostik und Datenverarbeitung. Nach Erlernen der Kathetertechniken kann der Gefaschirurg meist auf: 1. eine prastationare ambulante Diagnostik mit einer sicheren Indikationsstellung, 2. eine stationare, auch intensivmediz. Behandlung mit dem Angebot aller Therapieverfahren, einschl. Kombinationsbehandlungen und der Behandlung von moglichen Komplikationen, 3. seine Kenntnisse und Erfahrungen der Gefasmorphologie und 4. auf eine poststationare Kontrolle und Weiterbehandlung verweisen. Es werden die ersten Ergebnisse publiziert.