K. Ktenidis

F. P. Weber Syrldrome Associated with a Brachial Artery Aneurysm A Case Report

Klippel-Trenaunay syndrome is characterized by the triad of unilateral port-wine heman giomas, varicose veins, and hypertrophy of bone and soft tissue affecting one or more limbs. The rare F. P. Weber syndrome describes the mentioned entity and additional arteriovenous malformations. The association of an arterial aneurysm with the F. P. Weber syndrome has never been described in the current literature. A case of a brachial artery aneurysm in a patient with F. P. Weber syndrome is presented and the etiology of arterial aneurysm combined with congenital vascular abnormalities is discussed.

Perioperative Monitoring in Carotid Surgery

From 1971 to 1991, 76 patients were operated on for lesions of aortic arch branches (83 surgical procedures). Surgical therapy and long term results will be presented. In 80.7 % of the procedures, extrathoracic surgical methods were performed, overwhelming as carotid-subclavian bypasses using knitted dacron grafts (6 mm and 8 mm, respectively). A transthoracic approach was used 19.3 % of the time. No patients died after operation and no ischemic neurological deficits occured. The cumulative survival rate was 92.81 % after three years and 84.16 % after seven. No failure occured within the first 30 days after operation. The early graft patency (up to one year) was 96.1 % and the late patency rate ranged 91.8 % (mean follow up of 83.2 months). In the subgroup with the transthoracic approach, the cumulative patency was 100 % after five years and ten years, respectively. A total of 91.6 % of the patients have been symptom-free and 8.4 % improved . The results verify that surgical procedures due to lesions of the aortic arch branches show very good long term patency results.

Transcranial cerebral oxymetry (TCO): a valid monitoring method during carotid surgery?

Present-day discussions amongst specialists show that carotid surgery has to stand up to constantly increasing demands. Apart from strict guidelines for surgical indications as well as involved surgical technique, the necessity of perioperative monitoring is increasingly stressed (5). The monitoring during carotid reconstructions is particularly demanded. The significance of this monitoring consists of evaluating of the clamping effect, determining the necessity of using a shunt, evaluating of the effectiveness of the shunt, timely recognition of intraoperative complications, and the insurance of operative quality.

Treatment of severe peripheral arterial and vasospastic disease of the upper extremity by spinal cord stimulation

Spinal cord stimulation (SCS) has been successfully introduced for treatment of severe peripheral arterial disease of the lower limbs. However, the effect of SCS for treatment of severe vasospastic disease (VD) and peripheral arterial disease (PAD) of the upper extremities remains uncertain. Therefore, the efficacy of SCS for pain reduction and increase of blood supply was studied in four patients with severe PAD and in six patients with VD of the upper limbs. Transcutaneous oxygen tension index (chest TcpO2/hand TcpO2), Doppler wrist pressure index (WPI), capillary microscopy (CM), and a patients pain score (PS) graded from 1 to 10 (1=no pain) were used as follow-up parameters. Pain reduction after SCS was excellent in all patients and remained significant throughout the follow-up period. TcpO2 index decreased significantly (2.01±0.79 prae-OP vs 1.57±0.62 at 18 months). Capillary microscopy improved regarding red blood cell velocity and capillary density. Doppler WPI remained unchanged throughout the course. The results demonstrate that treatment of severe PAD and VD by use of thoracic SCS reduces pain significantly in these patients and increases blood supply. SCS provides a successful method of treatment for refractory VD and PAD of the upper extremity.

Spinal cord stimulation in the treatment of Buerger’s disease

Buerger’s disease is a segmental, inflammatory occlusive disease primarily involving small and medium-sized arteries and veins of the extremity, affecting males who are in the third or fourth decade of life and heavy smokers.

Critical limb ischemia: definition, incidence and prevalence, pathophysiology and diagnostic management

The earliest classification, described by Fontaine in 1950’s (1) is based on signs and clinical symptoms, and is very useful in daily practice: stage I, asymptomatic or oligosymptomatic; stage II, intermittent claudication; stage III, ischemic pain at rest (forefoot); stage IV, ulceration or gangrene (inflammatory pain).

Spinal cord stimulation in non-reconstructable or daredevil reconstructable patients with critical limb ischemia

The Gate Theory of pain transmission in the dorsal horn of the spinal cord provided the foundation for the use of electrical stimulation for pain relief.

Intraoperative assessment of cerebral ischemia: somatosensory evoked potentials, transcranial Doppler and oxymetry

Present-day discussions amongst specialists show that carotid surgery has to stand up to constantly increasing demands. Apart from strict guidelines for surgical indications as well as involved surgical technique, the necessity of perioperative monitoring is increasingly stressed.

Spinal cord stimulation (SCS) in the treatment of non-reconstructable arterial occlusive disease of upper extremities

Ischemic vascular disease of the upper extremity is less common than peripheral arterial vascular disease of the lower limbs. Arterial occlusive vascular disease of the upper extremities as a result of severe generalized atherosclerotic disease represents a difficult therapeutic problem. In the presence of extensive distal atherosclerotic disease, arterial reconstruction is frequently impossible (15). Aggressive medical treatment has been the mainstay of treatment in these situations. Medical treatment, however, sometimes fails and tissue loss, dysfunctional limbs or major amputation may occur (16). The importance of the hand in daily living activities mandates aggressive therapeutic attempts.

Operative results after reconstruction of extracranial carotid artery aneurysms (ECAA)

Extracranial carotid aneurysm are uncommon, but their clinical significance has long been recognized. Indeed, surgical treatment like proximal ligation was first employed successfully in 1808 (2). In 1952 Dimtza introduced the reconstructive operation, but the first successful reconstruction (aneurysm resection with end-to-end anastomosis) was carried out by Shea in 1955 (2, 3, 4).