10)18llighi, is usual1ly striking hen. there is nio lipid in the' veies and ulmltiioniarv arteries,xwhere lixpoxia is imarked. Hence intuliial I)erIneabilitx dloe to hivpoxia or C(0 exposure muist be one of the nminor aggravatinlg factors in etiology of vaseular dlisease, comparable to dlriniking soft rather thiani hard water. If \strup s hly)othesis xvas valid, lipid deposition shotuld I)egil in coronary veinis, xw here oxygen tenlsiotn is lowver thlan in ant>s other vessel, and be least in the svstemic arteries. Ohvviouslv arterial pressure is the most sigrnificant aggravatinig factor andl Ioxx pressure, protects veinls and pulmonary arteries. Butt xxithouit lipid levels highi for anx species, there cani ibei o intimiial lipid accumiuitilation. In miiani the riormal lexvel is under 180 for cholesterol, 100 for trigl ceeridle. Julst as there cani he Hio tuberculosis xvithouit the Koch bacillus, there can be 110 xanitlhomas of the skini x ithout plasrma cholesterol over three or fouir hliunidlred milligrarns per deciliter, i \xailitlliomas of the intimia xithouit 1evels lhalf as hligil.WLV LIAi DocK, M.D. Transfemoral Cardiac Pacing and Phlebitis'l'o the I{ditor.In the Januiiary issue (f Circulationi, Nleister et al.' expressed concern tilat phlebitis miight complicate prolonigeCl pacing from the trallsfernoral approacth. Hence, proplIvlac tic '--mini dose-' heparin xxas litilizetl to prevenit the corm plication of tllronl)op)hlel)itis.After reviewxing our experience w ith tranisfemoral carcliae pacing in 80 consecutive inorn-aniticoagtulatecl patients, xw e concluded that thrombophlebitis of the catheterized leg is a clear hlazard(of the procedure. TIhe 80 patienlts that xvere referred for cardliac pacing hlacl aii average age oIf 75 'vears and irielnclued 44 men ancl 36 xxomenO . Temporarv transvenous pac'ig as performed via the transfernoral route xith a number 5 bipolar catheter.(riticallx ill patients had temporary pacemilaker itnsertioni in the cardiiae catheterization laloratorv or in the Intenisive Care tl'liit. In the latter area the procedlre xxas facilitatedl by the ust' (If a fluoroseopiic bed arinl a portable X-ray nmachliine equipped vwith ani imnage intensifier.In the entire groulp) of cathetetrization, five coniplicatioiis (6.3W) wereI noted. One episodle of femoral phlebitis occurred anoting the 4 1 patients in whom a tranisfernoral catheter was inlsertedel for less than twenity-four liotirs. Phlebitis occurred in the catheterized leg of this patintit after inadvertent femrnral arte,ry puncture restilted inl a sigrnificaiit hermatoma.In addition, fouir (f 39 patients developed phlebitis xxwhen transfemoral pacing catheters were left in position from onie to eleven tlaxs. l)eep calf thromrbophlebitis xas evident in oute j)atien1t th-ree clays after reinoval of a catheter which hatl Ibeen in ponsiti in for nine daIs. Femoral thromrbophlebitis of the cathet'erized leg (occulrrcdl in an additional three patients from temporarypacers xxhich had been placed for three to fouir (lavs. The complication wa...
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