Bei 20 Hunden wurden Vesiko-Vaginal-Fisteln (10 Hunde) und Vesiko-Rektal-Fisteln (10 Hunde) angelegt und bei den überlebenden 14 Tieren die Fistel 8 Wochen danach mit Hilfe von lyophilisierter menschlicher Dura verschlossen. Bis auf ein Tier war der Fistelverschluss (bis zu einem Jahr Kontrollen) permanent. Die Dichtigkeit der entsprechenden Hohlorgane wurde klinisch, röntgenologisch und pathologisch-anatomisch bestätigt. Es wird weiterhin über die ersten drei klinischen Fälle berichtet.
23 patients were operated on between 3 and 24 hours (group 1) and between 2 and 14 days (group 2) after a stroke with a diagnosis of carotid obstruction. A retrospective study for patients of stage IIIa and IIIb showed that clinical and functional results of both groups correspond. The mortality of group 1 was slightly less than that of group 2. Group 1 showed the largest number of successful vascular reconstructions. Thus an early operation of stage IIIa and possibly IIIb seems indicated. In view of the high mortality (5 out of 6 patients) surgery cannot be recommended in stage IV.
A total of 384 supra-aortic branches were operated in 318 patients. Forty-four operations were carried out on 35 pa tients with unilateral stenosis and contralateral occlusion of the internal carotid artery (aci). Eighteen patients were classified in stage IV. The symptomatology was largely de termined by the occluded side (27 patients). In 23 cases only the stenosis was operated, in 3 cases only the occlu sion. Both sides were operated in 9 cases. The rate of mor tality within the first 30 days was 11.4 % (cerebral death: 2 patients, non-cerebral death: 2 patients). The rate of mortality within a time span of up to 10 years was 20 % (7 patients). Early results showed that the condition of one patient in stage III and 4 patients in stage IV had improved. Two pa tients deteriorated clinically, while the other 28 patients remained unchanged, although with some improvement in respect to stage II. Long-term results showed that only one patient of the surviving 24 patients had worsened clinically (2 years postoperatively), and 5 patients showed no improve ment An improvement in neurological condition was ob served in 18 patients. This retrospective study shows that although a higher risk is involved in surgical therapy of carotid stenosis and occlu sion than of carotid stenosis alone, it definitely provides better results than do all forms of conservative therapy. The revascularization of non-chronic occlusion thus can be successful.
Axillofemoral grafts (144 prostheses: 103 unilateral, 25 bifemoral = y-shaped, and 8 bilateral) were performed in a total of 136 patients with aortoiliac occlusion. The average patient was 69 years old. Surgery was indicated only in "high-risk patients" in either stage II (n = 7; walking distance until onset of pain less than 50 m), stage III (n = 55), or stage IV (n = 74). Early occlusion of the prosthesis occurred in 26 cases; 15 were treated successfully by remedial surgery. The total rate of infection after first and remedial operations was 9.7%. The amputation rate, both early and late, was 19%. The early results showed that 114 patients had reached stage II (walking distance until onset of pain over 100 m). The postoperative follow-up period of up to 116 months (average 27.6 months) revealed that the implanted prosthesis had remained patent in 80% of each group of patients at different postoperative intervals. This is extraordinary considering their length and course. Four fifths of the patients lived an average of 22 months, remaining in stage II without loss of limb(s); we believe it made their life more worth living. We conclude that axillofemoral grafts yield satisfactory results for a selective group, namely the "high-risk patient" with aortoiliac occlusion.
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