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Sample records for mammary artery graft

  1. Antegrade filling of mammary graft by inappropriately revascularized artery.

    PubMed

    Hosseini, Saeid; Samiei, Niloufar; Bassiri, Hossein Ali; Peighambari, M Mehdi; Peighambari, Shadi; Mestres, Carlos-A

    2016-01-01

    A 57-year-old man underwent multiple-arterial revascularization including a sequential left internal mammary artery graft to the diagonal branch and left anterior descending coronary artery. Twenty-one months later, repeat angiography due to a new onset of chest discomfort confirmed string sign and nonfunctional proximal left internal mammary artery, and antegrade filling of the distal leg of the sequential graft and the left anterior descending artery through the diagonal branch. This is a known but uncommon angiographic finding that confirms the importance of eventual competitive flow. PMID:24848517

  2. Physiological adaptability: the secret of success of the internal mammary artery grafts.

    PubMed

    Singh, R N; Beg, R A; Kay, E B

    1986-03-01

    Angiographic studies in 3 patients illustrate the physiological adaptability of internal mammary artery (IMA) grafts. Intact vascular smooth muscle permits the IMA grafts to retain a flexible caliber and a blood flow dictated by myocardial demands in the distribution of the grafted coronary artery. This physiological nature may be one of the reasons for their continued patency regardless of whether they are grafted to large or small coronary arteries. Further, this adaptable behavior permits use of the IMA even if its distal lumen is smaller than that of the recipient coronary artery, provided the anastomosis can be safely performed and the demand for flow is present. PMID:3954493

  3. Coronary steal through anomalous internal mammary artery graft. Treated by ligation without sternotomy.

    PubMed Central

    Hijazi, A; Mazhar, R; Odeh, S; Qunnaby, I

    1996-01-01

    A patient who had undergone adequate coronary revascularization with a left internal mammary artery graft to the left anterior descending coronary artery and with saphenous vein grafts to the right coronary artery and to the 1st and 2nd obtuse marginal branches presented with early-onset recurrent angina. A repeat angiogram showed an abnormally large branch arising from the very proximal segment of the left internal mammary artery and supplying the whole lateral chest wall via many intercostal tributaries. Relief of symptoms was achieved by ligation of this branch, and the patient remains symptom free more than 6 years after the procedure. Images PMID:8885107

  4. Barriers to the universal adoption of bilateral internal mammary artery grafting.

    PubMed

    Umakanthan, Jeremiah; Jeyakumar, Panch; Umakanthan, Branavan; Jeyakumar, Nikeshan; Senthilkumar, Nadarajah; Saraswathy, Mathioli R; Umakanthan, Padminidevi; Umakanthan, Janani; Sial, Tamoor; Abrina, Sofia; Buendia, Frances M; Pan, Irene; Kamath, Ramadas K; Pathmarajah, Canagaratnam; Sivalingam, Kanagaratnam; Nathan, Shan A; Sunder, Shun K; Mahendra, Tom; Umakanthan, Ramanan

    2015-04-01

    The left internal mammary artery (LIMA) graft is considered the "gold standard" of coronary artery bypass grafting (CABG). This conduit provides increased survival, symptomatic relief, increased freedom from myocardial infarction, and increased freedom from re-intervention when compared to saphenous venous grafting. It has a remarkable long term patency rate with clinical and angiographic outcomes that are unmatched by other conduits. Given the fact that patients often require more than one graft during a coronary revascularization procedure, the prospect of bilateral internal mammary artery (BIMA) grafting has been very appealing to some surgeons. BIMA grafting has been extensively studied via multiple retrospective and prospective cohort studies and findings have indicated that BIMA grafting can have an increased survival benefit when compared to LIMA grafting alone. As a result, this technique has accrued increasing popularity over the course of the last decade. Yet, questions still remain on whether BIMA grafting is the optimal treatment modality for patients in terms of long-term prognosis. There is limited data at the present time from randomized controlled trials and only 4-12% of CABGs performed today utilize BIMA grafting. Concerns regarding perioperative complications, which patient subsets are at higher risks for complications from the technique, and the technical challenges involved in utilizing and teaching the technique have limited its widespread use. PMID:25644543

  5. Assessment of internal mammary artery and saphenous vein graft patency and flow reserve using transthoracic Doppler echocardiography

    NASA Technical Reports Server (NTRS)

    Chirillo, F.; Bruni, A.; Balestra, G.; Cavallini, C.; Olivari, Z.; Thomas, J. D.; Stritoni, P.

    2001-01-01

    OBJECTIVE: To investigate transthoracic Doppler echocardiography in the identification of coronary artery bypass graft (CABG) flow for assessing graft patency. DESIGN: The initial study group comprised 45 consecutive patients with previous CABG undergoing elective cardiac catheterisation for recurrent ischaemia. The Doppler variables best correlated with angiographic graft patency were then tested prospectively in a further 84 patients (test group). SETTING: Three tertiary referral centres. INTERVENTIONS: Flow velocities in grafts were recorded at rest and during hyperaemia induced by dipyridamole (0.56 mg/kg/4 min), under the guidance of transthoracic colour Doppler flow mapping. Findings on transthoracic Doppler were compared with angiography. MAIN OUTCOME MEASURES: Feasibility of identifying open grafts by Doppler and diagnostic accuracy for Doppler detection of significant (>/= 70%) graft stenosis. RESULTS: In the test group the identification rate for mammary artery grafts was 100%, for saphenous vein grafts to left anterior descending coronary artery 91%, for vein grafts to right coronary artery 96%, and for vein grafts to circumflex artery 90%. Coronary flow reserve (the ratio between peak diastolic velocity under hyperaemia and at baseline) of < 1.9 (95% confidence interval 1.83 to 2.08) had 100% sensitivity, 98% specificity, 87.5% positive predictive value, and 100% negative predictive value for mammary artery graft stenosis. Coronary flow reserve of < 1.6 (95% CI 1.51 to 1.73) had 91% sensitivity, 87% specificity, 85.4% positive predictive value, and 92.3% negative predictive value for significant vein graft stenosis. CONCLUSIONS: Transthoracic Doppler can provide non-invasive assessment of CABG patency.

  6. Coronary Artery Bypass Grafting

    MedlinePLUS

    ... from the NHLBI on Twitter. What Is Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is ... bypass multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of ...

  7. Role of gender, smoking profile, hypertension, and diabetes on saphenous vein and internal mammary artery endothelial relaxation in patients with coronary artery bypass grafting

    PubMed Central

    Muir, Andrew Duncan; McKeown, Pascal Patrick

    2010-01-01

    The aim of this study was to investigate if there was a link between the relaxant responses in saphenous vein (SV) and internal mammary artery (IMA) segments obtained from patients undergoing coronary artery bypass grafting and the patients' cardiovascular risk factors. Endothelium-(in)dependent relaxations were assessed by isometric tension studies. Endothelium-dependent relaxant responses were greater in IMA than SV and gender, smoking profile and history of hypertension but not diabetes appeared to have an influence on these responses. Endothelium-dependent relaxant responses in both IMA and SV were greater in males than females and relaxant responses in IMA segments were attenuated in smokers, whereas the opposite effect was noted in SV segments. Endothelium-dependent relaxant responses in SV were lower in patients with hypertension. Endothelium-independent relaxant responses were greater in IMA than SV. Endothelium-independent responses were greater in male patients' SV segments, but gender played no role in IMA segments. Diabetes had no effect on endothelium-independent responses in IMA, but SV segments from diabetic patients had greater responses. Neither conduit's endothelium-independent response was affected by hypertensive status. The relationship between risk factor status and endothelial responses is multifactorial, with gender, hypertension, diabetes and smoking status all contributing. PMID:20716944

  8. Role of gender, smoking profile, hypertension, and diabetes on saphenous vein and internal mammary artery endothelial relaxation in patients with coronary artery bypass grafting.

    PubMed

    Muir, Andrew Duncan; McKeown, Pascal Patrick; Bayraktutan, Ulvi

    2010-01-01

    The aim of this study was to investigate if there was a link between the relaxant responses in saphenous vein (SV) and internal mammary artery (IMA) segments obtained from patients undergoing coronary artery bypass grafting and the patients' cardiovascular risk factors. Endothelium-(in)dependent relaxations were assessed by isometric tension studies. Endothelium-dependent relaxant responses were greater in IMA than SV and gender, smoking profile and history of hypertension but not diabetes appeared to have an influence on these responses. Endothelium-dependent relaxant responses in both IMA and SV were greater in males than females and relaxant responses in IMA segments were attenuated in smokers, whereas the opposite effect was noted in SV segments. Endothelium-dependent relaxant responses in SV were lower in patients with hypertension. Endothelium-independent relaxant responses were greater in IMA than SV. Endothelium-independent responses were greater in male patients' SV segments, but gender played no role in IMA segments. Diabetes had no effect on endothelium-independent responses in IMA, but SV segments from diabetic patients had greater responses. Neither conduit's endothelium-independent response was affected by hypertensive status. The relationship between risk factor status and endothelial responses is multifactorial, with gender, hypertension, diabetes and smoking status all contributing. PMID:20716944

  9. Atherosclerosis and the internal mammary arteries

    SciTech Connect

    Singh, R.N.

    1983-06-01

    One hundred and fifty patients with coronary artery disease (CAD), 14 (9.3%) of whom had coexisting peripheral vascular disease, underwent bilateral internal mammary arteriography to study the incidence and extent of atherosclerosis in these vessels. Significant atherosclerosis of the internal mammary arteries (IMAs) was present in three patients (2%), of whom one had coexisting peripheral vascular disease. Lesions in the IMAs were found either proximally, close to the origin or distally, around the terminal bifurcation. Six of the 14 patients with peripheral vascular disease (4% of total subjects) had significant atherosclerosis of the brachiocephalic arteries. Atherosclerotic involvement of the IMA is very unusual and rarely interferes with the use of these vessels for coronary bypass. More common, however, is atherosclerosis of the subclavian arteries, a contraindication for IMA grafting if the lesion is proximal to the IMA origin.

  10. Bilateral internal thoracic artery grafting

    PubMed Central

    2013-01-01

    The effectiveness of the left internal mammary artery graft to the anterior descending coronary artery as a surgical strategy has been shown to improve the survival rate and decrease the risk of adverse cardiac events in patients undergoing coronary bypass surgery. These clinical benefits appear to be related to the superior short and long-term patency rates of the internal thoracic artery graft. Although the advantages of using of both internal thoracic arteries (ITA) for bypass grafting have taken longer to prove, recent results from multiple data sets now support these findings. The major advantage of bilateral ITA grafting appears to be improved survival rate, while the disadvantages of complex ITA grafting include the increased complexity of operation, and an increased risk of wound complications. While these short-term disadvantages have been mitigated in contemporary surgical practice, they have not eliminated. Bilateral ITA grafting should be considered the procedure of choice for patients undergoing coronary bypass surgery that have a predicted survival rate of longer than ten years. PMID:23977627

  11. Mammary artery harvesting using the Da Vinci Si robotic system

    PubMed Central

    Canale, Leonardo Secchin; Bonatti, Johannes

    2014-01-01

    Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. Totally endoscopic coronary artery bypass graft surgery has become reality in many centers as a safe and effective alternative to conventional surgery in selected patients. Internal mammary artery harvesting is the initial part of the procedure and should be performed equally safely if one wants to achieve excellence in patency rates for the bypass. We here describe the technique for mammary harvesting with the Da Vinci Si robotic system. PMID:24896171

  12. Saphenous vein graft vs. radial artery graft searching for the best second coronary artery bypass graft

    PubMed Central

    Al-Sabti, Hilal Ali; Al Kindi, Adil; Al-Rasadi, Khalid; Banerjee, Yajnavalka; Al-Hashmi, Khamis; Al-Hinai, Ali

    2013-01-01

    Coronary artery bypass grafting (CABG) was first used in the late 1960s. This revolutionary procedure created hope among ischemic heart disease patients. Multiple conduits are used and the golden standard is the left internal mammary artery to the left anterior descending artery. Although all approaches were advocated by doctors, the use of saphenous vein grafts became the leading approach used by the majority of cardiac surgeons in the 1970s. The radial artery graft was introduced at the same time but was not as prevalent due to complications. It was reintroduced into clinical practice in 1989. The procedure was not well received initially but it has since shown superiority in patency as well as long-term survival after CABG. This review provides a summary of characteristics, technical features and patency rates of the radial artery graft in comparison with venous conduits. Current studies and research into radial artery grafts and saphenous vein grafts for CABG are explored. However, more studies are required to verify the various findings of the positive effects of coronary artery bypass grafting with the help of radial arteries on mortality and long-lasting patency. PMID:24198449

  13. [Angina pectoris due to coronary-subclavian steal syndrome caused by the LIMA graft in the patient after CABG with the use of the right and left mammary artery].

    PubMed

    Balak, Wojciech; Sinkiewicz, W?adys?aw; Krzanowski, Marek; Wróbel, Wojciech; Sinkiewicz, Anna; Banach, Joanna; Soba?ski, Piotr; Suppan, Karol

    2012-01-01

    We present a case of a patient with unstable angina pectoris two years after coronary artery by-pass graft surgery with the use of the right and left mammary artery. The symptoms were caused by the critical RIMA stenosis and coronary-subclavian steal syndrome through the LIMA graft. Unsuccessful attempt of percutaneous angioplasty of the closed left subclavian artery was made. The angioplasty of the proximal part of the RIMA with the implantation of a drug eluting stent followed by the angioplasty of both left circumflex artery and obtuse marginal artery with the implantation of bare metal stents was performed. These procedures resulted in disappearance of anginal symptoms. Neurological examination did not reveal any signs of vertebrobasilar steal. PMID:22528725

  14. Effects of intraoperative diltiazem infusion on flow changes in arterial and venous grafts in coronary artery bypass graft surgery

    PubMed Central

    Erdem, Ozan; Memeto?lu, Mehmet Erdem; Tekin, Ali ?hsan; Arslan, Ümit; Akkaya, Özgür; Kutlu, Rasim; Gölba??, ?lhan

    2015-01-01

    Objective This study aimed to show the effects of intra-operative diltiazem infusion on flow in arterial and venous grafts in coronary artery bypass graft surgery. Methods Hundred fourty patients with a total of 361 grafts [205 (57%) arterial and 156 (43%) venous] underwent isolated coronary surgery. All the grafts were measured by intraoperative transit time flow meter intra-operatively. Group A (n=70) consisted of patients who received diltiazem infusion (dose of 2.5 microgram/kg/min), and Group B (n=70) didn't receive diltiazem infusion. Results Mean graft flow values of left internal mammary artery were 53 ml/min in Group A and 40 ml/min in Group B (P<0.001). Pulsatility index (PI) values of left internal mammary artery for Group A and Group B were 2.6 and 3.0 respectively (P<0.001). No statistically significant difference was found between venous graft parameters. Conclusion We recommend an effect of diltiazem infusion in increasing graft flows in coronary artery bypass graft operations.

  15. Who Needs Coronary Artery Bypass Grafting?

    MedlinePLUS

    ... from the NHLBI on Twitter. Who Needs Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is used to treat people ... or after a heart attack to treat blocked arteries. Your doctor may recommend CABG if other treatments, ...

  16. Outcomes of Middle Cardiac Vein Arterialization via Internal Mammary/Thoracic Artery Anastomosis

    PubMed Central

    Yu, Yang; Li, Hai-tao; Gao, Ming-xin; Zhang, Fan; Gu, Cheng-xiong

    2013-01-01

    Objective Cardiac vein arterialization is seldom applied for treating right coronary artery disease. This study aimed to improve outcomes of cardiac vein arterialization in a porcine model using intramammary artery anastomosis. Methods A chronic, stenotic coronary artery model was established in 12 of 14 Chinese experimental miniature pigs of either sex, which were randomly divided into equal control (n?=?6) and experimental (n?=?6) groups. In experimental animals, blood flow was reconstructed in the right coronary artery using intramammary artery. Arterialization involved dissection of right internal mammary artery from bifurcation to apex of thorax followed by end-to-side anastomosis of internal mammary artery and middle cardiac vein plus posterior descending branch of right coronary artery. Intraoperative heart rate was maintained at 110 beats/min. Graft flow assessment and echocardiography were performed when blood pressure and heart rate normalized. Results The experimental group had significantly higher mean endocardial and epicardial blood flow postoperatively than control group (mean endocardial blood flow: 0.37 vs. 0.14 ml/(g*min), p<0.001; mean epicardial blood flow: 0.29 vs. 0.22, p?=?0.014). Transmural blood flow was also higher in experimental group than in control group (0.33 vs. 0.19, p<0.001); ejection fraction increased from 0.46% at baseline to 0.51% (p?=?0.0038) at 6 hours postoperatively, and mean blood flow of internal mammary artery was 44.50, perfusion index 0.73 at postoperative 6 months, 43.33 and 0.80 at 3 months. Conclusion Successful cardiac vein arterialization via intramammary artery in a porcine model suggests that this may be a viable method for reconstructing blood flow in chronic, severe coronary artery disease. PMID:24278355

  17. Left Subclavian Artery Revascularization in Preparation for Coronary Artery Bypass Grafting.

    PubMed

    Rahimi, Saum A; Shah, Noor; Labinskyy, Volodymyr; Lee, Leonard Y

    2016-01-01

    Coronary subclavian steal syndrome is a rare but important condition that occurs after a left internal mammary artery (LIMA) to coronary artery bypass in the setting of a stenotic left subclavian artery. The lack of blood flow through the subclavian artery causes the reversal of flow in the LIMA so that it essentially steals blood from the myocardium. In order to avoid this complication, many surgeons now opt to either revascularize the stenotic subclavian artery prior to coronary artery bypass grafting or to use an alternate vessel as the bypass graft. Here, we present the case of an asymptomatic patient with poor exercise tolerance who was recently diagnosed with both triple-vessel coronary disease and peripheral arterial disease, which was most notably characterized by occlusion of the left subclavian artery. This case demonstrates the surgical management of this complex clinical entity. PMID:26613584

  18. Types of Coronary Artery Bypass Grafting

    MedlinePLUS

    ... from the NHLBI on Twitter. Types of Coronary Artery Bypass Grafting There are several types of coronary ... for you based on your needs. Traditional Coronary Artery Bypass Grafting Traditional CABG is used when at ...

  19. Complication after arterial bypass grafting.

    PubMed

    Dizon, M; Wallach, P; Matfin, G; Adelman, H M

    1998-10-15

    A 57-year-old man experienced sudden onset of pleuritic chest pain and respiratory distress 10 days after undergoing four-vessel coronary artery bypass grafting (CABG). The surgery was performed after cardiac catheterization had shown right coronary artery dominance and the presence of lesions occluding 40% of the mid right coronary artery, 20% of the left main coronary artery, and 99% of the lower left anterior descending artery and its first diagonal branch. The patient had initially presented with acute dyspnea following an episode of crushing, nonradiating pain in the left chest and was diagnosed as having a non-Q-wave myocardial infarction after cardiac enzyme testing. His hospital course before and immediately after CABG was uneventful. The first sign of difficulty was detected one week after surgery, on day 17. An echocardiogram showed a small pericardial effusion, moderate to severe concentric thickening of the left ventricle, a left ventricular ejection fraction of 0.60 (normal, 0.67 +/- 0.08), normal valves, and normal segmental wall motion. The pleural chest pains began two days later, on day 19. PMID:9793541

  20. Rupture of a left internal mammary artery during cardiopulmonary resuscitation

    PubMed Central

    Metting, Austin; Curtis, Brydan; Mixon, Timothy

    2016-01-01

    We present a rare case of a left internal mammary artery rupture during cardiopulmonary resuscitation (CPR). This case demonstrates that intrinsic cardiac/vascular injuries can occur even with manual CPR, and each patient should be monitored closely, considering the very subtle signs that can clue the physicians into the diagnosis. PMID:26722182

  1. Robotic totally endoscopic multivessel coronary artery bypass grafting: procedure development, challenges, results.

    PubMed

    Bonatti, Johannes; Lee, Jeffrey D; Bonaros, Nikolaos; Schachner, Thomas; Lehr, Eric J

    2012-01-01

    Closed-chest totally endoscopic coronary artery bypass grafting (TECAB) is feasible using robotic technology. During the early phases, TECAB was restricted to single bypass grafts to the left anterior descending artery system. Because most patients referred for coronary artery bypass surgery have multivessel disease, development of endoscopic multiple bypass grafting is mandatory. Experimental work on multivessel TECAB was carried out in the early 2000s, and first clinical cases were already performed. With further technological development of operating robots, double, triple, and quadruple TECAB has become feasible both on the arrested heart and on the beating heart. To date, 161 cases of multivessel TECAB using the da Vinci telemanipulation systems are published in the literature. The main advances enabling multivessel TECAB were the availability of a robotic endostabilizer for beating heart procedures and increased surgeon skills using remote access heart-lung machine perfusion and endo-cardioplegia. Both internal mammary arteries can be harvested and both radial artery and vein graft can be used in multivessel TECAB. Y-grafting and sequential grafting are feasible. Multivessel endoscopic surgical revascularization can be combined with percutaneous coronary interventions in advanced hybrid coronary revascularization. Time requirements for multivessel TECAB are significant, and conversion rates to larger thoracic incisions are higher than those observed for single-vessel TECAB. Clinical short- and long-term outcomes, however, seem to meet the standards of open coronary bypass surgery through sternotomy. The main advantages of multivessel TECAB are a completely preserved sternum, use of double internal mammary artery even in risk groups, and a remarkably short recovery time. PMID:22576029

  2. Late fiber deterioration in Dacron arterial grafts.

    PubMed Central

    Berger, K; Sauvage, L R

    1981-01-01

    The occurrence of late fiber deterioration was examined in 493 Dacron arterial prostheses. Grafts implanted were of four types: 137 Meadox Wesolowski Weavenit (WN), 71 Golaski Microknit (MK), 70 USCI Sauvage(Tm) external velour non-crimped (EVNC), and 215 USCI Sauvage external velour random-crimped (EVRC). Prostheses had been implanted for three to 15.3 years; no defects were detected prior to three years. Deterioration occurred in 15 of 493 grafts (mean incidence: 3%). Between 4.9% and 5.8% of patients had graft deterioration-nearly the same incidence in all four types of grafts. Deterioration consisted of thinning and breakage of yarn filaments, causing development of holes and, in some cases, graft dilatation. Dilatation did not always precede filament breakage. Broken filament ends were either tapered or square-ended, suggesting that modes of breakage. Tensile strength tests howed that fibers sometimes weakened nonuniformly within a specimen. Fiber breakage was associated with crimp ridges. The findings suggest that manufacturing variations probably reduce fiber resistance to mechanical fatigue. Other contributing factors may include storage conditions, sterilization methods, handling, and the degradative effects of tissue fluids and enzymes. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. PMID:6452101

  3. Treatment of an Iatrogenic Left Internal Mammary Artery to Pulmonary Artery Fistula with a Bovine Pericardium Covered Stent

    SciTech Connect

    Heper, Gulumser Barcin, Cem; Iyisoy, Atila; Tore, Hasan F.

    2006-10-15

    We report a case with an acquired fistula between the left internal mammary artery and the pulmonary artery following coronary bypass surgery treated with a bovine pericardium covered stent. We also reviewed similar cases reported previously.

  4. Platelet--arterial synthetic graft interaction and its modification

    SciTech Connect

    Callow, A.D.; Connolly, R.; O'Donnell, T.F. Jr.; Gembarowicz, R.; Keough, E.; Ramberg-Laskaris, K.; Valeri, C.R.

    1982-11-01

    We compared the in vivo platelet reactivity of two commonly used clinical grafts, Dacron and expanded polytetrafluoroethylene (PTFE), with that of a control autogenous artery graft and assessed whether platelet reactivity was modified by the platelet-antiaggregating agent prostacyclin (PGI2) (epoprostenol). Grafts were randomly placed into the carotid arteries of 21 baboons. Platelets labeled with /sup 111/In were infused within one hour after implantation graft for gamma camera scanning of platelet uptake. The accumulation of platelets on Dacron grafts began almost immediately after injection and reached a peak after one to two hours. The PTFE and control autogenous artery grafts accumulated comparable small amounts of platelets. Prostacyclin was then infused in a second series of baboons with Dacron grafts, at a rate of 150 to 200 ng/kg/min. It prevented the usual platelet uptake when administered concomitant with graft implantation and reduced previously established platelet activity.

  5. Remote ischaemic preconditioning for coronary artery bypass grafting

    PubMed Central

    Benstoem, Carina; Stoppe, Christian; Liakopoulos, Oliver J; Meybohm, Patrick; Clayton, Tim C; Yellon, Derek M; Hausenloy, Derek J; Goetzenich, Andreas

    2015-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the benefits and harms of remote ischaemic preconditioning in patients undergoing coronary artery bypass grafting, with or without valve surgery.

  6. POST CORONARY ARTERY BYPASS GRAFT STUDY (CABG)

    EPA Science Inventory

    Relative effectiveness of moderate versus more aggressive lipid lowering, and of low dose anticoagulation versus placebo, in delaying saphenous vein coronary bypass graft atherosclerosis and preventing occlusion of saphenous grafts of patients with saphenous vein coronary bypass ...

  7. Superior epigastric artery pseudoaneurysm- a rare complication of chest drain insertion in coronary artery bypass grafting

    PubMed Central

    Sadat, Umar; Jah, Asif; Ward, Nick; Gaunt, Michael

    2007-01-01

    Background Although chest drain insertion during coronary artery bypass grafting is a fairly standard procedure, however it may result in extremely rare complications. Case presentation This is the first case being reported that demonstrates a pseudoaneurysm of superior epigastric artery resulting from chest drain insertion following coronary artery bypass grafting. Conclusion Adequate caution should be used along with good understanding of the anatomical landmarks during apparently simple and standard operative procedures. PMID:17459158

  8. Factors influencing acute thrombus formation on carotid artery vascular grafts

    SciTech Connect

    Torem, S.; Schneider, P.A.; Paxton, L.D.; Yasuda, H.; Hanson, S.R.

    1988-10-01

    Scintillation camera imaging of 111Indium-labeled platelets has been used to measure acute thrombus formation on modified expanded Teflon (ePTFE) vascular grafts placed in the carotid arteries of normal baboons. Platelet deposition plateaued over 2 hr postoperatively and occurred primarily at the graft-vessel anastomoses. A positive correlation was found between the circulating platelet count in individual animals and the extent of early platelet thrombus deposition. Unmodified ePTFE grafts accumulated 4.6 +/- 1.2 x 10(9) platelets per graft, or 2.3 +/- 0.71 x 10(9) platelets per anastomosis. Acutely, platelet accumulation was reduced versus control graft results by coating the graft lumenal surfaces with a smooth layer of silicone rubber polymer (0.60 +/- 0.19 x 10(9) platelets per anastomosis; P less than 0.02) but not by coating the grafts using a plasma polymer based on methane, which did not modify graft texture (8.2 +/- 1.7 x 10(9) platelets per graft; P greater than 0.10). The benefit of the silicone rubber coating persisted for at least 48 hr. However, longer term patency was not preserved because 10 of 12 grafts placed had failed within 1 to 2 months.

  9. Vein graft adaptation and fistula maturation in the arterial environment

    PubMed Central

    Lu, Daniel Y; Chen, Elizabeth Y; Wong, Daniel J; Yamamoto, Kota; Protack, Clinton D; Williams, Willis T; Assi, Roland; Hall, Michael R; Sadaghianloo, Nirvana; Dardik, Alan

    2014-01-01

    Veins are exposed to the arterial environment during two common surgical procedures, creation of vein grafts and arteriovenous fistulae (AVF). In both cases veins adapt to the arterial environment that is characterized by different hemodynamic conditions and increased oxygen tension compared to the venous environment. Successful venous adaptation to the arterial environment is critical for long term success of the vein graft or AVF, and in both cases is generally characterized by venous dilation and wall thickening. However, AVF are exposed to a high flow, high shear stress, low pressure arterial environment, and adapt mainly via outward dilation with less intimal thickening. Vein grafts are exposed to a moderate flow, moderate shear stress, high pressure arterial environment, and adapt mainly via increased wall thickening with less outward dilation. We review the data that describe these differences, as well as the underlying molecular mechanisms that mediate these processes. Despite extensive research, there are few differences in the molecular pathways that regulate cell proliferation and migration or matrix synthesis, secretion, or degradation currently identified between vein graft adaptation and AVF maturation that account for the different types of venous adaptation to arterial environments. PMID:24582063

  10. Percutaneous coronary intervention strategies and prognosis for graft lesions following coronary artery bypass grafting

    PubMed Central

    LIU, YIN; ZHOU, XIUJUN; JIANG, HUA; GAO, MINGDONG; WANG, LIN; SHI, YUTIAN; GAO, JING

    2015-01-01

    The purpose of this study was to compare the prognosis of graft-percutaneous coronary intervention (PCI) and native vessel (NV)-PCI, drug-eluting stents (DESs) and bare-metal stents (BMSs) for the treatment of graft lesions following coronary artery bypass grafting (CABG), and to determine the risk factors for major adverse cardiac events (MACEs). A total of 289 patients who underwent PCI following CABG between August 2005 and March 2010 were retrospectively analyzed. The effects on survival were compared among patients who underwent NV- and graft-PCI, and DES and BMS implantation. Additionally, the risk factors for MACEs following PCI for graft lesions were analyzed. The findings showed that MACE-free and revascularization-free survival rates were significantly higher in the NV-PCI group compared with those in the graft-PCI group. There were 63 cases (29.0%) of MACEs in the DES group and 25 cases (52.1%) in the BMS group. In patients undergoing NV-PCI, the DES group had significantly fewer MACEs and less target vessel revascularization (TVR) than the BMS group. In patients undergoing graft-PCI, the DES group showed a tendency for fewer MACEs and a lower incidence of cardiac mortality, myocardial infarction and TVR compared with the BMS group. Diabetes, an age of >70 years and graft-PCI were independent risk factors for MACEs in patients post-PCI. It is concluded that NV-PCI has superior long-term outcomes compared with graft-PCI, and should therefore be considered as the first-line treatment for graft disease following CABG. Despite this, graft-PCI remains a viable option. DESs are the first choice for graft-PCI due to their safety and efficacy and their association with reduced mortality and MACE rate. Diabetes, older age and graft-PCI are independent risk factors for MACEs in patients post-CABG who are undergoing revascularization. PMID:26136874

  11. Endovascular Stent-Grafting for Infected Iliac Artery Pseudoaneurysms

    SciTech Connect

    Sanada, Junichiro Matsui, Osamu; Arakawa, Fumitaka; Tawara, Mari; Endo, Tamao; Ito, Hiroshi; Ushijima, Satoshi; Endo, Masamitsu; Ikeda, Masahiro; Miyazu, Katsuyuki

    2005-01-15

    We report two cases of acutely infected pseudoaneurysms of the iliac arteries, successfully treated with endovascular stent-grafting. Two patients underwent stent-graft treatment for erosive rupture of the iliac artery caused by surrounding infection. The first case is that of a 61-year-old man who had undergone Miles' operation for an advanced rectal cancer. Postoperatively, he developed intrapelvic abscess formation, from which methicillin-resistant Staphylococcus aureus was cultured, followed by rupture of the right external iliac artery. The second case is that of a 60-year-old man who had a pseudoaneurysm of the left common iliac artery, which was contiguous with a left psoas muscle abscess, from which Streptococcus agalactiae was cultured. Both patients were successfully treated with only a stent-graft and antibiotic therapy, and remained symptom-free 12 months and 10 months later. Although endovascular stent-grafting should not be considered standard therapy for infected aneurysms, our cases suggest that it can result in repair of infected aneurysms even in the uncontrolled active stage.

  12. [Mediastinal bronchial artery aneurysm: treatment with stent-graft].

    PubMed

    Bouayad, M; Bagan, P; Brian, E; Benabdesselam, A; Couffinhal, J-C

    2011-02-01

    Mediastinal bronchial artery aneurysm is rare but potentially life-threatening, and requires prompt treatment to avert rupture with catastrophic results. Inflammatory conditions dominate the aetiologies. Conventional therapies are surgery via thoracotomy and endovascular embolization. We report a case of a giant saccular aneurysm of the bronchial artery described in an 80-year-old man, adjacent to the descending aorta, simulating aortic aneurysm and causing esophageal compression. It was totally excluded with an aortic stent-graft (TX2, Cook) performed through femoral access. Our case is the fourth reported of mediastinal bronchial aneurysm stent-graft exclusion. The analysis of success, complications rate and hospital stay duration favors endovascular grafting comparing with conventional techniques. PMID:21131150

  13. Development of small diameter nanofiber tissue engineered arterial grafts.

    PubMed

    Kurobe, Hirotsugu; Maxfield, Mark W; Tara, Shuhei; Rocco, Kevin A; Bagi, Paul S; Yi, Tai; Udelsman, Brooks; Zhuang, Zhen W; Cleary, Muriel; Iwakiri, Yasuko; Breuer, Christopher K; Shinoka, Toshiharu

    2015-01-01

    The surgical repair of heart and vascular disease often requires implanting synthetic grafts. While synthetic grafts have been successfully used for medium-to-large sized arteries, applications for small diameter arteries (<6 mm) is limited due to high rates of occlusion by thrombosis. Our objective was to develop a tissue engineered vascular graft (TEVG) for small diameter arteries. TEVGs composed of polylactic acid nanofibers with inner luminal diameter between 0.5 and 0.6 mm were surgically implanted as infra-renal aortic interposition conduits in 25 female C17SCID/bg mice. Twelve mice were given sham operations. Survival of mice with TEVG grafts was 91.6% at 12 months post-implantation (sham group: 83.3%). No instances of graft stenosis or aneurysmal dilatation were observed over 12 months post-implantation, assessed by Doppler ultrasound and microCT. Histologic analysis of explanted TEVG grafts showed presence of CD31-positive endothelial monolayer and F4/80-positive macrophages after 4, 8, and 12 months in vivo. Cells positive for ?-smooth muscle actin were observed within TEVG, demonstrating presence of smooth muscle cells (SMCs). Neo-extracellular matrix consisting mostly of collagen types I and III were observed at 12 months post-implantation. PCR analysis supports histological observations. TEVG group showed significant increases in expressions of SMC marker, collagen-I and III, matrix metalloproteinases-2 and 9, and itgam (a macrophage marker), when compared to sham group. Overall, patency rates were excellent at 12 months after implantation, as structural integrity of these TEVG. Tissue analysis also demonstrated vessel remodeling by autologous cell. PMID:25830942

  14. Development of Small Diameter Nanofiber Tissue Engineered Arterial Grafts

    PubMed Central

    Tara, Shuhei; Rocco, Kevin A.; Bagi, Paul S.; Yi, Tai; Udelsman, Brooks; Zhuang, Zhen W.; Cleary, Muriel; Iwakiri, Yasuko; Breuer, Christopher K.; Shinoka, Toshiharu

    2015-01-01

    The surgical repair of heart and vascular disease often requires implanting synthetic grafts. While synthetic grafts have been successfully used for medium-to-large sized arteries, applications for small diameter arteries (<6 mm) is limited due to high rates of occlusion by thrombosis. Our objective was to develop a tissue engineered vascular graft (TEVG) for small diameter arteries. TEVGs composed of polylactic acid nanofibers with inner luminal diameter between 0.5 and 0.6 mm were surgically implanted as infra-renal aortic interposition conduits in 25 female C17SCID/bg mice. Twelve mice were given sham operations. Survival of mice with TEVG grafts was 91.6% at 12 months post-implantation (sham group: 83.3%). No instances of graft stenosis or aneurysmal dilatation were observed over 12 months post-implantation, assessed by Doppler ultrasound and microCT. Histologic analysis of explanted TEVG grafts showed presence of CD31-positive endothelial monolayer and F4/80-positive macrophages after 4, 8, and 12 months in vivo. Cells positive for ?-smooth muscle actin were observed within TEVG, demonstrating presence of smooth muscle cells (SMCs). Neo-extracellular matrix consisting mostly of collagen types I and III were observed at 12 months post-implantation. PCR analysis supports histological observations. TEVG group showed significant increases in expressions of SMC marker, collagen-I and III, matrix metalloproteinases-2 and 9, and itgam (a macrophage marker), when compared to sham group. Overall, patency rates were excellent at 12 months after implantation, as structural integrity of these TEVG. Tissue analysis also demonstrated vessel remodeling by autologous cell. PMID:25830942

  15. Patient’s Perception About Coronary Artery Bypass Grafting

    PubMed Central

    Mendonça, Kelminda Maria Bulhões; de Andrade, Tarcisio Matos

    2015-01-01

    OBJECTIVE The diagnosis of coronary artery disease referred for heart surgery has an important psychological component. The purpose of this study was to access the difficulties experienced by individuals awaiting coronary artery bypass grafting and to determine strategies that facilitate adaptation to a new lifestyle, modified by the disease. METHODS A qualitative, exploratory study involving patients admitted to a university teaching hospital in the city of Salvador, Bahia, Brazil, awaiting coronary artery bypass grafting. Semi-structured interviews were performed in accordance with a previously defined script based on the study objective. Each transcription was read in its entirety to verify the representativeness, homogeneity and pertinence of the data obtained (pre-analysis), followed by separation of categories of analysis. RESULTS The descriptions of this study show that patients admitted to the completion of coronary artery bypass grafting experience a wide range of psychological difficulties, considering that surgery acquires interpretations that vary according to individuals' subjectivity. The patients recognized the benefit of being able to discuss their feelings as a means of diminishing their fear and anxiety. CONCLUSION Helping patients find resources to confront more positively the daily hospitalization is an important aspect for the health care professionals who assist them. This goal can be achieved through modification of the biomedical model of care for a biopsychosocial view. The investment of time and attention is of fundamental importance and aims to overcome existing deficiencies that interfere with the outcome of patients after cardiac surgery.

  16. Coronary artery bypass grafting in a patient with organophosphate poisoning.

    PubMed

    Pieris, Rajeeva R; Fernando, Ravindra

    2015-01-01

    A 43-year-old male, with no previous history of mental illness, was diagnosed with coronary heart disease, after which he became acutely depressed and attempted suicide by ingesting an organophosphate pesticide. He was admitted to an intensive care unit and treated with pralidoxime, atropine, and oxygen. His coronary occlusion pattern required early coronary artery bypass grafting (CABG) surgery. His family, apprehensive of a repeat suicidal attempt, requested surgery be performed as soon as possible. He recovered well from the OP poisoning and was mentally fit to express informed consent 2 weeks after admission. Seventeen days after poisoning, he underwent coronary artery bypass grafting and recovered uneventfully. Six years later, he remains in excellent health. We report this case because to the best of our knowledge there is no literature regarding CABG performed soon after organophosphate poisoning. PMID:26334855

  17. Coronary artery bypass grafting in a Behçet's disease patient.

    PubMed

    Tasar, Mehmet; Eyileten, Zeynep; Arici, Burcu; Uysalel, Adnan

    2014-01-01

    Behçet's syndrome is a chronic, multisystemic, inflammatory, vasculitic disorder characterised by oral aphta, ocular lesions, genital ulcers and the involvement of other systems. Although vascular involvement is seen frequently, coronary artery disease is extremely rare in Behçet's disease and it is generally treated with invasive or conservative procedures. In this case, we aimed to present a successful bypass grafting of three vessels using cardiopulmonary bypass in a patient with Behçet's disease. PMID:25625557

  18. Numerical analysis of coronary artery bypass grafts: an over view.

    PubMed

    Owida, Amal Ahmed; Do, Hung; Morsi, Yos S

    2012-11-01

    Arterial bypass grafts tend to fail after some years due to the development of intimal thickening (restenosis). Non-uniform hemodynamics following a bypass operation contributes to restenosis and bypass failure can occur due to the focal development of anastomotic intimal hyperplasia. Additionally, surgical injury aggravated by compliance mismatch between the graft and artery has been suggested as an initiating factor for progress of wall thickening along the suture line Vascular grafts that are small in diameter tend to occlude rapidly. Computational fluid dynamics (CFD) methods have been effectively used to simulate the physical and geometrical parameters characterizing the hemodynamics of various arteries and bypass configurations. The effects of such changes on the pressure and flow characteristics as well as the wall shear stress during a cardiac cycle can be simulated. Recently, utilization of fluid and structure interactions have been used to determine fluid flow parameters and structure forces including stress and strains relationships under steady and transient conditions. In parallel to this, experimental diagnostics techniques such as Laser Doppler Anemometry, Particle Image Velocimetry, Doppler Guide wire and Magnetic Resonance Imaging have been used to provide essential information and to validate the numerical results. Moreover, clinical imaging techniques such as magnetic resonance or computed tomography have assisted considerably in gaining a detailed patient-specific picture of the blood flow and structure dynamics. This paper gives a review of recent numerical investigations of various configurations of coronary artery bypass grafts (CABG). In addition, the paper ends with a summary of the findings and the future directions. PMID:22217920

  19. Adolescent External Iliac Artery Trauma: Recurrent Aneurysmal Dilatation of an Iliofemoral Saphenous Vein Graft Treated by Stent-Grafting

    SciTech Connect

    Lenton, James; Davies, John; Homer-Vanniasinkam, S.; McPherson, Simon

    2008-09-15

    An adolescent male sustained a severe penetrating injury to the external iliac artery. Emergency surgical revascularization was with a reversed long saphenous vein interposition graft. The primary graft and the subsequent revision graft both became aneurysmal. The second graft aneurysm was successfully excluded by endovascular stent-grafts with medium-term primary patency. A venous graft was used initially rather than a synthetic graft to reduce the risk of infection and the potential problems from future growth. Aneurysmal dilatation of venous grafts in children and adolescents is a rare but recognized complication. To the best of our knowledge, exclusion of these aneurysms with stent-grafts has not been previously reported in the adolescent population.

  20. An Arteriovenous Fistula Between the Internal Mammary Artery and the Pulmonary Vein Following Blunt Chest Trauma

    SciTech Connect

    Ito, T. Sakamoto, Toshihisa; Norio, Hirofumi; Kaji, Tatsumi; Okada, Yoshiaki

    2005-01-15

    A 67-year-old man suffered a traffic accident and was transferred to an emergency hospital close to the scene. He was diagnosed to have bilateral pneumohemothorax with a lung contusion, an anterior fracture dislocation of the C6-vertebra and a cervical cord injury at the level of C7. On the 48th day, massive hemoptysis was suddenly recognized. He was transferred in a state of shock to our hospital to undergo hemostasis for the bleeding. On the day of admission, a selective arteriogram showed extravasation from the left bronchial artery, for which embolization was carried out using Gelfoam. In spite of this treatment, his hemoptysis continued. On the next day, a selective left internal mammary arteriogram showed an arteriovenous fistula between the left internal mammary artery and the left pulmonary vein without any apparent extravasation. The arteriovenous fistula was successfully embolized using platinum fiber coils. The patient no longer demonstrated any hemoptysis after embolization.

  1. Massive intracardiac thrombosis during coronary artery bypass grafting surgery

    PubMed Central

    Bhandary, Sujatha P; Papadimos, Thomas J; Essandoh, Michael K; Apostolakis, John

    2015-01-01

    Thrombosis is a potential life-threatening complication in patients undergoing cardiac surgery. Various clinical and heritable conditions, like cancer, trauma, immobilization, the presence of factor V Leiden or prothrombin 20210A, deficiency of or resistance to the inhibitor proteins C, S, or antithrombin, elevated levels of coagulation proteins, antiphospholipid antibody syndrome, pregnancy, and the use of exogenous hormones, may contribute to catastrophic thrombosis. Massive thrombi with cerebrovascular and cardiovascular events develop in patients with polycythemia vera (PV). However, thrombus formation in the cardiac chambers is extremely rare. We report a case of massive intracardiac thrombosis in a patient undergoing coronary artery bypass grafting. PMID:25810967

  2. Autologous Internal Iliac Artery Graft in a Popliteal Artery Injury Defect in War Surgery.

    PubMed

    Noorzai, M Yaqub; Carpp, Nicole; Ertl, Christian W

    2015-12-01

    A 23-year-old Afghan National Policeman sustained a right popliteal artery injury secondary to a ground-based blast. Initial treatment was an application of a tourniquet, and after triage at a local civilian hospital a shunt was placed, 3 hours after the initial injury, and then was transferred to Kabul for definitive care, 24 hours after injury. Extensive trauma to both legs precluded use of greater saphenous vein as a graft. To avoid an above-the-knee amputation, a branch of the internal iliac artery was harvested for grafting. Postoperative computed tomography angiography indicated the presence of excellent flow, and he was discharged fully ambulatory on postoperative day 17. Autologous arterial grafting has only been used infrequently, and in this case represents innovation in a low-resource environment. Surgical training in Afghanistan has seen great strides at the National Hospital. If this patient were treated at any other facility, he likely would have had a high amputation. Without advising or direction of coalition surgeons, the Afghan Trauma Team independently made the decision to harvest the artery and salvage the limb, and this is one example of how coalition support has bolstered the confidence of Afghan surgeons to develop unconventional solutions to conventional problems. PMID:26633676

  3. Treatment of a Hepatic Artery Aneurysm by Endovascular Stent-Grafting

    SciTech Connect

    Jenssen, Guttorm L. Wirsching, Jan; Pedersen, Gustav; Amundsen, Svein Roar; Aune, Steinar; Dregelid, Einar; Jonung, Torbjorn; Daryapeyma, Alireza; Laxdal, Elin

    2007-06-15

    Aneurysms of the visceral arteries are rare. Traditional treatment has been surgical or endovascular with coil embolization. Recently, however, reports on endovascular therapy with stent-grafts have been published. We report the case of a 61-year-old man who was successfully treated with a stent-graft for a symptomatic combined celiac/hepatic artery aneurysm.

  4. Pancreatitis-Associated Splenic Artery Pseudoaneurysm: Endovascular Treatment with Self-Expandable Stent-Grafts

    SciTech Connect

    Brountzos, Elias N.; Vagenas, Kostantinos; Apostolopoulou, Sotiria C.; Panagiotou, Irene; Lymberopoulou, Dimitra; Kelekis, Dimitrios A.

    2003-02-15

    We present a patient with a splenic arterypseudoaneurysm (SAPA) treated with placement of self-expandable stent-grafts. The procedure was complicated by stent-graft migration,but successful management resulted in lasting exclusion of the SAPA,while the patency of the splenic artery was preserved. This is the first report of self-expandable stent-graft treatment of SAPA.

  5. Endovascular Treatment of a Ruptured Profunda Femoral Artery Branch After Fogarty Thrombectomy of a Femoro-Femoral Crossover Arterial Graft: A Case Report and Review of the Literature

    SciTech Connect

    Manousaki, Eirini; Tsetis, Dimitrios; Kostas, Theodoros; Katsamouris, Asterios

    2010-02-15

    We present a very rare case of a life-threatening rupture of a profunda femoral artery distal branch after a Fogarty thrombectomy of a thrombosed crossover synthetic graft between the ipsilateral common femoral artery and a contralateral iliac-popliteal graft; the bleeding profunda femoral artery branch was successfully embolized with metallic coils through the axillary artery approach.

  6. Percutaneous Closure of a Coronary Artery-to-Vein Graft Anastomotic Pseudoaneurysm Presenting as Acute Coronary Syndrome after Recent Coronary Artery Bypass Grafting

    PubMed Central

    Sharma, Suresh; Gupta, Kamal; Wiley, Mark; Parashara, Deepak

    2015-01-01

    Pseudoaneurysm formation has been reported in degenerated coronary artery saphenous vein bypass grafts, as well as in native coronary arteries after interventional procedures or blunt trauma. In contrast, pseudoaneurysm formation arising from the anastomotic site of native coronary vessels soon after coronary artery bypass grafting is rare, and neither the clinical presentation of this phenomenon nor its treatment is well described. We present the case of a 63-year-old man, a recent coronary artery bypass grafting patient, who presented with acute coronary syndrome due to a large and expanding pseudoaneurysm of the saphenous vein-to-ramus intermedius artery graft anastomosis. After several attempts, we successfully treated the pseudoaneurysm by means of percutaneous coil embolization. To our knowledge, this is the first report of acute coronary syndrome secondary to a pseudoaneurysm at the coronary artery–saphenous vein graft anastomosis. In addition, this appears to be the first report of the percutaneous treatment of such a pseudoaneurysm by means of coil embolization. PMID:26175645

  7. A Computational Model of Optimal Vein Graft Adaptation in an Arterial Environment

    NASA Astrophysics Data System (ADS)

    Ramachandra, Abhay B.; Sankaran, Sethuraman; Humphrey, Jay; Marsden, Alison

    2012-11-01

    In coronary artery disease, surgical revascularization using venous bypass grafts is performed to relieve symptoms and prolong life. Coronary bypass graft surgery is performed on approximately 500,000 people every year in the United States, with graft failure rates as high as 50% within 5 years. When a vein graft is implanted in the arterial system it adapts to the high flow rate and high pressure of the arterial environment by changing composition and geometry, and thus stiffness. Hemodynamic loads, resulting in altered wall shear and intramural stresses, are major factors impacting vein graft remodeling. Here, a constrained mixture theory of growth and remodeling for arteries is extended to model the evolution of a vein graft subjected to arterial flow and pressure conditions. A derivative-free optimization method is used to estimate the optimal set of constitutive parameters that best match passive biaxial mouse inferior vena cava data from experiments. Optimization is performed using surrogate management framework, a pattern search method with established convergence theory. The resulting parameter set is used to predict optimal vein adaptation in an arterial environment for two illustrative cases: a) Step change b) Gradual change in loading. Results are compared against vein graft data from the literature and a possible set of mechanisms for sub-optimal vein graft remodeling is suggested.

  8. Conservative Management of Chylothorax after Coronary Artery Bypass Grafting

    PubMed Central

    Pulathan, Zerrin; Kutanis, Dilek; Hemsinli, Dogus; Erturk, Engin; Civelek, Ali

    2015-01-01

    Chylothorax is a rare sequela to cardiac surgery, associated with high rates of morbidity and mortality. There are various medical and surgical options for its management. We describe 2 cases of chylothorax that developed after coronary artery bypass grafting and were managed successfully with medical therapy alone. Conservative treatment such as we describe aims to reduce chyle flow, to drain the pleural cavity in an effective manner, and to prevent chronic sequelae. Optimal conservative treatment, consisting of nothing by mouth and the administration of a pleurodetic agent, should be started immediately upon diagnosis. In most cases, it reduces the need for reoperation and long-term hospitalization. Prospective randomized controlled trials are nonetheless needed to confirm these assumptions. PMID:25873827

  9. Endovascular Stent-Graft Treatment of Giant Celiac Artery Pseudoaneurysm

    PubMed Central

    Tuncel, Sedat Alpaslan; Gülcü, Aytaç; Y?lmaz, Erdem; Çiftçi, Taner; Göktay, Ahmet Yi?it

    2015-01-01

    Summary Background Visceral artery aneurysms (VAAs) comprise an uncommon but life-threatening vascular disease. When rupture is the first clinical presentation, mortality rate reaches 70%. Increased use of cross-sectional imaging has led to a greater rate of diagnosis (40–80%) of asymptomatic VAAs. In the past, surgery was the treatment of choice for VAAs carrying high risk of mortality and morbidity. Case Report A 22-year-old man, who had undergone gastric, pancreatic and aortic surgery 2.5 years earlier, presented with progressive abdominal pain. Multidetector computed tomography scan revealed an 8-cm celiac pseudoaneurysm. We report a giant celiac pseudoaneurysm treated with stent-graft implantation. Conclusions Endovascular treatment of VAA is a safe and effective method alternative to surgery. PMID:26236417

  10. Angiographic Evaluation of Carotid Artery Grafting with Prefabricated Small-Diameter, Small-Intestinal Submucosa Grafts in Sheep

    SciTech Connect

    Pavcnik, Dusan; Obermiller, Josef; Uchida, Barry T.; Van Alstine, William; Edwards, James M.; Landry, Gregory J.; Kaufman, John A.; Keller, Frederick S.; Roesch, Josef

    2009-01-15

    The purpose of this study was to report the longitudinal angiographic evaluation of prefabricated lyophilized small-intestinal submucosa (SIS) grafts placed in ovine carotid arteries and to demonstrate a variety of complications that developed. A total of 24 grafts, 10 cm long and 6 mm in diameter, were placed surgically as interposition grafts. Graft patency at 1 week was evaluated by Doppler ultrasound, and angiography was used for follow-up at 1 month and at 3 to 4 months. A 90% patency rate was found at 1 week, 65% at 1 month, and 30% at 3 to 4 months. On the patent grafts, angiography demonstrated a variety of changes, such as anastomotic stenoses, graft diffuse dilations and dissections, and aneurysm formation. These findings have not been previously demonstrated angiographically by other investigators reporting results with small-diameter vessel grafts made from fresh small-intestinal submucosa (SIS). The complications found were partially related to the graft construction from four SIS layers. Detailed longitudinal angiographic study should become an essential part of any future evaluation of small-vessel SIS grafting.

  11. Stent-Graft Repair of a Large Cervical Internal Carotid Artery Pseudoaneurysm Causing Dysphagia

    SciTech Connect

    Gupta, Vivek Niranjan, Khandelwal; Rawat, Lokesh; Gupta, A. K.

    2009-05-15

    Pseudoaneurysms of the cervical internal carotid artery (ICA) are rare and most frequently result from trauma, infection, or sometimes spontaneously. They have the potential to cause life-threatening hemorrhage; thus, their immediate management is necessary. Endovascular treatment by stent graft placement in the affected artery appears to be a safe and effective treatment option. We present a case of a child who presented with neck swelling and dysphagia caused by a ruptured cervical ICA pseudoaneurysm which was managed by stent graft placement.

  12. Iatrogenic Iliac Artery Rupture: Emergency Management by Longer Stent-Graft on a Shorter Balloon

    SciTech Connect

    Trehan, Vijay; Nigam, Arima; Ramakrishnan, S.

    2007-02-15

    Rupture of an iliac artery during percutaneous transluminal coronary angioplasty is a rare but potentially devastating complication. We report a case of iatrogenic external iliac artery rupture that was successfully treated by temporary balloon occlusion followed by endovascular stent graft placement in an unusual manner. Limited availability of the hardware necessitated the use of a longer bare stent graft mounted on a relatively shorter balloon.

  13. Evaluation of olfactory memory after coronary artery bypass grafting

    PubMed Central

    Yurttas, Veysel; Bilgi, Murat; Dem?rhan, Abdullah; Apuhan, Tayfun; Bugra, Onursal; Daglar, Bahadir

    2014-01-01

    Introduction This study determined whether coronary artery bypass grafting (CABG) surgery has any effect on olfactory function, employing the Brief Smell Identification Test (B-SIT). Material and methods All the participants were informed preoperatively about the B-SIT test and the mode of its application. The test was performed by each patient preoperatively (d0) as well as 1 (d1) and 3 (d3) days following the surgery. C-reactive protein (CRP) levels were recorded at the same time as the smell test. Results This prospective study included 45 patients. The mean age was 67 ± 7.55, and the group was 29% male. The mean durations of cross clamping and cardiopulmonary bypass were 54 ± 32 min and 62.5 ± 37.0 min, respectively. Eleven different odors were tested. Significant differences were observed for several odors: leather between d0 and d3, pine between d0 and d3, onion between d0 and d1, onion between d0 and d3, and soap between d0 and d1. The postoperative CRP levels were significantly higher than the preoperative levels. The correlation analysis determined that the postoperative CRP levels were negatively correlated with the B-SIT score (r = –0.48, p = 0.001). Conclusions Our findings suggest that patients after CABG are prone to develop olfactory dysfunction in the early postoperative period and that olfactory dysfunction is associated with postoperative CRP levels. PMID:26336453

  14. The role of the lymphatic system in acute arterial prosthetic graft infections.

    PubMed

    Rubin, J R; Malone, J M; Goldstone, J

    1985-01-01

    No experimental data have been published that evaluate the role of lower extremity lymphatics in the pathophysiology of arterial graft infection. Bilateral interpositional femoral artery graft (PTFE) replacements were performed in 21 greyhounds, accompanied by unilateral limb ischemia-rendering operations and ipsilateral bacterial inoculations with standardized inocula of Escherichia coli and Staphylococcus aureus. Inguinal lymphatics in the ischemic leg were either simply transected (group I), carefully preserved (group II), or excised and ligated (group III) at the time of femoral graft implantation. The grafts were harvested 48 hours later and graft and blood cultures obtained. There was an 87.5% incidence of positive graft cultures in groups I and II, but both organisms were cultured significantly more often in group II than in group I (62.5% vs. 12.5%; p less than 0.01). Blood culture data were similar. The incidence of positive graft and blood cultures in group III was only 20%, and no cultures obtained were positive for both organisms. Cultures of contralateral control grafts yielded both organisms in all group II dogs compared with only 25% of group I and 0% in group III (p less than 0.01). These results suggest that the lymphatics probably contribute to the development of acute graft infection by absorbing bacteria, and either transporting them to the systemic circulation via lymphatic-venous communications when the lymphatics are intact, causing hematogenous contamination of a graft, or by directly bathing the implanted graft when the lymphatics are disrupted proximal to a septic focus. Careful isolation, transection, and ligation of the inguinal lymphatics at the time of arterial reconstruction might minimize acute graft sepsis. PMID:3880833

  15. Implantation of Completely Biological Engineered Grafts Following Decellularization into the Sheep Femoral Artery

    PubMed Central

    Syedain, Zeeshan H.; Meier, Lee A.; Lahti, Mathew T.; Johnson, Sandra L.

    2014-01-01

    The performance of completely biological, decellularized engineered allografts in a sheep model was evaluated to establish clinical potential of these unique arterial allografts. The 4-mm-diameter, 2–3-cm-long grafts were fabricated from fibrin gel remodeled into an aligned tissue tube in vitro by ovine dermal fibroblasts. Decellularization and subsequent storage had little effect on graft properties, with burst pressure exceeding 4000?mmHg and the same compliance as the ovine femoral artery. Grafts were implanted interpositionally in the femoral artery of six sheep (n=9), with contralateral sham controls (n=3). At 8 weeks (n=5) and 24 weeks (n=4), all grafts were patent and showed no evidence of dilatation or mineralization. Mid-graft lumen diameter was unchanged. Extensive recellularization occurred, with most cells expressing ?SMA. Endothelialization was complete by 24 weeks with elastin deposition evident. These completely biological grafts possessed circumferential alignment/mechanical anisotropy characteristic of native arteries and were cultured only 5 weeks prior to decellularization and storage as “off-the-shelf” grafts. PMID:24417686

  16. Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery: protocol for the 2?×?2 factorial designed randomised NEO trial

    PubMed Central

    2014-01-01

    Background Coronary artery bypass grafting using the radial artery has, since the 1990s, gone through a revival. Observational studies have indicated better long-term patency when using radial arteries. Therefore, radial artery might be preferred especially in younger patients where long time patency is important. During the last 10 years different endoscopic techniques to harvest the radial artery have evolved. Endoscopic radial artery harvest only requires a small incision near the wrist in contrast to open harvest, which requires an incision from the elbow to the wrist. However, it is unknown whether the endoscopic technique results in fewer complications or a graft patency comparable to open harvest. When the radial artery has been harvested, there are two ways to use the radial artery as a graft. One way is sewing it onto the aorta and another is sewing it onto the mammary artery. It is unknown which technique is the superior revascularisation technique. Methods/Design The NEO Trial is a randomised clinical trial with a 2?×?2 factorial design. We plan to randomise 300 participants into four intervention groups: (1) mammario-radial endoscopic group; (2) aorto-radial endoscopic group; (3) mammario-radial open surgery group; and (4) aorto-radial open surgery group. The hand function will be assessed by a questionnaire, a clinical examination, the change in cutaneous sensibility, and the measurement of both sensory and motor nerve conduction velocity at 3 months postoperatively. All the postoperative complications will be registered, and we will evaluate muscular function, scar appearance, vascular supply to the hand, and the graft patency including the patency of the central radial artery anastomosis. A patency evaluation by multi-slice computer tomography will be done at one year postoperatively. We expect the nerve conduction studies and the standardised neurological examinations to be able to discriminate differences in hand function comparing endoscopic to open harvest of the radial artery. The trial also aims to show if there is any patency difference between mammario-radial compared to aorto-radial revascularisation techniques but this objective is exploratory. Trial registration ClinicalTrials.gov identifier: NCT01848886. Danish Ethics committee number: H-3-2012-116. Danish Data Protection Agency: 2007-58-0015/jr.n:30–0838. PMID:24754891

  17. Calcification of Cryopreserved Arterial Graft Causing Delayed Obstruction of Portal Vein Flow After Liver Transplant.

    PubMed

    Cimsit, Bayindir; Yankol, Yucel; Mecit, Nesimi; Kanmaz, Turan; Acarli, Koray; Kalayoglu, Munci

    2015-10-01

    In patients with biliary atresia, portal vein problems may cause challenges for liver transplant. Interposition grafts have been used for vascular anastomoses in transplant recipients with varied success. A cryopreserved iliac artery graft was used for the reconstruction of the portal vein in a 29-month-old infant with biliary atresia. At 17 months after transplant, she developed upper gastrointestinal bleeding that was caused by portal vein occlusion because of vascular calcifications in the graft. Upper gastrointestinal endoscopy showed esophageal varices with fresh bleeding, and the varices were band ligated. At 3 months after the bleeding episode, the patient was asymptomatic and biochemical tests were normal. In summary, liver transplant with cryopreserved iliac artery graft may be complicated by calcifications and portal vein occlusion, and caution is advised in using this graft material for portal vein anastomoses. PMID:24919040

  18. Internal mammary artery injury during central venous catheter insertion for TPN: rare but fatal.

    PubMed

    Mazeh, Haggi; Alaiyan, Bilal; Vald, Ori; Mizrahi, Ido; Klimov, Alexander; Eid, Ahmed; Freund, Herbert R

    2010-01-01

    Vascular injuries caused by subclavian central venous catheter (CVC) insertion can be associated with major complications. Such injuries differ in clinical presentation as well as optimal management, which ranges from observation only to surgical or endovascular repair. We report an injury to a branch of the internal mammary artery following an attempt to introduce a subclavian CVC, resulting in a massive hemothorax. This very rare injury was diagnosed and treated by angiography and embolization; however, the patient later succumbed to multi-organ failure. Suspicion of such an injury in a similar clinical setting should result in immediate angiography that can be lifesaving. To the best of our knowledge, this is the only report of such an adverse event in an adult. PMID:20392598

  19. Infrascrotal, Perineal, Femorofemoral Bypass for Arterial Graft Infection at the Groin.

    PubMed

    Illuminati, Giulio; Caliò, Francesco G; D'Urso, Antonio; Giacobbi, Daniela; Papaspyropoulos, Vassilios; Ceccanei, Gianluca

    2004-12-01

    HYPOTHESIS: Infrascrotal, perineal, femorofemoral bypass is an acceptable procedure for treating infection of a prosthetic arterial graft limited to a unilateral groin. DESIGN: A consecutive sample clinical study with a mean follow-up of 29 months. SETTING: The surgical department of an academic tertiary care center and an affiliated secondary care center. PATIENTS: Nineteen patients with a mean age of 68 years with prosthetic graft infection at the outflow anastomosis on a femoral artery at the Scarpa triangle underwent an infrascrotal, perineal, femorofemoral bypass, with excision of the graft material limited at the groin. The recipient artery was the profunda femoris artery in 12 cases, the superficial femoral in 5, and the distal common femoral artery in 2. MAIN OUTCOME MEASURES: Cumulative survival, recurrence of sepsis, primary graft patency, and limb salvage rates expressed by standard life-table analysis. RESULTS: Postoperative mortality rate was 5%. Cumulative (SE) survival rate was 65% (11.6%) at 3 years. Cumulative (SE) rate of freedom from recurrent sepsis was 88% (8.6%) at 3 years. Cumulative (SE) primary patency and limb salvage rates were 86% (9.4%) and 91% (7.9%), respectively, at 3 years. CONCLUSION: Femorofemoral bypass with an infrascrotal perineal approach is a valuable procedure for the treatment of femoral arterial graft infection limited at a unilateral groin. PMID:15613291

  20. Effects of antiplatelet therapy with indobufen or aspirin-dipyridamole on graft patency one year after coronary artery bypass grafting.

    PubMed

    Rajah, S M; Nair, U; Rees, M; Saunders, N; Walker, D; Williams, G; Critchley, A; Beton, D; Campbell, C; Lawson, R A

    1994-04-01

    Saphenous vein coronary artery bypass graft patency can be increased by antiplatelet therapy. Aspirin plus dipyridamole are effective but are associated with tolerability problems. Indobufen is a possible alternative antiplatelet agent that may be better tolerated. A prospective, randomized, double-blind, parallel-group study was undertaken to compare the efficacy and safety of indobufen 200 mg twice daily with aspirin 300 mg thrice daily plus dipyridamole 75 mg thrice daily in preventing occlusion of autologous saphenous vein coronary artery bypass grafts. A total of 803 patients were randomized in the study, of whom 552 had a follow-up coronary angiogram approximately 1 year after operation. All anastomoses were patent in 56% of indobufen-treated patients and 59% of aspirin-dipyridamole recipients (p = 0.384). The percentage of all anastomoses patent was 82% in the indobufen group and 83% in the aspirin-dipyridamole group (p = 0.297). Mean postoperative blood loss was significantly less in the indobufen group (p = 0.043). Patients who received indobufen also had significantly fewer adverse events considered to be treatment-related compared with aspirin-dipyridamole recipients (p = 0.02). At the doses tested indobufen was as effective as aspirin plus dipyridamole in preventing occlusion of saphenous vein grafts and was better tolerated. Because indobufen was associated with less postoperative blood loss it may be used before operation in coronary artery bypass grafting. PMID:8159037

  1. Outcome in Patients Having Salvage Coronary Artery Bypass Grafting.

    PubMed

    Santarpino, Giuseppe; Ruggieri, Vito G; Mariscalco, Giovanni; Bounader, Karl; Beghi, Cesare; Fischlein, Theodor; Onorati, Francesco; Faggian, Giuseppe; Gatti, Giuseppe; Pappalardo, Aniello; De Feo, Marisa; Bancone, Ciro; Perrotti, Andrea; Chocron, Sidney; Dalen, Magnus; Svenarud, Peter; Rubino, Antonino S; Mignosa, Carmelo; Gherli, Riccardo; Musumeci, Francesco; Dell'Aquila, Angelo M; Kinnunen, Eeva-Maija; Biancari, Fausto

    2015-10-15

    Salvage coronary artery bypass grafting (CABG) is often performed for cardiogenic shock on compassionate basis without clinical data justifying this aggressive approach. The aim of this study was to analyze early and intermediate outcomes after salvage CABG. We retrospectively reviewed the data of 85 patients who underwent salvage CABG at 11 European cardiac surgery centers. Salvage CABG was defined according to the EuroSCORE criteria, that is, a procedure performed in patients requiring cardiopulmonary resuscitation (external cardiac massage) en route to the operating theater or before induction of anesthesia. A percutaneous coronary intervention procedure preceded salvage CABG in 55 patients (64.7%). Thirty patients (35.3%) died during the inhospital stay. The mean EuroSCORE II was 32.0% and the observed-to-expected ratio was 1.08. Salvage CABG was associated with high rates of postoperative stroke (9.4%), resternotomy for bleeding (23.5%), resternotomy for hemodynamic instability (15.3%), dialysis (18.8%), severe gastrointestinal complications (12.9%), and deep sternal wound infection (10.6%). Survival at 1, 3, and 5 years was 58.6%, 49.8%, and 40.9%, respectively. Twenty patients (23.5%) were postoperatively treated with extracorporeal membrane oxygenation (ECMO). The rates of adverse events after ECMO were particularly high (stroke 40%, resternotomy for bleeding 60%, dialysis 35%, gastrointestinal complications 30%, and deep sternal wound infection 30%). Of patients treated with ECMO, 8 (40%) survived to discharge, and 1-year survival was 29.2%. Salvage CABG is associated with high risk of immediate mortality and severe adverse events. However, the observed immediate and intermediate outcome justify coronary surgery in these critically ill patients. A number of these patients are currently treated by ECMO, and its results are encouraging. PMID:26303635

  2. A mechanical argument for the differential performance of coronary artery grafts.

    PubMed

    Prim, David A; Zhou, Boran; Hartstone-Rose, Adam; Uline, Mark J; Shazly, Tarek; Eberth, John F

    2016-02-01

    Coronary artery bypass grafting (CABG) acutely disturbs the homeostatic state of the transplanted vessel making retention of graft patency dependent on chronic remodeling processes. The time course and extent to which remodeling restores vessel homeostasis will depend, in part, on the nature and magnitude of the mechanical disturbances induced upon transplantation. In this investigation, biaxial mechanical testing and histology were performed on the porcine left anterior descending artery (LAD) and analogs of common autografts, including the internal thoracic artery (ITA), radial artery (RA), great saphenous vein (GSV) and lateral saphenous vein (LSV). Experimental data were used to quantify the parameters of a structure-based constitutive model enabling prediction of the acute vessel mechanical response pre-transplantation and under coronary loading conditions. A novel metric ? was developed to quantify mechanical differences between each graft vessel in situ and the LAD in situ, while a second metric ? compares the graft vessels in situ to their state under coronary loading. The relative values of these metrics among candidate autograft sources are consistent with vessel-specific variations in CABG clinical success rates with the ITA as the superior and GSV the inferior graft choices based on mechanical performance. This approach can be used to evaluate other candidate tissues for grafting or to aid in the development of synthetic and tissue engineered alternatives. PMID:26437296

  3. Up-regulation of endothelin type B receptors in the human internal mammary artery in culture is dependent on protein kinase C and mitogen-activated kinase signaling pathways

    PubMed Central

    Nilsson, David; Gustafsson, Lotta; Wackenfors, Angelica; Gesslein, Bodil; Edvinsson, Lars; Paulsson, Per; Ingemansson, Richard; Malmsjö, Malin

    2008-01-01

    Background Up-regulation of vascular endothelin type B (ETB) receptors is implicated in the pathogenesis of cardiovascular disease. Culture of intact arteries has been shown to induce similar receptor alterations and has therefore been suggested as a suitable method for, ex vivo, in detail delineation of the regulation of endothelin receptors. We hypothesize that mitogen-activated kinases (MAPK) and protein kinase C (PKC) are involved in the regulation of endothelin ETB receptors in human internal mammary arteries. Methods Human internal mammary arteries were obtained during coronary artery bypass graft surgery and were studied before and after 24 hours of organ culture, using in vitro pharmacology, real time PCR and Western blot techniques. Sarafotoxin 6c and endothelin-1 were used to examine the endothelin ETA and ETB receptor effects, respectively. The involvement of PKC and MAPK in the endothelin receptor regulation was examined by culture in the presence of antagonists. Results The endohtelin-1-induced contraction (after endothelin ETB receptor desensitization) and the endothelin ETA receptor mRNA expression levels were not altered by culture. The sarafotoxin 6c contraction, endothelin ETB receptor protein and mRNA expression levels were increased after organ culture. This increase was antagonized by; (1) PKC inhibitors (10 ?M bisindolylmaleimide I and 10 ?M Ro-32-0432), and (2) inhibitors of the p38, extracellular signal related kinases 1 and 2 (ERK1/2) and C-jun terminal kinase (JNK) MAPK pathways (10 ?M SB203580, 10 ?M PD98059 and 10 ?M SP600125, respectively). Conclusion In conclusion, PKC and MAPK seem to be involved in the up-regulation of endothelin ETB receptor expression in human internal mammary arteries. Inhibiting these intracellular signal transduction pathways may provide a future therapeutic target for hindering the development of vascular endothelin ETB receptor changes in cardiovascular disease. PMID:18778461

  4. Successful Antibiotic Treatment of Severe Staphylococcal Infection of a Long Stent Graft in the Superficial Femoral Artery with Graft Preservation in the Long Term

    SciTech Connect

    Treitl, Marcus; Rademacher, Antje; Becker-Lienau, Johanna; Reiser, Maximilian F.; Hoffmann, Ulrich; Czihal, Michael

    2011-06-15

    Introduction: Bacterial infection of endovascular stent grafts is a serious condition, regularly leading to graft replacement by open bypass surgery.Case ReportWe describe the case of a staphylococcal infection of a 150-mm covered stent graft (Gore Viabahn), placed in the superficial femoral artery. Stent graft infection was successfully treated by oral administration of penicillinase-resistant flucloxacillin and the lipopeptide daptomycin with complete graft preservation, not requiring surgical treatment. During 1-year follow-up, the graft infection did not reappear. However, the patient developed restenosis at the proximal margin of the stent with recurrence of mild claudication, so far treated conservatively. Conclusion: With the increased use of covered stent grafts in the peripheral vasculature, the frequency of graft infection will increase. We demonstrate that with newly developed antibiotics, it is possible to treat this severe complication conservatively, with complete graft preservation and without the need for bypass surgery in selected cases.

  5. Should computed tomography angiography supersede invasive coronary angiography for the evaluation of graft patency following coronary artery bypass graft surgery?

    PubMed

    Gabriel, Joseph; Klimach, Stefan; Lang, Peter; Hildick-Smith, David

    2015-08-01

    Invasive coronary angiography (ICA) has long been the established gold standard in assessing graft patency following coronary artery bypass graft (CABG). Over the past decade or so however, improvements in computed tomography angiography (CTA) technology have allowed its emergence as a useful clinical tool in graft assessment. The recent introduction of 64-slice and now 128-slice scanners into widespread distribution, and the development of 320-detector row technology allowing volumetric imaging of the entire heart at single points in time within one cardiac cycle, has increased the potential of CTA to supersede ICA in this capacity. This study sought to examine the evidence surrounding this potential. A best evidence topic was constructed according to a structured protocol. The enquiry: In [patients who have undergone coronary artery bypass graft surgery] is [computed tomography angiography or invasive coronary angiography] superior in terms of [graft patency assessment, stenosis detection, radiation exposure and complication rate]? Four hundred and twenty-four articles were identified from the search strategy. Four additional articles were identified from references of key articles. Seventeen articles selected as best evidence were tabulated. The reliability of CTA as a tool in the detection of graft patency and stenosis has continued to improve with each successive generation of multislice technology. The latest 64- and 128-slice CTA techniques are able to detect graft patency and stenosis with very high sensitivities and specificities comparable with ICA, while remaining non-invasive procedures associated with fewer complications (ICA carries a 0.08% risk of myocardial infarction and 0.7% risk of minor complications in clinically stable patients). Present limitations of the technology include the accurate visualization of distal anastomoses and clip artefacts. In addition, the capacity of diagnostic ICA to be combined simultaneously with percutaneous coronary interventions is an important advantage and a further limitation of CTA alone. Recent developments, however, including the derivation of fractional flow reserve and perfusion assessment from CTA as functional measures of stenosis severity have given CTA at present the capacity to become a first-line tool in the assessment of patients with suspected graft dysfunction. Novel computer-automated diagnostic software, though currently in infancy, has shown promise in facilitating and speeding image interpretation. With further improvements in scanning technologies, CTA is likely to supersede ICA for graft assessment in the near future. PMID:25924868

  6. Effect of a selective thromboxane synthase inhibitor on arterial graft patency and platelet deposition in dogs

    SciTech Connect

    McDaniel, M.D.; Huntsman, W.T.; Miett, T.O.; Cronenwett, J.L.

    1987-08-01

    This study examined the effect of selective thromboxane synthase inhibition and nonselective cyclooxygenase inhibition on vascular graft patency and indium 111-labeled platelet deposition in 35 mongrel dogs undergoing carotid artery replacement with 4 mm X 4 cm polytetrafluoroethylene (PTFE) (one side) and Dacron (opposite side) end-to-end grafts. Aspirin-dipyridamole therapy improved one-week graft patency, from 46% in untreated dogs to 93% in treated dogs. Thromboxane synthase inhibition (U-63557A) improved graft patency in these dogs to 81%. Both drug treatments reduced platelet deposition on Dacron and PTFE grafts by 48% to 68% compared with control dogs. Dacron grafts accumulated significantly more platelets than PTFE grafts but had comparable patency rates. Low-dose aspirin therapy had no significant effect on either graft patency or platelet deposition. All treatment groups showed a 60% to 76% reduction in serum thromboxane B2, but only thromboxane synthase inhibitor treatment increased plasma 6-keto-prostaglandin F1 alpha by 100%. Selective thromboxane synthase inhibition improved small-caliber prosthetic graft patency to the same extent as did conventional cyclooxygenase inhibition in this preliminary study.

  7. Surgical repair of infected peripheral graft and abdominal aortic aneurysm using arterial homograft.

    PubMed

    Locati, P; Socrate, A M; Costantini, E

    2000-03-01

    We report a case of combined surgical repair including lower limb revascularization (below-knee bypass) and abdominal aortic aneurysm repair using cryopreserved arterial homograft. The patient experienced lower limb ischemia due to repeated thrombosis of a long-infected polytetrafluoroethylene (PTFE) graft, and was also shown to have a complicating abdominal aortic aneurysm. Infection was eradicated with total graft excision and intravenous antibiotics. Two-year patency of the in situ arterial homograft revascularization was demonstrated with hemodynamic and tomographic controls; no degenerations have been found to date. Benefits of the use of in situ arterial homograft for arterial reconstruction may include improved hemodynamics and greater resistance to infection compared to when alloplastic materials are used. Because of the risk of allograft deterioration, close follow-up of the patient is required. PMID:10742435

  8. The role of stent grafts in the management of traumatic tibial artery pseudoaneurysms: case report and review of the literature.

    PubMed

    Joglar, Fernando; Kabutey, Nii-Kabu; Maree, Andrew; Farber, Alik

    2010-07-01

    Tibial artery pseudoaneurysms can occur in the setting of trauma. Operative exposure and repair of these injuries can be challenging, and surgical management options include direct arterial repair, interposition grafting, or arterial ligation. Other techniques including duplex-guided compression, thrombin injection, and endovascular intervention have been described. We present the case of a 39-year-old man who sustained blunt trauma to his right lower extremity and developed a delayed symptomatic pseudoaneurysm of the posterior tibial artery. He was successfully managed with endovascular stent graft exclusion of the pseudoaneurysm. Endovascular stent-grafting techniques can be successfully applied to the management of traumatic tibial pseudoaneurysms. PMID:20484071

  9. Spiral CT During Selective Accessory Renal Artery Angiography: Assessment of Vascular Territory Before Aortic Stent-Grafting

    SciTech Connect

    Dorffner, Roland; Thurnher, Siegfried; Prokesch, Rupert; Youssefzadeh, Soraya; Hoelzenbein, Thomas; Lammer, Johannes

    1998-03-15

    We evaluated the vascular territory of accessory renal arteries in cases where the vessel might be overlapped by an aortic stent-graft. Spiral CT during selective accessory renal artery angiography was performed in four patients with abdominal aortic aneurysms (including one with a horseshoe kidney). The volume of the vascular territory of each renal artery was measured using a software program provided by the CT unit manufacturer. The supernumerary renal arteries perfused 32%, 37%, 15%, and 16% of the total renal mass, respectively. In two patients, stent-grafts were implanted, which resulted in occlusion of the supernumerary renal artery. The volume of the renal infarction was equal to the volume perfused by the artery as calculated before implantation of the stent-graft.The method proposed is accurate for estimating the size of the expected renal infarction. It might help to determine whether placement of a stent-graft is acceptable.

  10. Predicting extraction and uptake of arterial energy metabolites by the mammary glands of lactating cows when blood flow is perturbed.

    PubMed

    Cant, J P; Madsen, T G; Cieslar, S R L

    2016-01-01

    Previous work shows that mammary uptake of milk precursors from blood can be affected by the rate of blood flow (F) to the glands. The purpose of the current work was to test the ability of compartmental and cylindrical capillary models to account for the variation in mammary extraction and net uptake of plasma metabolites produced by perturbation of mammary F. The data for model fitting were obtained from a previous experiment in which mammary arteriovenous differences of acetate + ?-hydroxybutyrate (2C), glucose, triacylglycerol (TAG), and long-chain fatty acids (LCFA) were measured in 4 cows before, during, and after intraarterial infusion of inhibitors of endothelial nitric oxide synthase and cyclooxygenase, which are 2 major systems of F control in the mammary glands. The 4 models tested were (1) constant extraction within each cow, (2) clearance from an extracellular compartment is a linear function of F with an intercept, (3) total capillary volume in a cylindrical representation is a linear function of F with an intercept, and (4) uptake from an extracellular compartment obeys Henri-Michaelis-Menten kinetics, where maximum velocity (Vmax) is a linear function of F with an intercept. According to prediction errors, model 4 fitted 2C extraction data best, accounting for 82% of the observed variation. The estimated Km (Henri-Michaelis-Menten constant) for venous 2C was 0.4 mM. For glucose clearance, a variant of model 2 with a positive effect of 2C uptake on clearance was identified as best, producing a coefficient of determination (R(2)) of 0.31. For TAG, model 2 with a positive effect of arterial TAG concentration on TAG clearance was best, with an R(2) of 0.22. For LCFA, model 2 with a positive effect of arterial LCFA on LCFA clearance was best, with an R(2) of 0.29. Models 2 and 3 fitted the extraction data with the same R(2)-values and prediction errors, so both compartmental and cylindrical approaches to describing the vascular bed were equally capable of describing the effect of F on mammary uptakes. A combined fit of all best-fit models to extraction data for all 4 metabolites at once explained 52, 42, 73, and 77% of variation in net uptakes of 2C, glucose, TAG, and LCFA, respectively. According to the fitted model, each 1 L/min increase in F increased the mammary volumes of distribution of 2C, glucose, TAG, and LCFA by 13, 14, 18, and 7%, respectively. PMID:26585481

  11. Intraoperative Assessment and Quantification of Coronary Artery Graft Patency Performed on or off Cardiopulmonary Bypass

    PubMed Central

    Rauch, Eric D.; Leach, Christopher; Barnes, Terry; Driscoll, Kurt; Strutz, Kurt; Holt, David W.

    2007-01-01

    Abstract: Within the last 10 years, the incorporation of off-pump coronary artery bypass grafting (OPCAB) into many surgical practices has grown. OPCAB requires the surgeon to operate on a beating heart, and it is generally accepted that OPCAB procedures are more technically demanding. Concerns of possible incomplete revascularizations and decreased graft patency have been noted in the literature. The objective of this study was to evaluate and compare on-pump and off-pump intraoperative coronary artery bypass graft (CABG) flow parameters. Intraoperative flow studies conducted with the Butterfly (Medi-Stim Norge AS, Oslo, Norway) flow meter were analyzed retrospectively on 74 patients. Comparisons were completed between patient groups having had their revascularizations performed on or off cardiopulmonary bypass. Our study revealed significant differences in the mean flow rate through saphenous vein grafts (SVG) to the obtuse marginal artery (OM; p = .014), to the diagonal artery (Diag; p = .003), to the right coronary artery (RCA; p = .001), and to the posterior descending artery (PDA; p = .001). Total blood product use showed significantly increased use of both platelets (PLTs) and cryoprecipitate (Cryo) in the on-pump group (p = .027 and .012, respectively). No differences were found for transfusions of red blood cells (RBCs) or fresh frozen plasma (FFP). Additional findings showed a significantly decreased median length of stay (LOS) for the off-pump group. The on-pump patients had a median hospital stay of 7 days (range, 4–24 days), whereas the off-pump patients had a median stay of 6 days (range, 3–22 days; p = .049). Although we were able to show some significance in the mean flow data supporting increased graft flow with the on-pump technique, we were not able to show an overall increase in all recorded flow characteristics to support one method over another. PMID:17672187

  12. Successful n-butyl cyanoacrylate embolization of a spontaneous rupture of the internal mammary artery in a patient with myelodysplastic syndrome: report of a case.

    PubMed

    Muradi, Akhmadu; Yamaguchi, Masato; Sakamoto, Noriaki; Okada, Takuya; Idoguchi, Koji; Sugimoto, Koji

    2014-03-01

    Hemomediastinum and hemothorax due to spontaneous internal mammary artery (IMA) rupture is extremely rare, and can be a life-threatening condition. We herein present, to the best of our knowledge, the first case of spontaneous IMA rupture complicating myelodysplastic syndrome, and the first case that was successfully treated by emergency trans-arterial embolization using n-butyl cyanoacrylate. PMID:23161481

  13. Myocardial infarction determined by technetium-99m pyrophosphate single-photon tomography complicating elective coronary artery bypass grafting for angina pectoris

    SciTech Connect

    Burns, R.J.; Gladstone, P.J.; Tremblay, P.C.; Feindel, C.M.; Salter, D.R.; Lipton, I.H.; Ogilvie, R.R.; David, T.E.

    1989-06-15

    The incidence of acute myocardial infarction (AMI) complicating coronary artery bypass grafting (CABG) has previously been based on concordance of electrocardiographic, enzymatic and scintigraphic criteria. Technetium-99m pyrophosphate (Tc-PPi) single-photon emission computed tomography now enables detection of AMI with high sensitivity and specificity. Using this technique, perioperative AMI was detected in 12 of 58 patients (21%) undergoing successful elective CABG for stable angina pectoris. Stepwise multivariate logistic regression analysis was performed to compare the predictive value of preoperative (New York Heart Association class, left ventricular ejection fraction and use of beta blockers) and intraoperative (number of grafts constructed, use of internal mammary anastomoses, use of sequential saphenous vein grafts, smallest grafted distal vessel lumen caliber and aortic cross-clamp time) variables. Preoperative New York Association class (p = 0.04) and smallest grafted distal vessel lumen caliber (p = 0.03) were significant multivariate predictors of perioperative AMI. Only 1 perioperative patient with AMI (and 1 pyrophosphate-negative patient) developed new Q waves. Serum creatine kinase-MB was higher in patients with AMI by repeated measures analysis of variance (p = 0.0003). Five AMIs occurred in myocardial segments revascularized using sequential saphenous vein grafts, and 7 in segments perfused by significantly stenosed epicardial vessels with distal lumen diameter and perfusion territory considered too small to warrant CABG. At 6-month follow-up, the mean left ventricular ejection fraction increased from 0.61 to 0.65 in Tc-PPI-negative patients (p = 0.01), but not in perioperative patients with AMI.

  14. The effects of crimping on the healing of prosthetic arterial grafts.

    PubMed

    Herring, M; Dilley, R; Gardner, A; Glover, J

    1980-01-01

    The purpose of this study was to determine whether the crimping of arterial prostheses affected their healing. In ten dogs, 6 mm knitted Dacron grafts were implanted in the infrarenal aortas; 6 grafts were crimped, 4 uncrimped. Each was seeded with venous endothelium to produce a cellular lining. The grafts were removed a month after implantation and compared by light microscopy as to the (1) thickness of the inner lining, (2) completeness of endothelial healing, and (3) patterns of vasa vasorum. (1) and (3) were assessed using H & E sections and (2) by AgNO3 Häutchen preparations. The lining in uncrimped grafts was thinner and more uniform than in crimped grafts: 50.1 +/- 45.7 vs 263 +/- 183 mu, p < 0.001. While the completeness of healing was similar for both groups, 4 crimped grafts had unhealed areas in the centers of the crimps, corresponding to the thicker areas of the linings. In both kinds of grafts, vasa vasorum communicated with vascular channels parallel to the axis of flow and near the perigraft fat. In the uncrimped grafts, the smaller secondary vasa also were directed along the axis of flow, in contrast to crimped grafts in which they were circumferential to the graft and parallel to the crimps. In all instances vasa penetrated within 500 mu of the lumen. We conclude that crimping causes a change in the pattern of development of vasa vasorum in healing fabric grafts and a thicker inner lining associated with areas of delayed healing which may increase the risk of thrombosis. PMID:7451567

  15. Relative importance of patient, procedural and anatomic risk factors for early vein graft thrombosis after coronary artery bypass graft surgery

    PubMed Central

    MCLEAN, R. C.; NAZARIAN, S. M.; GLUCKMAN, T. J.; SCHULMAN, S. P.; THIEMANN, D. R.; SHAPIRO, E. P.; CONTE, J. V.; THOMPSON, J. B.; SHAFIQUE, I.; MCNICHOLAS, K. W.; VILLINES, T. C.; LAWS, K. M.; RADE, J. J.

    2015-01-01

    Aim The aim of the present study was to investigate the relative importance of a wide array of patient demographic, procedural, anatomic and perioperative variables as potential risk factors for early saphenous vein graft (SVG) thrombosis after coronary artery bypass graft (CABG) surgery. Methods The patency of 611 SVGs in 291 patients operated on at four different hospitals enrolled in the Reduction in Graft Occlusion Rates (RIGOR) study was assessed six months after CABG surgery by multidetector computed tomography coronary angiography or clinically-indicated coronary angiography. The odds of graft occlusion versus patency were analyzed using multilevel multivariate logistic regression with clustering on patient. Results SVG failure within six months of CABG surgery was predominantly an all-or-none phenomenon with 126 (20.1%) SVGs totally occluded, 485 (77.3%) widely patent and only 16 (2.5%) containing high-grade stenoses. Target vessel diameter ?1.5 mm (adjusted OR 2.37, P=0.003) and fetnale gender (adjusted OR 2.46, P=0.01) were strongly associated with early SVG occlusion. In a subgroup analysis of 354 SVGs in which intraoperative graft blood flow was measured, lower mean flow was also significantly associated with SVG occlusion when analyzed as a continuous variable (adjusted OR 0.984, P=0.006) though not when analyzed dichotomously, <40 mL/min versus ?40 mL/min (adjusted OR 1.86, P=0.08). Conclusion Small target vessel diameter, female gender and low mean graft blood flow are significant risk factors for SVG thrombosis within six months of CABG surgery in patients on postoperative aspirin therapy. This information may be useful in guiding revascularization strategies in selected patients. PMID:22051997

  16. Fenestrated stent graft in treatment of type IV thoracoabdominal aneurysm involving all visceral arteries

    PubMed Central

    Majewski, Wac?aw; Juszkat, Robert; Stanisi?, Micha?; Kulesza, Jerzy; Majewska, Natalia; Oszkinis, Grzegorz

    2015-01-01

    Conventional open surgical repair of thoracoabdominal aortic aneurysm (TAAA) is associated with high perioperative mortality and morbidity risk. Our report of successful treatment of a 56-year-old patient with TAAA involving all visceral arteries and with many comorbidities with a fenestrated stent graft supports its application in high-risk TAAA patients. PMID:26336502

  17. Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin.

    PubMed

    Pecoraro, Felice; Sabatino, Ermanno R; Dinoto, Ettore; La Rosa, Giuliana; Corte, Giuseppe; Bajardi, Guido

    2015-10-01

    A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, the wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion. PMID:25156947

  18. Superior Mesenteric Artery Stent-graft Placement in a Patient with Pseudoaneurysm Developing from a Pancreatic Pseudocyst

    SciTech Connect

    Ogino, H.; Banno, T.; Sato, Y.; Hara, M.; Shibamoto, Y.

    2004-01-15

    Pseudoaneurysm is a relatively rare but serious complication of pancreatitis which is often fatal. We report successful stent-graft placement in the superior mesenteric artery in a 45-year-old man with a pancreatic pseudocyst that grew during therapy for chronic pancreatitis and developed into a pseudoaneurysm. After a stent graft was inserted in the superior mesenteric artery, the pseudoaneurysm disappeared and no further complications developed. Stent-graft placement was considered to be a useful therapy for pseudoaneurysms in the superior mesenteric arterial region.

  19. Pseudoaneurysm of a branch of left internal mammary artery: a late and potentially fatal complication after redo-sternotomy.

    PubMed

    Falconieri, Fabio; Raevsky, Evgeny; Davies, Simon; Moat, Neil

    2015-06-01

    Post-sternotomy pseudoaneurysms of the internal mammary arteries (IMAs) and their branches are rare and often present with rupture-associated haemothorax and haemodynamic instability. In those cases, urgent surgical correction or embolization can be the treatment of choice. Traumatic chest injuries might lead to IMA branch injury as well; after cardiac surgery, injuries to these branches during sternal closure can be an extremely rare cause of pseudoaneurysm. We describe the case of a 78-year old lady with a left IMA branch pseudoaneurysm, arising from left sternal edge a few weeks after redo-sternotomy for mitral valve surgery. We also describe its non-surgical successful repair. PMID:25788578

  20. Changes in Heart Rate Variability after Coronary Artery Bypass Grafting and Clinical Importance of These Findings

    PubMed Central

    Lakusic, Nenad; Mahovic, Darija; Cerkez Habek, Jasna; Novak, Miroslav; Cerovec, Dusko

    2015-01-01

    Heart rate variability is a physiological feature indicating the influence of the autonomic nervous system on the heart rate. Association of the reduced heart rate variability due to myocardial infarction and the increased postinfarction mortality was first described more than thirty years ago. Many studies have unequivocally demonstrated that coronary artery bypass grafting surgery generally leads to significant reduction in heart rate variability, which is even more pronounced than after myocardial infarction. Pathophysiologically, however, the mechanisms of heart rate variability reduction associated with acute myocardial infarction and coronary artery bypass grafting are different. Generally, heart rate variability gradually recovers to the preoperative values within six months of the procedure. Unlike the reduced heart rate variability in patients having sustained myocardial infarction, a finding of reduced heart rate variability after coronary artery bypass surgery is not considered relevant in predicting mortality. Current knowledge about changes in heart rate variability in coronary patients and clinical relevance of such a finding in patients undergoing coronary artery bypass grafting are presented. PMID:26078960

  1. Stent-Graft Treatment for Bleeding Superior Mesenteric Artery Pseudoaneurysm After Pancreaticoduodenectomy

    SciTech Connect

    Suzuki, Kojiro Mori, Yoshine; Komada, Tomohiro; Matsushima, Masaya; Ota, Toyohiro; Naganawa, Shinji

    2009-07-15

    We report two cases of intraperitoneal bleeding from superior mesenteric artery (SMA) pseudoaneurysm after pancreaticoduodenectomy for pancreatic head carcinoma. In both cases, a stent-graft was deployed on the main SMA to exclude pseudoaneurysm and to preserve blood flow to the bowel. Bleeding stopped after the procedure. One patient was able to be discharged but died from carcinoma recurrence 4 months later. The other patient died of sepsis and stent-graft infection 5 months later. These patients remained free of intraperitoneal rebleeding during the follow-up period.

  2. Endovascular Repair of Acute Symptomatic Pararenal Aortic Aneurysm With Three Chimney and One Periscope Graft for Complete Visceral Artery Revascularization

    SciTech Connect

    Brechtel, Klaus Ketelsen, Dominik; Endisch, Andrea; Heller, Stephan; Heuschmid, Martin; Stock, Ulrich A.; Kalender, Guenay

    2012-04-15

    PurposeTo describe a modified endovascular technique for complete revascularization of visceral and renal arteries in symptomatic pararenal aortic aneurysm (PRAA).TechniqueArterial access was surgically established in both common femoral arteries (CFAs) and the left subclavian artery (LSA). Revascularization of the left renal artery, the celiac trunk, and the superior mesenteric artery was performed through one single sheath via the LSA. Suitable covered stents were put in the aortic branches but not deployed. The right renal artery was accessed over the left CFA. Due to the longitudinal extension of the presented aneurysm two stent-grafts were introduced via the right CFA. After deploying the aortic stent-grafts, all covered stents in the side branches were deployed consecutively with a minimum overlap of 5 mm over the cranial and caudal stent-graft edges. Simultaneous ballooning was performed to fully expand all stent-grafts and warranty patency. Conclusion: This is the first report in the literature of chimney grafting in PRAA for complete revascularization of visceral and renal branches by using more than two covered stents introduced from one side through one single sheath. However this technique is modified, it should be used only in bailout situations when branched stent-grafts are not available and/or surgery is not suitable.

  3. Coronary artery surgery: now and in the next decade.

    PubMed

    Ennker, J C; Ennker, I C

    2012-01-01

    In coronary artery surgery the superiority of the internal mammary artery graft in 10-year survival was documented in 1986. In 1999 it was demonstrated that death, reoperation and percutaneous transluminary coronary angioplasty were more frequent in patients undergoing single rather than bilateral internal mammary artery grafting. Today coronary artery bypass grafting surgery is challenged by the success story of modern interventional cardiology. The Syntax Study, however, clearly underlined the better outcome for patients with triple-vessel and/or left main disease undergoing coronary artery bypass grafting in terms of repeat revascularization. Another point of ongoing discussion is the comparison between on-pump and off-pump coronary artery revascularization techniques. Even if mixed results exists in the literature, in experienced hands the combination of aortic no-touch and total arterial revascularization, probably leads to the superiority in off pump coronary artery bypass grafting in terms of significantly decreased rates of mortality, stroke, major adverse cardiac and cerebral vascular events. Coronary artery surgery in the next decade will be influenced by the further progression of minimally invasive surgical principles and by a variety of other factors. The role of robotics and hybrid surgery has yet to be defined. Alternatives within surgery will not only need to move to a less disruptive strategy (e.g. from on-pump to off-pump bypass) but also have to secure sustained innovation, as we can be sure that the current coronary artery bypass grafting activity will change substantially. PMID:23439278

  4. Association of pre and intraoperative variables with postoperative complications in coronary artery bypass graft surgery

    PubMed Central

    Gimenes, Camila; Barrile, Silvia Regina; Martinelli, Bruno; Ronchi, Carlos Fernando; Arca, Eduardo Aguilar; Gimenes, Rodrigo; Okoshi, Marina Politi; Okoshi, Katashi

    2013-01-01

    Objective To associate the pre- and intraoperative variables with postoperative complications of patients undergoing coronary artery bypass graft surgery. Methods The pre- and intraoperative risk factors of individuals of both genders with diagnosis of coronary insufficiency undergoing coronary artery bypass graft have been studied. Results Fifty-eight individuals with median age 62 ± 10 year-old were included in the study, 67% of whom were male. Fourteen (24.1%) patients were smokers, 39 (67.2%) had previous myocardial infarction history, 11 (19%) had undergone coronary angioplasty, 74% had hypertension, 27% had diabetes mellitus, 64% had dyslipidemia and 15.5% had chronic obstructive pulmonary disease. Eighteen (31%) patients presented postoperative complications, most frequent being: infection in surgical incision, difficulties in deambulation, dyspnea, urinary infection and generalized weakness. Male patients had fewer complications than females (P=0.005). Patients with chronic obstructive pulmonary disease remained hospitalized for longer time periods (P=0.019). Postoperative complications occurred in 50% of the patients with creatinine increased, while only 27.1% of the patients with normal value of creatinine had complications (P=0.049). In addition, complications occurred in 50% of the patients with diabetes mellitus, while only 23.8% of patients without diabetes mellitus had complications (P=0.032). The intraoperative factors showed no statistically significant differences. Conclusion The preoperative factors are associated with postoperative complications in patients undergoing coronary artery bypass graft surgery. PMID:24598958

  5. Endovascular Exclusion of Visceral Artery Aneurysms with Stent-Grafts: Technique and Long-Term Follow-up

    SciTech Connect

    Rossi, Michele; Rebonato, Alberto Greco, Laura; Citone, Michele; David, Vincenzo

    2008-01-15

    This paper describes four cases of visceral artery aneurysms (VAAs) successfully treated with endovascular stent-grafts and discusses the endovascular approach to VAAs and the long-term results. Four balloon expandable stent-grafts were used to treat three splenic artery aneurysms and one bleeding common hepatic artery pseudoaneurysm. The percutaneous access site and the materials were chosen on the basis of CT angiography findings. In all cases the aneurysms were successfully excluded. In one case a splenic infarction occurred, with nonrelevant clinical findings. At 16- to 24-month follow-up three patients had patent stents and complete exclusion and shrinkage of the aneurysms. One patient died due to pancreatitis and sepsis, 16 days after successful stenting and exclusion of a bleeding pseudoaneurysm. We conclude that endovascular treatment using covered stent-grafts is a valid therapeutic option for VAAs. Multislice CT preoperative study helps in planning stent-graft positioning.

  6. Successful Covering of a Hepatic Artery Aneurysm with a Coronary Stent Graft

    SciTech Connect

    Sakai, Hidetsugu; Urasawa, Kazushi; Oyama, Naotsugu; Kitabatake, Akira

    2004-09-15

    In a 54-year-old woman with liver cirrhosis who underwent orthotopic liver transplantation, the postoperative course was complicated by aneurysm formation in the hepatic artery. Abdominal ultrasonography showed a daily increase in the size of the aneurysm in spite of careful management including strict rest and continuous intravenous infusion of antihypertensive agents. Since the patient's poor systemic status was a major obstruction to operative resection, transcatheter therapy was thought more preferable. We evaluated the lesion with intravascular ultrasonography as an adjunct to angiography and a dissection with a flap was well visualized. The aneurysm was covered with a commercially available stent-graft, designed for treatment of the coronary artery. This is a rare case in which a Jostent was implanted into the hepatic artery after liver transplantation.

  7. [Integrated coronary artery bypass strategy prevents urgent pump conversion during off-pump coronary artery bypass grafting].

    PubMed

    Yokoyama, H; Takase, S; Misawa, Y; Hagiwara, K; Tanji, M; Takahashi, S; Watanabe, M; Kondo, S

    2009-01-01

    Urgent pump conversion during off-pump coronary artery bypass (OPCAB) results in high morbidity and mortality. We retrospectively evaluated if the peri-operative integrated strategy prevents this lethal event in our 400 consecutive OPCAB operations. The patients with preoperative cardiogenic shock and/or ventricular arrhythmias underwent on-pump coronary artery bypass grafting (CABG). All other patients (99% of total CABG) were scheduled to undergo OPCAB (n=400). Prophylactic intraaortic balloon pumping (IABP) was applied to the patients with critical (>95%) left main trunk stenosis or low (<0.35) left ventricular ejection fraction. All the patients received the deep pericardial suture, apex-traction device, suction-type stabilizer, test-clamp of target coronary arteries by micro bulldog clamp, and intra-coronary shunts. Intra-operative IABP was applied in the case of sustained ST-segment change and/or elevated pulmonary artery pressure. Pump conversion was indicated for the patients with ventricular fibrillation and/or cardiogenic shock. Two patients (0.5%) had pump conversion due to ventricular arrhythmia and sustained hypotension, respectively. These pump conversion did not result in hospital mortality. Three hospital deaths (0.7%) occurred due to non-cardiac causes. The integrated strategy using prophylactic or intra-operative IABP in OPCAB produce a low pump conversion rate even during an early period of surgeon's learning curve. PMID:19195183

  8. Bilateral Renal Artery Aneurysm: Percutaneous Treatment with Stent-Graft Placement

    SciTech Connect

    Gandini, R.; Spinelli, A.; Pampana, E.; Fabiano, S.; Pendenza, G. Simonetti, G.

    2006-10-15

    A 51-year-old man with an 8-year history of hypertension (170/115 mmHg with two drugs) and altered renal function (5.6 mg/dl serum creatinine, 101 mg/dl BUN) was referred to our Department to evaluate the renal arteries and rule out renovascular hypertension. Doppler ultrasound and magnetic resonance angiography revealed significant bilateral renal artery stenosis and the presence of bilateral renal artery aneurysms. A self-expandable polytetrafluoroethylene (PTFE)-covered nitinol stent-graft was deployed in each renal artery to treat the stenoses and to exclude the aneurysm. Postprocedural digital subtraction angiography confirmed the resolution of the renal artery stenoses and the complete exclusion of the aneurysms. At the 6 month follow-up, color Doppler confirmed normal patency of the renal arteries with complete exclusion of the aneurysms and significant reduction of the blood pressure (130/85 mmHg with one drug) and serum creatinine levels (2.1 mg/dl)

  9. An Infected Aneurysm of the Vertebral Artery Treated with a Stent-graft: A Case Report.

    PubMed

    Hashimoto, Kenji; Isaka, Fumiaki; Yamashita, Kohsuke

    2015-11-16

    In a 75-year-old man, a growing vertebral artery aneurysm at the C3/4 intervertebral level was found at postoperative evaluation of cervical abscess, which was diagnosed as a complication of sepsis subsequent to cholangitis. Even after a successful antibiotic treatment and a surgical drainage, the aneurysm grew enough to cause compression of esophagus and trachea. The aneurysm was judged to be infection-related, based on the clinical course and the anatomical vicinity to the abscess. Following a dual antiplatelet treatment (clopidogrel 75 mg and aspirin 100 mg per day) for a week, the patient underwent endovascular treatment of the aneurysm with a stent-graft. Postoperative angiography showed complete obliteration of the aneurysm with preserving patency of the vertebral artery. A dual antiplatelet treatment was continued for 6 months and was changed to a single antiplatelet treatment (clopidogrel 75 mg per day) thereafter. Neither recurrence of the aneurysm nor stent-graft infection was observed for 4 years of follow-up. This case illustrates the potential use of a stent-graft in the treatment of an infected aneurysm. PMID:26437795

  10. Combined MR imaging and numerical simulation of flow in realistic arterial bypass graft models.

    PubMed

    Papaharilaou, Y; Doorly, D J; Sherwin, S J; Peiro, J; Griffith, C; Cheshire, N; Zervas, V; Anderson, J; Sanghera, B; Watkins, N; Caro, C G

    2002-01-01

    We report methods for (a) transforming a three-dimensional geometry acquired by magnetic resonance angiography (MRA) in vivo, or by imaging a model cast, into a computational surface representation, (b) use of this to construct a three dimensional numerical grid for computational fluid dynamic (CFD) studies, and (c) use of the surface representation to produce a stereo-lithographic replica of the real detailed geometry, at a scale convenient for detailed magnetic resonance imaging (MRI) flow studies. This is applied to assess the local flow field in realistic geometry arterial bypass grafts. Results from a parallel numerical simulation and MRI measurement of flow in an aorto-coronary bypass graft with various inlet flow conditions demonstrate the strong influence of the graft inlet waveform on the perianastomotic flow field. A sinusoidal and a multi harmonic coronary flow waveform both with a mean Reynolds number (Re) of 100 and a Womersley parameter of 2.7 were applied at the graft inlet. A weak axial flow separation region just distal to the toe was found in sinusoidal flow near end deceleration (Re = 25). At the same location and approximately the same point in the cycle (Re = 30) but in coronary flow, the axial flow separation was stronger and more spatially pronounced. No axial flow separation occurred in steady flow for Re = 100. Numerical predictions indicate a region in the vicinity of the suture line (where there is a local narrowing of the graft) with a wall shear magnitude in excess of five times that associated with fully developed flow at the graft inlet. PMID:12122276

  11. Indium-111 platelet imaging for detection of platelet deposition in abdominal aneurysms and prosthetic arterial grafts

    SciTech Connect

    Ritchie, J.L.; Stratton, J.R.; Thiele, B.; Haminton, G.W.; Warrick, L.N.; Huang, T.W.; Harker, L.A.

    1981-04-01

    Thirty-four platelet imaging studies were performed in 23 patients to determine whether platelet deposition could be detected in patients with vascular aneurysms (18 patients) or in patients in whom Dacron prosthetic grafts had been placed (5 patients). In patients in whom abnormal platelet deposition was detected, the effect of administration of platelet-active drugs on platelet deposition was examined. Of the 18 patients with an aneurysm, 12 had equivocally positive studies on initial imaging and 2 had equivocally positive images. Of five patients with Dacron arterial grafts in place, four had diffuse platelet deposition in the grafts; the fifth patient had a platelet deposition only in a pseudoaneurysm. Eight patients with an abdominal aneurysm and positive or equivocally positive baseline images were restudied during platelet-active drug therapy either with aspirin plus dipyridamole (seven patients) or with sulfinpyrazone (four patients). No patient studied during treatment with aspirin plus dipyridamole had detectably decreased platelet deposition compared with baseline determinations. In contrast, two of four patients studied while receiving sulfinpyrazone showed decreased platelet deposition. Thus, platelet imaging may be of value for studying platelet physiology in vivo and for assessing platelet-active drugs and the thrombogenicity of prosthetic graft materials in human beings.

  12. Endovascular salvage of a right brachial artery-right atrium hemodialysis graft using a covered endoprosthesis.

    PubMed

    Anaya-Ayala, Javier E; Ismail, Nyla; Reardon, Michael J; Peden, Eric K

    2012-01-01

    Creation of a functional hemodialysis access in patients with exhausted peripheral access sites and concomitant central venous occlusive disease (CVOD) is a multifaceted challenge; often requiring complex, innovative solutions, not without their own complications. We present a 57-year-old hemodialysis patient with a history of hypercoagulable disorder and multiple failed arteriovenous accesses. Because of inadequate peripheral access sites and chronic occlusions in superior vena cava, brachiocephalic veins and inferior vena cava, in addition to multiple transhepatic catheter related issues; we decided to perform a right brachial artery to right atrium (RA) hemodialysis graft. The access was used without complications for 18 months at which point he had his first episode of thrombosis; open thrombectomy and percutaneous balloon angioplasty (PTA) at the atrial anastomosis were done with success. The following three months, he endured two more thrombectomies and PTAs. During the last intervention we performed an intravascular Ultrasound (IVUS) through the atrial anastomosis, which demonstrated stenosis; and the decision was made to extend the outflow anastomosis with a covered stent into the atrium. Therefore a 10 cm x 10 mm Viabahn stent-graft (W. L. Gore and Associates, Flagstaff, Ariz.) was deployed and post dilated with 8 mm balloon within the graft component. Repeat injection and Intravascular Ultrasound (IVUS) demonstrated significant improvement and free outflow. The brachial-RA hemodialysis graft could be use immediately and at 5 months has remained fully functional and no reinterventions have been necessary. PMID:22522413

  13. Multiscale modeling and simulation of blood flow in coronary artery bypass graft surgeries

    NASA Astrophysics Data System (ADS)

    Sankaran, Sethuraman; Esmaily Moghadam, Mahdi; Kahn, Andy; Marsden, Alison

    2011-11-01

    We present a computational framework for modeling and simulation of blood flow in patients who undergo coronary artery bypass graft (CABG) surgeries. We evaluate the influence of shape on the homeostatic state, cardiac output, and other quantities of interest. We present a case study on a patient with multiple CABG. We build a patient-specific model of the blood vessels comprised of the aorta, vessels branching from the top of the aorta (brachiocephalic artery and carotids) and the coronary arteries, in addition to bypass grafts. The rest of the circulatory system is modeled using lumped parameter 0D models comprised of resistances, compliances, inertances and elastance. An algorithm is presented that computes these parameters automatically given constraints on the flow. A Finite element framework is used to compute blood flow and pressure in the 3D model to which the 0D code is coupled at the model inlets and outlets. An adaptive closed loop BC is used to capture the coupling of the various outlets of the model with inlets, and is compared with a model with fixed inlet BC. We compare and contrast the pressure, flowrate, coronary perfusion, and PV curves obtained in the different cases. Further, we compare and contrast quantities of interest such as wall shear stress, wall shear stress gradients and oscillatory shear index for different surgical geometries and discuss implications of patient-specific optimization. I would like to acknowlege AHA for funding this work.

  14. Vein to artery grafts. A quantitative study of revascularization by vasa vasorum and its relationship to intimal hyperplasia.

    PubMed Central

    McGeachie, J; Campbell, P; Prendergast, F

    1981-01-01

    Iliolumbar vein to iliac artery grafts were placed in 40 rats by microsurgical technique. Groups of animals were perfused with fixative at eight intervals between one and 20 weeks after operation, and sections of the graft and control arteries (the opposite iliacs) were analyzed microscopically. The revascularization of the graft by capillaries commenced within the first postoperative week. The level of vascularity (capillaries per cross-sectional mm2) increased during the first four weeks, maintained a constant level and declined after week 16. The grafts of the 17--20 week group were substantially less vascular than the earlier groups. Intimal thickening commenced at three to four weeks after operation, i.e. during the period of increasing graft vascularity. The mean intimal proportion of the graft was 14% at four to five weeks and at 17--20 weeks was 35% of the cross-sectional area of the graft wall. However, the actual thickness of the intima did not increase significantly with time, rather the whole graft wall tended to become thinner. At 17--20 weeks grafts which showed a high degree of intimal thickening had significantly fewer capillaries within their walls. Quantitative evidence is presented to suggest that the continued growth of the graft intima may not be supported by a similar increase in the number of vasa vasorum. Therefore, it is suggested that the reduced level of vascularity in grafts with hyperplastic intimae may form an ischemic basis for degenerative changes which are known to take place in some long-term grafts. Images Fig. 1. Fig. 4. Fig. 5. Fig. 6. Fig. 7. PMID:7247528

  15. Evolution of shear stress, protein expression, and vessel area in an animal model of arterial dilatation in hemodialysis grafts

    PubMed Central

    Misra, Sanjay; Fu, Alex A.; Misra, Khamal D.; Glockner, James F.; Mukhopadyay, Debabrata

    2010-01-01

    Purpose To evaluate the wall shear stress, protein expression of matrix metalloproteinases-2 (MMP-2), -9 (MMP-9), and the inhibitors (tissue inhibitor of matrix metalloproteinases-1 (TIMP-1), and -2 (TIMP-2)), and vessel area over time in a porcine model for hemodialysis polytetrafluoroethylene (PTFE) grafts. Materials and methods In 21 pigs, subtotal renal infarction was performed and 28 days later, a PTFE graft was placed to connect the carotid artery to the ipsilateral jugular vein. Phase contrast MR was used to measure blood flow and vessel area at 1, 3, 7, and 14 days after graft placement. Wall shear stress was estimated from Poiseuille’s law. Animals were sacrificed at day 3 (N=7), day 7 (N=7), and day 14 (N=7) and expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 were determined at the grafted and control arteries. Results The mean wall shear stress of the grafted artery was higher than the control artery at all time points (P<0.05). It peaked by day 3 and decreased by days 7–14 as the vessel area nearly doubled. By days 7–14, there was a significant increase in active MMP-2 followed by a significant increase in pro and active MMP-9 by day 14 (P<0.05, grafted artery versus control). TIMP-1 expression peaked by day 7 and then decreased while TIMP-2 expression was decreased at days 7–14. Conclusions The wall shear stress of the grafted artery peaks by day 3 with increased MMP-2 activity by days 7–14 followed by pro and active MMP-9 by day 14 and the vessel area nearly doubled. PMID:20123196

  16. Modified T-Graft for Extracorporeal Membrane Oxygenation in a Patient with Small-Caliber Femoral Arteries

    PubMed Central

    Calderon, Daniel; El-Banayosy, Aly; Koerner, Michael M.; Reed, Amy B.

    2015-01-01

    Extracorporeal membrane oxygenation (ECMO) is generally used as a last resort to provide cardiopulmonary support in patients whose advanced cardiac or respiratory failure does not respond to less invasive treatments. Lower-limb ischemia secondary to the large diameter of the arterial cannula is one of ECMO's major limitations: in patients who have small-caliber arteries, the cannulas can reduce native blood flow. The creation of a T-graft—a well-described technique to avoid limb ischemia—enables flow into the ECMO cannula without jeopardizing blood flow to the limb. However, leaving the graft exposed through an open groin wound can result in dislodgment, and it increases the risk of infection. We describe our modification of a conventional T-graft in an 18-year-old woman who had systolic heart failure, acute respiratory distress syndrome, and small-caliber femoral vessels. We tunneled a polytetrafluoroethylene graft inside a Dacron graft, then ran the combined graft through a subcutaneous tunnel similar to that created for a peripheral bypass. Thus, the graft was protected from environmental exposure and the risk of infection. Our technique seems safer and more secure than the original T-graft technique, and we recommend its consideration during ECMO cannulation. PMID:26664305

  17. Platelet Hyperreactivity in Response to On- and Off-pump Coronary Artery Bypass Grafting

    PubMed Central

    Bochsen, Louise; Rosengaard, Lisbeth Bredahl; Nielsen, Allan Bybeck; Steinbrüchel, Daniel A.; Johansson, Pär I.

    2009-01-01

    Abstract: Hypercoagulability has been reported after off-pump coronary artery bypass grafting (OPCAB) compared with patients undergoing standard coronary artery bypass grafting (CABG) with cardiopulmonary bypass. The aim of this study was to evaluate the changes in platelet reactivity in response to cardiac surgery, both OPCAB and CABG. Platelet reactivity was monitored pre- and postoperatively (days 1 and 4) in elective OPCAB (n = 29) and CABG (n = 24) patients using the maximal amplitude (MA) parameter obtained with thrombelastography. Platelet reactivity was also examined at 1 month in 30 of the 53 patients. Twenty-three percent of the patients (12/53) had a preoperative MA value above normal reference value (MA > 69 mm). By postoperative day 4, 88% of the patients presented with an MA > 69 mm, and significant increases in MA were shown in both groups (p < .0001). Of the 30 patients examined at 1 month after surgery, 75% of the patients with high preoperative MA (6/8) remained at this level. In contrast, only 4.5% of patients with normal preoperative MA (1/22) presented with high MA at day 30. MA has previously been shown to correlate with the incidence of thrombotic and ischemic complications and this study identified 23% of patients needing coronary bypass surgery to be at high risk for recurrent ischemic events at 1 month after surgery, based on the MA. These results suggest that a more aggressive antithrombotic treatment might be warranted for patients undergoing coronary artery bypass grafting, both OPCAB and CABG, presenting with a high MA pre- and post-surgery. PMID:19361027

  18. Coronary Artery Bypass Graft Surgery: The Past, Present, and Future of Myocardial Revascularisation

    PubMed Central

    Chedrawy, Edgar G.

    2014-01-01

    The development of the heart-lung machine ushered in the era of modern cardiac surgery. Coronary artery bypass graft surgery (CABG) remains the most common operation performed by cardiac surgeons today. From its infancy in the 1950s till today, CABG has undergone many developments both technically and clinically. Improvements in intraoperative technique and perioperative care have led to CABG being offered to a more broad patient profile with less complications and adverse events. Our review outlines the rich history and promising future of myocardial revascularization. PMID:25374960

  19. Effects of Aspirin Responsiveness and Platelet Reactivity on Early Vein Graft Thrombosis after Coronary Artery Bypass Graft Surgery

    PubMed Central

    Gluckman, Tyler J.; McLean, Rhondalyn C.; Schulman, Steven P.; Kickler, Thomas S.; Shapiro, Edward P.; Conte, John V.; McNicholas, Kathleen W.; Segal, Jodi B.; Rade, Jeffrey J.

    2011-01-01

    Objectives To determine if an incomplete response to and/or inadequate antiplatelet effect of aspirin contribute to saphenous vein graft (SVG) occlusion after coronary artery bypass graft (CABG) surgery. Background Thrombosis is the predominant cause of early SVG occlusion. Aspirin, which inhibits cyclooxygenase-1 activity and thromboxane generation in platelets, reduces early SVG occlusion by half. Methods Aspirin-responsiveness and platelet reactivity were characterized 3 days and 6 months after CABG in 229 subjects on aspirin monotherapy by; platelet aggregation to arachidonic acid, ADP, collagen and epinephrine; PFA-100 closure time (CT) using collagen/epinephrine (CEPI) and collagen/ADP (CADP) agonist cartridges; VerifyNow Aspirin assay, and; urine levels of 11-dehydro-thromboxane B2 (UTXB2). SVG patency was determined 6 months after surgery by computed tomography coronary angiography. Results Inhibited arachidonic acid-induced platelet aggregation, indicative of aspirin-mediated cyclooxygenase-1 suppression, occurred in 95% and >99% of subjects 3 days and 6 months after surgery, respectively. Despite this, 73% and 31% of subjects at these times had elevated UTXB2. Among tested parameters, only UTXB2 and PFA-100 CADP CT measured 6 months after surgery correlated with outcome. By multivariate analysis, CADP CT ?88 seconds (OR 2.85, P=0.006), target vessel diameter ?1.5 mm (OR 2.38, P=0.01) and UTXB2 ?450 pg/mg creatinine (OR 2.59, P=0.015) correlated with SVG occlusion. CADP CT and UTXB2 in combination further identified subjects at particularly high- and low-risk for SVG occlusion. Conclusions Aspirin-insensitive thromboxane generation measured by UTXB2 and shear-dependent platelet hyper-reactivity measured by PFA-100 CADP CT are novel independent risk factors for early SVG thrombosis after CABG surgery. PMID:21349398

  20. Management of infected peripheral bypass by selective partial graft removal and arterial homograft insertion. Two case reports.

    PubMed

    Locati, P; Socrate, A M; Costantini, E; Maggiolo, F

    2000-04-01

    We present two cases of partial graft removal and cryopreserved arterial homograft insertion for treatment of patent axillobifemoral (AXB) polytetrafluoroethylene (PTFE) prosthesis with infection confined only to a part of the graft. In the first patient, infection was confined to the left inguinal site; in the second, there was a cutaneous fistula in the middle prosthetic thoracic tract. Neither patient presented signs of systemic sepsis and radio immunological tests were positive only in a confined tract. After surgery, both patients showed early recovery and currently (mean follow-up 21-month) they are disease-free. Selective partial graft removal appears to give satisfactory results and may reduce the risk of complications compared with total graft removal Moreover, arterial homograft shows greater resistance to infection compared to alloplastic materials, when autologous veins are not available and/or not suitable. PMID:10901543

  1. Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms

    SciTech Connect

    Okada, Takuya Yamaguchi, Masato; Kitagawa, Atsushi; Kawasaki, Ryota; Nomura, Yoshikatsu; Okita, Yutaka; Sugimura, Kazuro; Sugimoto, Koji

    2012-02-15

    Purpose: To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). Materials and Methods: Between January 2002 and March 2010, 20 patients (7 women and 13 men; mean age 74 years) underwent endovascular repair of 22 isolated IAAs. Two patients underwent endovascular repair for bilateral aneurysms. Ten para-anastomotic aneurysms (45%) developed after open abdominal aortic aneurysm (AAA) repair with an aorto-iliac graft, and 12 were true aneurysms (55%). Eleven straight and 11 tapered stent-grafts were placed. Contrast-enhanced computed tomography (CT) was performed to detect complications and evaluate aneurysmal shrinkage at week 1, 3, 6, and 12 months and once every year thereafter. Non-contrast-enhanced CT was performed in seven patients with chronic kidney disease. Results: All procedures were successful, without serious complications, during the mean (range) follow-up period of 746 days (47-2651). Type II endoleak not requiring treatment was noted in one patient. The mean (SD) diameters of the true and para-anastomotic aneurysms significantly (p < 0.05) decreased from 42.0 (9.3) to 36.9 (13.6) mm and from 40.1 (13.0) to 33.6 (15.8) mm, respectively; the mean (SD) shrinkage rates were 15.1% (20.2%) and 18.9% (22.4%), respectively. The primary patency rate was 100%, and no secondary interventions were required. Four patients (21%) developed transient buttock claudication, and one patient (5%) developed colorectal ischaemia, which was treated conservatively. Conclusion: Endovascular tubular stent-graft placement for the repair of isolated IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement.

  2. Surgical Treatment of Neonate With Congenital Left Main Coronary Artery Atresia.

    PubMed

    D'Souza, Travis F; Samuel, Bennett P; Vettukattil, Joseph J; Haw, Marcus P

    2016-01-01

    Left main coronary artery atresia (LMCAA) is a rare congenital malformation with a nonspecific and varied clinical presentation. Ventricular dysfunction and mitral insufficiency are expected ischemic consequences in the neonatal period. Left internal mammary artery (LIMA) bypass grafting (CABG) is uncommon because of the technical difficulties in performing this procedure in neonates. We describe LMCAA revascularization with a LIMA graft and mitral valve repair in a 7-week-old neonate with successful outcome 1 year postoperatively. PMID:26694277

  3. Prospective randomized clinical study of arterial pumps used for routine on pump coronary bypass grafting.

    PubMed

    Keyser, Andreas; Hilker, Michael K; Diez, Claudius; Philipp, Alois; Foltan, Maik; Schmid, Christof

    2011-05-01

    In a number of studies, centrifugal blood pumps--in comparison with roller pumps--have been shown to attenuate trauma to blood components. Nevertheless, the impact of these results on the postoperative course needs to be discussed controversially. In a prospective randomized study, 240 consecutive adult patients underwent elective myocardial revascularization with cardiopulmonary bypass employing five different pumps (Roller, Avecor, Sarns, Rotaflow, Bio-Medicus). We analyzed clinical course, blood loss, damage of blood components, and impairment of the hemostatic system. The study population was homogenous with respect to age, gender, myocardial function, and operative data. No differences were found with respect to time of ventilation, duration of intensive care stay, hospitalization, and laboratory data. The choice of arterial pump during standard extracorporeal bypass for elective coronary artery bypass grafting is no matter of concern. PMID:21269302

  4. Tungsten-rhenium suture needles with improved properties for coronary artery bypass graft surgery.

    PubMed

    Cichocki, Frank R; Maurer, Robert E; Bar, S Neil

    2010-08-01

    Suture needles are essential instruments for performing blood vessel anastomosis in coronary artery bypass graft (CABG) surgeries. Exceptional needle performance is needed now as never before because of the increasing prevalence of elderly patients with advanced stages of coronary disease and calcified tissue. The various properties that affect the performance of suture needles used in CABG surgery are reviewed and recent progress towards improving needle performance through the use of tungsten-rhenium alloys and novel lubricous needle coatings is presented. Substantial enhancement of properties beyond those exhibited by commercially available stainless steel suture needles has been made, including an approximate 40% increase in strength, 100% increase in stiffness, and superior multiple pass penetration performance in both synthetic rubber media and human cadaver carotid arteries (p < 0.01). PMID:20574974

  5. Dialysis grafts arterial plug: Retrieval using the tulip sheath device in vitro

    SciTech Connect

    Sharafuddin, Melhem J.; Titus, Jack L.

    1997-03-15

    The 'arterial plug' is a resistant thrombus that frequently persists at the arterial anastomosis of clotted hemodialysis grafts following thrombolytic therapy. We studied the physical and morphological characteristics of the plug and determined the feasibility of transcatheter removal in vitro using the tulip compression thrombectomy system. Sixteen thrombus plugs were recovered during surgical thrombectomy of clotted human dialysis grafts. The physical and gross physical characteristics of all plugs were analyzed. Eight specimens were evaluated microscopically. Transcatheter compression thrombectomy of eight plugs was attempted in vitro. Each plug was embedded in a polyvinyl tube filled with newly clotted blood and connected to a flow circuit. First, balloon-assisted aspiration thrombectomy (BAT) of soft thrombus was performed, while sparing the distal-most segment containing the plug. The tulip sheath was then introduced facing the 'arterial end' of the tube. The thrombus segment containing the plug was pulled back into the tulip mesh using either a 3 Fr Fogarty balloon catheter or a self-expanding rake. The tulip was closed to compress and remove the trapped plug. Near-complete thrombectomy of soft clot was achieved in all tested tubes. Compression and retrieval of the entire arterial plug was successful in all except one, where only partial compression of the plug occurred, presumably due to fibrotic changes. No fragmentation or embolization occurred in the remaining procedures. Spongy consistency was noted in 94% of the specimens. Microscopic evaluation showed organized layered thrombus with compaction in five plugs. Transcatheter removal of a thrombus plug is feasible in vitro using the tulip compression-thrombectomy system.

  6. Iatrogenic subclavian artery and aortic dissection with mesenteric ischemia following subclavian artery angioplasty: Endovascular management.

    PubMed

    Millán, Xavier; Azzalini, Lorenzo; Dorval, Jean-François

    2015-10-01

    Subclavian stenosis affects up to 5% of patients referred for coronary artery bypass grafting. Albeit usually asymptomatic, this condition can cause myocardial ischemia due to a steal phenomenon from the distal subclavian artery when the left internal mammary artery is used as a coronary bypass. We describe a case of proximal subclavian artery angioplasty complicated with aortic dissection and subsequent life-threatening mesenteric ischemia. For the first time, we illustrate an endovascular approach to both complications consisting in urgent stenting of the celiac trunk and the superior mesenteric artery followed by staged thoracic endovascular aortic repair due to progressive aortic dilatation. © 2015 Wiley Periodicals, Inc. PMID:25712709

  7. Intra-arterial Methylprednisolone Infusion in Treatment-Resistant Graft-Versus-Host Disease

    SciTech Connect

    Weintraub, Joshua L. Belanger, Adam R.; Sung, Chris C.; Stangl, P. Anondo; Nowakowski, F. Scott; Lookstein, Robert L.

    2010-06-15

    Acute graft-versus-host disease (GVHD) is a potentially fatal complication following allogeneic hematopoietic stem cell transplant. Standard primary therapy for acute GVHD includes systemic steroids, often in combination with other agents. Unfortunately, primary treatment failure is common and carries a high mortality. There is no generally accepted secondary therapy for acute GVHD. Although few data on localized therapy for GVHD have been published, intra-arterial injection of high-dose corticosteroids may be a viable option. We treated 11 patients with steroid-resistant GVHD using a single administration of intra-arterial high-dose methylprednisolone. Three patients (27%) died periprocedurally. Four patients (36%) had a partial response to intra-arterial treatment and were discharged on total parenteral nutrition and oral medication. Four patients (36%) had a complete response and were discharged on oral diet and oral medication. No immediate treatment or procedure-related complications were noted. Twenty-seven percent of patients survived long-term. Our preliminary results suggest that regional intra-arterial treatment of steroid-resistant GVHD is a safe and potentially viable secondary therapy in primary treatment-resistant GVHD.

  8. The effectiveness of lavender essence on strernotomy related pain intensity after coronary artery bypass grafting

    PubMed Central

    Heidari Gorji, Mohammad Ali; Ashrastaghi, Om Golsum; Habibi, Valiollah; Charati, Jamshid Yazdani; Ebrahimzadeh, Mohammad Ali; Ayasi, Mitra

    2015-01-01

    Background: Considering the side effects of pharmacological methods, there has been a suggestion to use nonpharmacological methods such Aromatherapy following coronary artery bypass grafting (CABG). This study aims to evaluate the effectiveness of lavender 2% aromatherapy on sternotomy pain intensity after coronary artery bypass graft surgery in patients who have undergone surgery. Materials and Methods: During this clinical trial, 50 patients who were candidates for CABG, were randomly divided into two equal groups, that is, the control group (n = 25) and the case group (n = 25). Following CABG, the case group received two drops of 2% lavender oil every 15 minutes with supplemental oxygen and the control group received only supplemental oxygen through a face mask. The data collection tools comprised of the demographic check list and visual analog scale (VAS) for evaluating the pain intensity. The pain intensity were assessed pre- and five, 30, and 60 minutes post aromatherapy. The final data were analyzed by the t-test and chi-squared test. Results: The findings showed that the pain perception intensity in the case group was lower than that in the control group at the 30- and 60-minute phases after intervention (P < 0.0001). Conclusion: The result indicated that aromatherapy can be used as a complementary method in postoperative pain reduction, as it reduced pain. The patients require two sedative drugs, and moreover, it avoids expenses of treatment. PMID:26261829

  9. Impact of Metabolic Syndrome on Mortality and Morbidity After Coronary Artery Bypass Grafting Surgery

    PubMed Central

    Ardeshiri, Maryam; Faritus, Zahra; Ojaghi-Haghighi, Zahra; Bakhshandeh, Hooman; Kargar, Faranak; Aghili, Rokhsareh

    2014-01-01

    Background: The prevalence of Metabolic syndrome (MetS) has been increased in Asian countries. It represents a cluster of cardiovascular risk factors including obesity, insulin resistance, lipid abnormality and hypertension. Objectives: The purpose of this study was to assess the association between MetS and outcome in patients undergoing coronary artery bypass grafting surgery (CABG). Patients and Methods: This prospective study was performed on patients scheduled for coronary artery bypass grafting surgery (CABG). All the patients were followed up in hospital and three months afterward. Patients were excluded if they were younger than 18 years or had severe comorbidities, a history of valvular heart disease, and low ejection fraction. Results: A total of 235 patients (135 women) with a mean age of 59 ± 9.3 years were included. MetS was more prevalent in women (P < 0.001). The most prevalent complications were bleeding [20 (8.5%)] and dysrhythmia [18 (7.7%)]. At three months follow-up, the frequency rates of readmission [24 (10.2%)] and mediastinitis [9 (3.8%)] were higher than other complications. Diabetes and MetS were risk factors for a long ICU stay (> 5 days) and atelectasia (P < 0.05). Significant associations were observed between diabetes and pulmonary embolism (P = 0.025) and mediastinitis (P = 0.051). Conclusions: Identification of MetS before CABG can predict the surgery outcome. Patients with MetS have increased risks for longer ICU stay and atelectasia. PMID:25478548

  10. Covered Stent-Graft Treatment of Traumatic Internal Carotid Artery Pseudoaneurysms: A Review

    SciTech Connect

    Maras, Dimitrios; Lioupis, Christos Magoufis, George; Tsamopoulos, Nikolaos; Moulakakis, Konstantinos; Andrikopoulos, Vasilios

    2006-12-15

    Objective. To review the literature concerning the management with placement of covered stent-grafts of traumatic pseudoaneurysms of the extracranial internal carotid artery (ICA) resulting from penetrating craniocervical injuries or skull base fractures. Method. We have reviewed, from the Medline database, all the published cases in the English literature since 1990 and we have added a new case. Results. We identified 20 patients with traumatic extracranial ICA pseudoaneurysms due to penetrating craniocervical injuries or skull base fractures who had been treated with covered stent-graft implantation. Many discrepancies have been ascertained regarding the anticoagulation therapy. In 3 patients the ICA was totally occluded in the follow-up period, giving an overall occlusion rate 15%. No serious complication was reported as a result of the endovascular procedure. Conclusion. Preliminary results suggest that placement of stent-grafts is a safe and effective method of treating ICA traumatic pseudoaneurysms resulting from penetrating craniocervical injuries or skull base fractures. The immediate results are satisfactory when the procedure takes place with appropriate anticoagulation therapy. The periprocedural morbidity and mortality and the early patency are also acceptable. A surveillance program with appropriate interventions to manage restenosis may improve the long-term patency.

  11. Long-term outcome of grafts with multiple arteries in live-donor renal allotransplantation: Analysis of 2100 consecutive patients

    PubMed Central

    Soliman, Shady A.; Shokeir, Ahmed A.; Kamal, Ahmed I.; El-Hefnawy, Ahmed S.; Harraz, Ahmed M.; Kamal, Mohamed M.; Osman, Yasser; Ali El-Dein, Bedair; Shehab El-Dein, Ahmed B.; Ghoneim, Mohamed A.

    2011-01-01

    Purpose To analyse the long-term outcome in relation to multiple graft arteries (MGA) in live-donor renal transplantation, and assess its effect on graft and patient survival. Patients and methods Between March 1976 and November 2009, a total of 2100 live-donor renal transplants were carried out at our centre. Patients were stratified according to the number of graft arteries into two groups, i.e. MGA (two or more arteries; 237 patients) and single-graft artery (SGA; 1863 patients). Variables assessed included patient demographics, site of vascular anastomosis, ischaemia time, onset of diuresis, delayed graft function, acute tubular necrosis (ATN), acute rejection, vascular and urological complications. Moreover, long-term patient and graft survival were compared among both groups. Patients were followed up for a mean (SD) of 112 (63) months. Results Grafts with MGA were associated with a prolonged ischaemia time (P = 0.001) and ATN (P = 0.005). Vascular thrombosis (arterial and venous) had a higher incidence in MGA (2.5%) than SGA (0.6%) (P = 0.01). Both groups were not significantly different for the onset of diuresis, acute rejection and urological complications (P = 0.16, 0.23 and 0.85, respectively). Graft and patient survival were comparable in both groups. The mean (SD) 1-, 5-, 10- and 20-year graft survival rates (%) for MGA were 96.1 (1.26), 86.6 (2.39), 61.3 (4.42) and 33.8 (7.23), and 97.5 (0.36), 86.8 (0.84), 66.0 (1.35) and 37.3 (2.76) for SGA (P = 0.54). Conclusions Although there was a higher incidence of prolonged ischaemia time, ATN and vascular thrombosis in live-donor renal transplants with MGA, it did not adversely affect patient or graft survival. The early, intermediate- and long-term follow-up showed an outcome comparable to that in patients with SGA.

  12. Combined Endovascular Repair of a Celiac Trunk Aneurysm Using Celiac-Splenic Stent Graft and Hepatic Artery Embolization

    SciTech Connect

    Carrafiello, Giampaolo; Rivolta, Nicola; Fontana, Federico; Piffaretti, Gabriele; Mariscalco, Giovanni; Bracchi, Elena; Ferrario, Massimo

    2010-04-15

    Celiac trunk aneurysms are rare and usually asymptomatic lesions. However, treatment is generally warranted to avoid catastrophic rupture. We report a case of a 70-year-old man who sought care for a celiac trunk aneurysm close to the hepatosplenic bifurcation managed endovascularly by using a combined treatment of celiac-splenic stent-graft implantation and hepatic artery embolization.

  13. Combined endovascular repair of a celiac trunk aneurysm using celiac-splenic stent graft and hepatic artery embolization.

    PubMed

    Carrafiello, Giampaolo; Rivolta, Nicola; Fontana, Federico; Piffaretti, Gabriele; Mariscalco, Giovanni; Bracchi, Elena; Ferrario, Massimo

    2010-04-01

    Celiac trunk aneurysms are rare and usually asymptomatic lesions. However, treatment is generally warranted to avoid catastrophic rupture. We report a case of a 70-year-old man who sought care for a celiac trunk aneurysm close to the hepatosplenic bifurcation managed endovascularly by using a combined treatment of celiac-splenic stent-graft implantation and hepatic artery embolization. PMID:19787397

  14. Giant Saphenous Venous Graft Aneurysm with Compression of the Pulmonary Artery: A Rare Cause of Heart Failure

    PubMed Central

    Kalavakunta, Jagadeesh K.; Agrawal, Yashwant; Williams, Alicia; Pratt, Jerry W.; Saltiel, Frank

    2015-01-01

    We report a case of a 74-year-old man who presented with dyspnea on exertion and pedal edema. He had five-vessel coronary artery bypass graft (CABG) surgery twenty-six years ago and redo three-vessel CABG done thirteen years later. Computed tomographic angiography (CTA) of the heart and coronary vessels demonstrated a giant aneurysm arising from the saphenous venous graft (SVG) to the first obtuse marginal of the left circumflex artery compressing the pulmonary artery (PA). He underwent coronary angiography, confirming the CTA findings. Surgical and percutaneous interventions were offered, but the patient opted for conservative management due to the high risk of morbidity and mortality. PMID:26649205

  15. Myasthenia gravis: a careful perioperative anesthetic management of coronary artery bypass grafting.

    PubMed

    Kowalczyk, Micha?; Nestorowicz, Andrzej; Stachurska, Katarzyna; Fija?kowska, Anna; St??ka, Janusz

    2015-06-01

    Nowadays, even hazardous cardiac surgery can be performed on patients with autoimmune diseases like myasthenia gravis. It requires a sensitive perioperative anesthetic approach especially in relation to nondepolarizing muscle relaxant administration. Myasthenic patients produce antibodies against the end-plate acetylcholine receptors causing muscle weakness and sensitivity to nondepolarizing muscle relaxants that could lead to respiratory failure. Perioperative nurse care is critical for uncomplicated course of treatment; therefore, apprehension of surgical procedure should be helpful on an everyday basis. We describe successful management without any pulmonary complications of two patients with myasthenia gravis undergoing coronary artery bypass grafting. In addition, antiacetylcholine receptor antibodies concentrations were evaluated during treatment time. In conclusion, we have found that reduced titrated doses of cisatracurium may be safely used in patients with myasthenia gravis undergoing cardiac surgery without anesthesia and respiratory-related complications. PMID:25943997

  16. Cardiac Compression of Lung Lower Lobes after Coronary Artery Bypass Graft with Cardiopulmonary Bypass

    PubMed Central

    Neves, Flávio H.; Carmona, Maria J.; Auler, José O. C.; Rodrigues, Roseny R.; Rouby, Jean Jacques; Malbouisson, Luiz M. S.

    2013-01-01

    Background Atelectasis is a major cause of hypoxemia after coronary artery bypass grafting (CABG) and is commonly ascribed to general anesthesia, high inspiratory oxygen concentration and cardiopulmonary bypass (CPB). The objective of this study was to evaluate the role of heart-induced pulmonary compression after CABG with CPB. Methods Seventeen patients without pre-operative cardiac failure who were scheduled for coronary artery bypass graft underwent pre- and postoperative thoracic computed tomography. The cardiac mass, the pressure exerted on the lungs by the right and left heart and the fraction of collapsed lower lobe segments below and outside of the heart limits were evaluated on a computed tomography section 1 cm above the diaphragmatic cupola. Results In the postoperative period, cardiac mass increased by 32% (117±31 g versus 155±35 g, p<0.001), leading to an increase in the pressure that was exerted on the lungs by the right (2.2±0.6 g.cm?2 versus 3.2±1.2 g.cm?2, p<0.05) and left heart (2.4±0.7 g.cm?2 versus 4.2±1.8 g.cm?2, p<0.001). The proportion of collapsed lung segments beneath the heart markedly increased [from 6.7% to 32.9% on the right side (p<0.001) and from 6.2% to 29% on the left side (p<0.001)], whereas the proportion of collapsed lung segments outside of the heart limits slightly increased [from 0.7% to 10.8% on the right side (p<0.001) and from 1.5% to 12.6% on the left side (p<0.001)]. Conclusion The pressure that is exerted by the heart on the lungs increased postoperatively and contributed to the collapse of subjacent pulmonary segments. PMID:24244331

  17. Should high risk patients receive clopidogrel as well as aspirin post coronary arterial bypass grafting?

    PubMed

    Kunadian, Babu; Thornley, Andrew R; Babu, Thotala N; Dunning, Joel

    2006-12-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether clopidogrel should be given in addition to aspirin in high risk patients after coronary bypass surgery to reduce thrombotic complications. High risk patients would include patients recently post MI or patients with a patent stent in situ. Altogether 511 papers were identified using the below mentioned search and all major international guidelines were included. Eleven presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. The 2004 American College of Chest Physicians (ACCP) guidelines recommend 9-12 months of clopidogrel in addition to aspirin for patients undergoing coronary arterial bypass grafting (CABG) for non-ST segment elevation acute coronary syndrome (grade 1C). This is based on subanalyses of the CURE and CAPRIE studies that showed significant reductions in the incidence of death, myocardial infarction and stroke in patients who had CABG during these trials. A randomised trial is currently underway to investigate this further. Thus, patients post CABG who have had a recent NSTEMI or have a stent not covered by a graft should have clopidogrel in addition to aspirin for 9-12 months. PMID:17670706

  18. Restoration of Failed Renal Graft Function After Successful Angioplasty of Pressure-Resistant Renal Artery Stenosis Using a Cutting Balloon: A Case Report

    SciTech Connect

    Peregrin, J. H.; Buergelova, M.

    2009-05-15

    This study is the report of a 37-year-old male with a transplanted kidney from a 3.5-year-old donor: the graft had two arteries transplanted with an aortic patch to an external iliac artery. Four months after transplantation, the graft function deteriorated, together with the development of hypertension. Stenosis of both graft arteries was detected and the patient was referred for angioplasty. The angiographic result was suboptimal, nevertheless, the graft function improved and was more or less stable (serum creatinine, 160-200 {mu}mol/l) for 4 years, along with persistently difficult-to-control hypertension. Five years after transplantation, the graft function deteriorated again and severe graft artery restenosis was detected. The restenosis did not respond to dilatation, graft function failed, hypertension decompensated, and left ventricular failure developed. The patient required dialysis. A cutting balloon angioplasty opened the artery, and kidney function was restored after a few days: the serum creatinine level dropped to 140-160 {mu}mol/l, and the glomerular filtration rate (creatinine clearance) to 0.65 ml/min/1.73 m{sup 2}. The graft function has now been stable for more than 2 years, however, the hypertension is still difficult to control.

  19. Percutaneous Stent-Graft Repair of a Mycotic Pulmonary Artery Pseudoaneurysm

    SciTech Connect

    Chou Meichun; Liang Hueilung Pan Huayban; Yang Chienfang

    2006-10-15

    Ruptured mycotic pulmonary pseudoaneurysm is a lethal complication. Emergent surgical repair is usually recommended, but still associated with a high mortality rate. We present a patient in whom mycotic pulmonary pseudoaneurysm was a complication after surgical lobectomy 2 weeks earlier. This patient had suffered from repeated massive hemoptysis. After emergent surgical repair of the ruptured pulmonary artery stump, another episode of massive hemorrhage occurred. The pulmonary arteriogram revealed a segmental stenosis and a large, wide-necked, lobulated pseudoaneurysm at the left proximal pulmonary artery. We deployed a balloon-expandable stent-graft (48 mm in length mounted on a 12 mm x 40 mm angioplasty balloon) across the stenotic segment and the neck of the pulmonary pseudoaneurysm. Hemostasis was achieved immediately and, under a 4-week antibiotic treatment, patient was transferred to a local hospital for medical care. This case report demonstrates the benefit of minimally invasive endovascular therapy in a critically ill patient. A literature review of the etiology and management of mycotic pulmonary pseudoaneurysm is included.

  20. Combining carotid endarterectomy with off-pump coronary artery bypass graft surgery is safe and effective

    PubMed Central

    Garg, Arun; Bansal, Atma Ram; Singh, Dilip; Mishra, Manisha; Sharma, Pooja; Kasliwal, Ravi Ratan; Trehan, Naresh

    2015-01-01

    Background: We, as neurologists, are frequently consulted to give neurological clearance for surgery in patients who are undergoing coronary artery bypass graft (CABG) surgery and have suffered from stroke or transient ischemic attack (TIA) in past. Similarly clearance is also sought in another group of patients who, though have not suffered from stroke or TIA, but found to have significant carotid stenosis on routine screening prior to surgery. Cardiac surgeons and anesthetists want to know the risk of perioperative stroke in such patients and should carotid endarterectomy (CEA) be done along with CABG. In absence of any clear-cut guideline, neurologists often fail to give any specific recommendation. Aim: To find out safety and efficacy of synchronous CEA in patients undergoing CABG. Design: Retrospective study. Materials and Methods: Out of 3,700 patients who underwent CABG, 150 were found to have severe carotid stenosis of >70%. Out of this, 46 patients with >80% stenosis (three symptomatic and 43 asymptomatic) and one patient with >70% symptomatic carotid stenosis (TIA within last 2 weeks) were taken for simultaneous CEA along with CABG. These three symptomatic carotid patients had suffered from stroke within last 6 months. Results: One patient with asymptomatic near total occlusion of carotid artery suffered from hyperperfusion syndrome. None suffered from ischemic stroke, myocardial infarction (MI), or death during perioperative period. Conclusion: Combining CEA along with CABG is a safe and effective procedure. PMID:26713014

  1. Factors associated with extubation time in coronary artery bypass grafting patients

    PubMed Central

    Rezaianzadeh, Abbas; Maghsoudi, Behzad; Tabatabaee, Hamidreza; Keshavarzi, Sareh; Bagheri, Zahra; Sajedianfard, Javad; Gerami, Hamid

    2015-01-01

    Background and Objectives. Cardiovascular diseases are the leading cause of death worldwide, with coronary artery disease being the most common. With increasing numbers of patients, Coronary Artery Bypass Grafting (CABG) has become the most common operation in the world. Respiratory disorder is one of the most prevalent complications of CABG. Thus, weaning off the mechanical ventilation and extubation are of great clinical importance for these patients. Some post-operative problems also relate to the tracheal tube and mechanical ventilation. Therefore, an increase in this leads to an increase in the number of complications, length of hospital stay, and treatment costs. Since a large number of factors affect the post-operative period, the present study aims to identify the predictors of extubation time in CABG patients using casualty network analysis. Method. This longitudinal study was conducted on 800 over 18 year old patients who had undergone CABG surgery in three treatment centers affiliated to Shiraz University of Medical Sciences. The patients’ information, including pre-operative, peri-operative, and post-operative variables, was retrospectively extracted from their medical records. Then, the data was comprehensively analyzed through path analysis using MPLUS-7.1 software. Results. The mean of extubation time was 10.27 + 4.39 h. Moreover, extubation time was significantly affected by packed cells during the Cardiopulmonary Bypass (CPB), packed cells after CPB, inotrope use on arrival at ICU, mean arterial pressure 1st ICU, packed cells 1st ICU, platelets 1st ICU, Blood Urea Nitrogen 1st ICU, and hematocrit 1st ICU. Conclusion. Considering all of the factors under investigation, some peri-operative and post-operative factors had significant effects. Therefore, considering the post-operative factors is important for designing a treatment plan and evaluating patients’ prognosis. PMID:26644972

  2. Emergency Stent Grafting After Unsuccessful Surgical Repair of a Mycotic Common Femoral Artery Pseudoaneurysm in a Drug Abuser

    SciTech Connect

    Lupattelli, Tommaso; Garaci, Francesco Giuseppe; Basile, Antonio; Minnella, Daniela Paola; Casini, Andrea; Clerissi, Jacques

    2009-03-15

    Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement.

  3. Influence of endothelial cell seeding on platelet deposition and patency in small-diameter Dacron arterial grafts

    SciTech Connect

    Allen, B.T.; Long, J.A.; Clark, R.E.; Sicard, G.A.; Hopkins, K.T.; Welch, M.J.

    1984-01-01

    Serial platelet deposition, surface topography, and patency were evaluated in control (N . 28) and endothelial cell-seeded (N . 28) small-diameter (4 mm inner diameter) USCI Dacron grafts implanted in the carotid and femoral arteries of dogs. All dogs received aspirin (325 mg) daily for 2 weeks starting 24 hours prior to graft implantation. Endothelial cell seeding was performed by mixing suspensions of autologous endothelial cells that had been enzymatically harvested from segments of external jugular vein with blood that was used to preclot the prostheses. The platelet deposition on each graft was quantitated by means of indium 111-labeled platelets and technetium 99m-labeled red cells in a dual-isotope platelet-imaging technique. Platelet deposition on seeded grafts 24 hours after implantation was significantly higher than on the controls (p less than 0.05). Two weeks after implantation platelet deposition on seeded prostheses had decreased to a level significantly lower than that on the controls and continued to decline on serial studies up to 7 months. In contrast to seeded grafts, platelet accumulation on control grafts dramatically increased after the withdrawal of aspirin therapy and was associated with a sharp rise in control graft thromboses. Cumulative 7-month patency for seeded prostheses was significantly higher than for the controls (96% and 29%, respectively; p less than 0.001). We conclude that endothelial cell seeding in combination with short-term aspirin therapy is a simple, reliable diameter Dacron prostheses. Abrupt withdrawal of aspirin therapy may be contraindicated in nonseeded control grafts because it results in increased platelet deposition and thrombosis.

  4. Management of arterial stenosis affecting kidney graft perfusion: a single-centre study in 53 patients.

    PubMed

    Voiculescu, Adina; Schmitz, Michael; Hollenbeck, Markus; Braasch, Sabine; Luther, Bernd; Sandmann, Wilhelm; Jung, Gregor; Mödder, Ulrich; Grabensee, Bernd

    2005-07-01

    We assessed clinical and duplex sonographic (CDS) findings, and outcome in patients with stenosis of the transplant renal artery (TRAS) or the aorto-iliac segment proximal to the graft (Prox-TRAS) treated with dilatation (PTA), stenting (PTAS) and surgery. From 1988 to 2002, of 1189 patients with renal transplantations, 117 underwent angiography. Fifty-three patients with TRAS (n = 37)/Prox-TRAS (n = 16) were found (4.4%). Clinical presentation included deterioration of hypertension (144 +/- 15/84 +/- 9, 157 +/- 22/90 +/- 10 mmHg; p < 0.001), increase of creatinine (1.7 +/- 0.9, 2.5 +/- 1.3 mg/dL; p = 0.01) and renal failure (n = 12). CDS indicated insufficient perfusion and differentiated between TRAS and Prox-TRAS. From renal transplantation (RTX) until the detection of stenosis pulsatility indices (PI) decreased from 1.2 +/- 0.46 to 0.98 +/- 0.29; (p = 0.001). Fifty-two patients underwent invasive treatment (21 PTA, 10 PTAS and 21 surgery) after which hypertension and creatinine significantly improved. PI increased. Restenosis occurred in 16 (52%) cases of the interventional (PTA 62% and PTAS 30%) and in 3 (14%) of the surgical group (p = 0.011). Hypertension and graft dysfunction due to perfusion problems are rare. Clinical findings are nonspecific but CDS findings are helpful to select patients for angiography. Invasive treatment leads to clinical improvement. Surgery yields better results than PTA, but additional stenting will probably improve the outcome of angioplasty. PMID:15943633

  5. Aorto-right atrial fistula secondary to rupture of an occluded old saphenous venous graft to right coronary artery.

    PubMed

    Balestrini, Carlos Sebastian; Saaibi, José Federico; Ortiz, Santiago Navas

    2014-09-01

    We report a case of an acquired aorta-right atrial fistula, secondary to a ruptured proximal anastomosis of an old saphenous vein graft 12 years after a coronary artery bypass surgery, in a 57 year old patient with multiple cardiovascular risk factors. On admission, he presented with congestive heart failure and on examination a continuous murmur was detected on the right parasternal border. Catheterization showed a fistula from the proximal anastomosis of an occluded right coronary artery saphenous vein graft draining to the right atrium with a large left to right shunt. The fistula was successfully occluded by a percutaneous approach with a Life Tech duct occluder with complete resolution of heart failure. The patient was discharged one week afterwards. After a two-year follow-up, the fistula remained occluded. PMID:23404794

  6. Comparison of vasodilators in human internal mammary artery: ghrelin is a potent physiological antagonist of endothelin-1

    PubMed Central

    Wiley, Katherine E; Davenport, Anthony P

    2002-01-01

    The potential vasodilator function of the peptide ghrelin, recently identified as the endogenous ligand of the growth hormone secretagogue orphan receptor (GHS-R), was investigated in human endothelium-denuded internal mammary artery. The peptide endothelin-1 (ET-1) is a potent and long-lasting vasoconstrictor. Comparisons were made with established and putative endogenous vasodilators to determine if any could reverse ET-1-induced vasoconstriction in this vessel. Ghrelin (0.1–300 nM) potently dilated 10 nM ET-1-induced constrictions (pD2 8.39±0.29; EMAX 63±5.6%; n=9/14, responders/total). ANP (pD2 7.75±0.14; EMAX 106±2.0; n=5/5) and CGRP (pD2 8.08±0.17; EMAX 76±15% n=5/6) both produced complete reversal of the constrictor response to ET-1 (EMAX not significantly different from 100%, P>0.05 one-sample t-test). The following caused partial reversal of the ET-1 response: Adrenomedullin (n=9/9) and two peptides derived from proadrenomedullin, PAMP-12 (n=6/7) and PAMP-20 (n=9/9) (pD2 values 7.63±0.28, 7.97±0.23 and 8.51±0.29; EMAX 58±7.3, 54±10 and 51±7.8% respectively). Unexpectedly, amylin was only 2 fold less potent than CGRP, although there was less than 50% reversal of the ET-1 constriction (pD2 7.86±0.30; EMAX 41±5.4%; n=7/9). CNP (n=6/6) also partially reversed constrictions to ET-1 (EMAX 53±6.3; pD2 8.07±0.38). BNP (n=4/5) and PGI2 (n=6/8) were weak vasodilators, since concentration-response curves failed to reach a maximum within the range tested. PGE2 caused a small dilatation in some vessels (EMAX 17±2.1%; pD2 8.63±0.36; n=4/8). We have demonstrated ghrelin to be an effective, endothelium-independent vasodilator of the long-lasting constrictor ET-1 in human arteries producing responses similar to those of adrenomedullin (P>0.05, ANOVA). PMID:12163347

  7. In vivo quantitation of platelet deposition on human peripheral arterial bypass grafts using indium-111-labeled platelets. Effect of dipyridamole and aspirin

    SciTech Connect

    Pumphrey, C.W.; Chesebro, J.H.; Dewanjee, M.K.; Wahner, H.W.; Hollier, L.H.; Pairolero, P.C.; Fuster, V.

    1983-03-01

    Indium-111-labeled autologous platelets, injected 48 hours after operation, were used to evaluate the thrombogenicity of prosthetic material and the effect of platelet inhibitor therapy in vivo. Dacron double-velour (Microvel) aortofemoral artery bifurcation grafts were placed in 16 patients and unilateral polytetrafluoroethylene femoropopliteal grafts were placed in 10 patients. Half the patients in each group received platelet inhibitors before operation (dipyridamole, 100 mg 4 times a day) and after operation (dipyridamole, 75 mg, and acetylsalicylic acid, 325 mg 3 times a day); the rest of the patients served as control subjects. Five-minute scintigrams of the graft region were taken with a gamma camera interfaced with a computer 48, 72, and 96 hours after injection of the labeled platelets. Platelet deposition was estimated from the radioactivities of the grafts and expressed as counts per 100 pixels per microcurie injected. Dipyridamole and aspirin therapy significantly reduced the number of platelets deposited on Dacron grafts and prevented platelet accumulation over 3 days. With the small amount of platelet deposition on polytetrafluoroethylene femoropopliteal artery grafts even in control patients, platelet inhibitor therapy had no demonstrable effect on platelet deposition on these grafts. It is concluded that (1) platelet deposition on vascular grafts in vivo can be quantitated by noninvasive methods, and (2) dipyridamole and aspirin therapy reduced platelet deposition on Dacron aortofemoral artery grafts.

  8. The Performance of Cross-linked Acellular Arterial Scaffolds as Vascular Grafts; Pre-clinical Testing in Direct and Isolation Loop Circulatory Models

    PubMed Central

    Pennel, Timothy; Fercana, George; Bezuidenhout, Deon; Simionescu, Agneta; Chuang, Ting-Hsien; Zilla, Peter; Simionescu, Dan

    2014-01-01

    There is a significant need for small diameter vascular grafts to be used in peripheral vascular surgery; however autologous grafts are not always available, synthetic grafts perform poorly and allografts and xenografts degenerate, dilate and calcify after implantation. We hypothesized that chemical stabilization of acellular xenogenic arteries would generate off-the-shelf grafts resistant to thrombosis, dilatation and calcification. To test this hypothesis, we decellularized porcine renal arteries, stabilized elastin with penta-galloyl glucose and collagen with carbodiimide / activated heparin and implanted them as transposition grafts in the abdominal aorta of rats as direct implants and separately as indirect, isolation-loop implants. All implants resulted in high patency and animal survival rates, ubiquitous encapsulation within a vascularized collagenous capsule, and exhibited lack of lumen thrombogenicity and no graft wall calcification. Peri-anastomotic neo-intimal tissue overgrowth was a normal occurrence in direct implants; however this reaction was circumvented in indirect implants. Notably, implantation of non-treated control scaffolds exhibited marked graft dilatation and elastin degeneration; however PGG significantly reduced elastin degradation and prevented aneurismal dilatation of vascular grafts. Overall these results point to the outstanding potential of crosslinked arterial scaffolds as small diameter vascular grafts. PMID:24816365

  9. Assessment of Wall Shear Stress Changes in Arteries and Veins of Arteriovenous Polytetrafluoroethylene Grafts Using Magnetic Resonance Imaging

    SciTech Connect

    Misra, Sanjay Woodrum, David A.; Homburger, Jay; Elkouri, Stephane; Mandrekar, Jayawant N.; Barocas, Victor; Glockner, James F.; Rajan, Dheeraj K.; Mukhopadhyay, Debabrata

    2006-08-15

    The purpose of the study was to determine simultaneously the temporal changes in luminal vessel area, blood flow, and wall shear stress (WSS) in both the anastomosed artery (AA) and vein (AV) of arteriovenous polytetrafluoroethylene (PTFE) grafts. PTFE grafts were placed from the iliac artery to the ipsilateral iliac vein in 12 castrated juvenile male pigs. Contrast-enhanced magnetic resonance angiograpgy with cine phase-contrast magnetic resonance imaging was performed. Luminal vessel area, blood flow, and WSS in the aorta, AA, AV, and inferior vena cava were determined at 3 days (D3), 7 days (D7), and 14 days (D14) after graft placement. Elastin von Gieson staining of the AV was performed. The average WSS of the AA was highest at D3 and then decreased by D7 and D14. In contrast, the average WSS and intima-to-media ratio of the AV increased from D3 to D7 and peaked by D14. Similarly, the average area of the AA was highest by D7 and began to approximate the control artery by D14. The average area of the AV had decreased to its lowest by D7. High blood flows through the AA causes a decrease in average WSS and increase in the average luminal vessel area, whereas at the AV, the average WSS and intima-to-media ratio both increase while the average luminal vessel area decreases.

  10. Impact of body mass index on outcome in patients undergoing coronary artery bypass grafting and/or valve replacement surgery

    PubMed Central

    Costa, Vinícius Eduardo Araújo; Ferolla, Silvia Marinho; dos Reis, Tâmara Oliveira; Rabello, Renato Rocha; Rocha, Eduardo Augusto Victor; Couto, Célia Maria Ferreira; Couto, José Carlos Ferreira; Bento, Alduir

    2015-01-01

    Objective This study aimed to analyze the impact of body mass index on outcomes of 101 patients undergoing coronary artery bypass grafting, valve replacement, or combined valve/ coronary artery bypass grafting surgery in a private hospital in Belo Horizonte, Brazil. Methods This was a prospective cross-sectional study of patients undergoing cardiac surgery from May 2009 to December 2012. All patients were followed up from the first day of admission until discharge or death. Patients were divided into three groups according to BMI: normal weight, overweight, and obese. The main outcome measure was the association between BMI and postoperative morbidities and mortality. Results Multivariate analysis identified obesity as an independent predictor of increased risk of surgical reintervention (odds ratio [OR] 13.6; 95%CI 1.1 - 162.9; P=0.046) and reduced risk of bleeding (OR 0.05; 95% CI 0.09 - 0.69; P=0.025). Univariate analysis showed that obesity was associated with increased frequency of wound dehiscence (P=0.021). There was no association between BMI and other complications or mortality in univariate analysis. There was also no association between body mass index and duration of cardiopulmonary bypass, aortic clamping, mechanical ventilation, and intensive care unit or hospital stay. Conclusion Obese individuals undergoing coronary artery bypass grafting, valve replacement, or combined surgery have a higher postoperative risk of surgical reintervention and lower chances of bleeding. PMID:26313724

  11. Clinical Evaluation of Poly(2-methoxyethylacrylate) in Primary Coronary Artery Bypass Grafting

    PubMed Central

    Vang, See N.; Brady, Chad P.; Christensen, Kevin A.; Isler, Jack R.; Allen, Keith R.

    2005-01-01

    Abstract: In an attempt to make cardiopulmonary bypass (CPB) less traumatic for patients undergoing cardiac surgery, extracorporeal circuits (ECC) have been modified to achieve this goal. Poly(2-methoxyethylacrylate) (PMEA, X-coating™) is a new polymer coating used in the ECC. PMEA studies have shown excellent biocompatibility with the components of blood. In this evaluation, PMEA-coated ECC were compared with control (CTR) circuits with emphasis on hematological parameters, perioperative homologous blood product usage, and clinical outcomes. Patients undergoing elective coronary artery bypass grafting were randomized to either a PMEA group (n = 30) or a CTR group (n = 30). Extracorporeal circuit components in the PMEA group were coated except for the cardioplegia delivery device and cannulas. Patients in the CTR group had just the arterial line filter coated. The following hematological parameters were measured: platelet count (PLT), white blood cell count (WBC), red blood cell count (RBC), and hematocrit (Hct). Blood product usage was observed along with clinical outcomes for the following parameters: ventilation time, mediastinal tube output, intensive care unit (ICU) and hospital lengths of stay. The preoperative patient profiles were comparable between the two groups. The PMEA group had marginally higher CPB times (134 ± 31.9 vs. 118 ± 33.7 minutes) and cross clamp times (83.9 ± 21.3 vs. 73.7 ± 21.6 minutes), however no significant differences were reached. Platelet count, RBC, and Hct levels were also comparable between groups with no significant differences. However, there was a significant difference in WBC between groups (p = 0.041). Less platelets were administered both intraoperatively and 48 hours postoperatively in the PMEA group. The authors evaluated PMEA-coating by measuring clinical outcomes, such as ventilation time, ICU and hospital lengths of stay, and homologous blood utilization. PMEA patients trended towards less homologous blood transfusions, which helped save an average of $83.41 per patient. Further clinical studies are needed to evaluate the benefits of this new polymer coating. PMID:15804153

  12. The value of exercise radionuclide ventriculography in risk stratification after coronary arterial bypass grafting

    SciTech Connect

    Iskandrian, A.S.; Hakki, A.H.; Goel, I.P.; Mundth, E.D.; Kane, S.; Schenk, C.

    1985-05-01

    Cardiac events after coronary artery bypass surgery (CABG) may be related to left ventricular (LV) function, residual coronary artery diseases (CAD), graft occlusion, and progression of CAD. This study examined the value of rest and exercise (EX) radionuclide ventriculography (RNV) done 3-6 mos after CABG in risk stratification in 212 pts. There were 185 men and 27 women, aged 57 +- 8 years (mean +- SD). During a followup period of up to 4 years, (15 +- 10 months), there were 23 cardiac events; 13 pts died of cardiac causes and 20 had non-fatal acute myocardial infarctions. The pts with and without events did not differ in: clinical presentation after CABG (most were asymptomatic), medications and ECG findings at rest and EX. The pts with events had lower EX systolic blood pressure (p < 0.01); resting LV ejection fraction (EF) (p = 0.002), and EX EF (40 +- 18% vs 54 +- 16%, p = 0.002). The change in EF (rest to EX) was not significantly different (l.6 +- 8.2%, vs 2.1 +- 9.2%). Survival analysis (Cox model) identified the EX EF as the best predictor of death and total events (X/sup 2/ = 4.3 and 2.4, p = 0.04 and 0.07 respectively). Actuarial life table analysis showed that the risk increased as the EX EF decreased when pts were grouped into EX EF greater than or equal to 50, 30-49, and <30%, (p < 0.001, Mantel-Cox). Thus, EX RNA is useful in risk stratification after CABG. The EX LVEF is an important descriptor that categorizes pts into different risks groups. The pts at high risk probably require more aggressive followup and continued medical therapy.

  13. Frequency of myocardial indium-111 antimyosin uptake after uncomplicated coronary artery bypass grafting

    SciTech Connect

    van Vlies, B.; van Royen, E.A.; Visser, C.A.; Meyne, N.G.; van Buul, M.M.; Peters, R.J.; Dunning, A.J. )

    1990-11-15

    The reported incidence of myocardial damage after coronary artery bypass grafting (CABG) is highly related to the methods used. Since indium-111 monoclonal antimyosin antibody scintigraphy has been shown to be highly specific and sensitive for myocardial necrosis, even in small lesions, uptake of this radiotracer was evaluated after CABG. In 23 consecutive patients without previous myocardial infarction who underwent CABG for stable angina, 80 MBq indium-111 antimyosin was injected on the third postoperative day. Planar images were obtained 48 hours later and analyzed for myocardial uptake of indium-111 antimyosin. Scintigraphic results were related to creatine kinase MB levels, duration of both aortic cross-clamping and cardiopulmonary bypass, and electrocardiographic changes. In all patients surgical procedure and postoperative course was uncomplicated. Indium-111 antimyosin uptake was present in 19 of 23 patients (82%). It was diffused in 7 patients and localized in 12. No pathologic Q waves occurred postoperatively. Fourteen patients exhibited ST-segment changes. No good relation was found among indium-111 antimyosin uptake and creatine kinase MB levels, duration of cross-clamping or bypass, and ST-T changes. It is concluded that some degree of myocardial damage, though silent, is common after CABG.

  14. Virtual coaching for the high-intensity training of a powerlifter following coronary artery bypass grafting

    PubMed Central

    Adams, Richard; Qin, Huanying; Bilbrey, Tim; Schussler, Jeffrey M.

    2015-01-01

    A 55-year-old powerlifter in Tennessee learned about the sport-specific, high-intensity cardiac rehabilitation training available in Dallas, Texas, and contacted the staff by phone. He was recovering from quadruple coronary artery bypass grafting (CABG) and had completed several weeks of traditional cardiac rehabilitation in his hometown, but the exercise program no longer met his needs. He wanted help in returning both to his normal training regimen and to powerlifting competition but was unable to attend the Dallas program in person. An exercise physiologist with the program devised a virtual coaching model in which the patient was sent a wrist blood pressure cuff for self-monitoring and was advised about exercises that would not harm his healing sternum, even as the weight loads were gradually increased. After 17 weeks of symptom-limited, high-intensity training that was complemented by phone and e-mail support, the patient was lifting heavier loads than he had before CABG. At a powerlifting competition 10 months after CABG, he placed first in his age group. This case report exemplifies the need for alternative approaches to the delivery of cardiac rehabilitation services. PMID:25552808

  15. Prevalence of Delirium in Opium Users after Coronary Artery Bypass Graft Surgery

    PubMed Central

    Eizadi-Mood, Nastaran; Aghadavoudi, Omid; Najarzadegan, Mohammad Reza; Fard, Masoud Mozhdehi

    2014-01-01

    Background: Postoperative cognitive dysfunction, especially delirium commonly occurs after cardiac surgery. Clinical evidences suggest an increase in delirium in opium abusers after Coronary Artery Bypass Graft (CABG) surgery. In this study, the prevalence of delirium in addict (opium user) and nonaddict patients after CABG were compared. Methods: In a cross-sectional study after obtaining institutional approval and informed consent, 325 patients candidate for elective CABG were included in the study. All patients with history of opium abuse met the criteria for opioid dependence using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition definitions. Delirium after CABG was assessed in addict (opium user) and nonaddict patients up to a maximum of 5 days after surgery with the Intensive Care Delirium Screening Checklist. Results: A total of 325 patients were evaluated (208 without and 117 with a history of opium abuse). Postoperative delirium occurred within 72 h after surgery in 44.31% of all patients. There was a significant difference in the prevalence of postoperative delirium between the opium users (80.7%) and nonaddict patients (25%) in the intensive care unit (P < 0.001). Opium addiction was a risk factor for postoperative delirium after CABG Surgery. Conclusions: Delirium after CABG surgery is more prevalent in opium users compared with nonaddict patients. Therefore, opium abuse is a possible risk factor for postoperative delirium in cardiac surgical patients. PMID:25105003

  16. Previous percutaneous coronary intervention increases morbidity after coronary artery bypass grafting

    PubMed Central

    Mehta, Gaurav S.; LaPar, Damien J.; Bhamidipati, Castigliano M.; Kern, John A.; Kron, Irving L.; Upchurch, Gilbert R.; Ailawadi, Gorav

    2014-01-01

    Background We hypothesized that the incidence of previous percutaneous coronary intervention (PCI) is increasing and that prior PCI influences patient morbidity and mortality after coronary artery bypass grafting (CABG). Methods A total of 34,316 patients underwent isolated CABG operations at 16 different statewide, institutions from 2001 to 2008. Patients were stratified into prior PCI (n = 4346; 12.7%) and no prior PCI (n = 29,970). Patient risk factors, intraoperative variables, and outcomes were compared by univariate and multivariate analyses. Results The incidence of prior PCI in CABG has risen from <1% to 22.0% from 2001 to 2008 (P < .001). Prior PCI patients were younger (P < .001) and more commonly had previous myocardial infarction (P < .001), but less commonly had heart failure (P < .001). The operative mortality was similar between groups (2.3% vs 1.9%; P = .13). Prior PCI patients had more major complications (15.0% vs 12.0%; P < .001), longer hospitalization (P = .01), and higher readmission rates (P = .01). Importantly, by multivariate analyses, prior PCI was not associated with mortality, but was an independent predictor of major complications after CABG (odds ratio, 1.15; P = .01). Conclusion The incidence of prior PCI in patients undergoing CABG is increasing. Previous PCI is associated with a higher risk of major complications, greater hospital length of stay, and higher readmission rates after CABG. PMID:22503323

  17. Spinal anesthesia reduces postoperative delirium in opium dependent patients undergoing coronary artery bypass grafting.

    PubMed

    Tabatabaie, O; Matin, N; Heidari, A; Tabatabaie, A; Hadaegh, A; Yazdanynejad, S; Tabatabaie, K

    2015-01-01

    We investigated the effect of high spinal anesthesia on postoperative delirium in opium dependent patients undergoing coronary artery bypass grafting (CABG). The study was conducted in a tertiary referral university hospital on a population of 60 opium dependent patients undergoing CABG surgery. Patients were divided into two groups based on anesthesia protocol. One group were given general anesthesia (GA Group), the other group additionally received intrathecal morphine and bupivacaine (SGA Group). Postoperative delirium (POD) was defined as the main outcome of interest. Incidence of POD was significantly higher in patients of GA Group as compared with those in SGA Group (47% and 17% for GA and SGA respectively; P-value = 0.01). Time to extubation was on average 2.2 h shorter in SGA than in GA (7.1 h and 9.3 h respectively, P-value < 0.001). Intrathecal morphine and bupivacaine reduced the risk of POD after CABG in a population of opium dependent patients. PMID:26455008

  18. The application of walking training in the rehabilitation of patients after coronary artery bypass grafting.

    PubMed

    Sobczak, Dorota; Dylewicz, Piotr

    2015-09-01

    Walking is regarded as one of the most common and utilitarian activities of everyday life. Rehabilitation programs developed on the basis of this form of activity often constitute the primary method of rehabilitating patients after coronary artery bypass grafting. This paper provides a review of literature concerning various forms of walking training, discussing their impact on the parameters of exercise capacity and verifying the training methods with regard to the current guidelines. Attention is drawn to the diversity of the exercise protocols applied during the early and late stages of rehabilitation and pre-rehabilitation programs including: treadmill walking, walking down the corridor, treadmill walking enriched with virtual reality, and walking as an element of training sessions consisting of many different forms of activities. Exercise protocols were also analyzed in terms of their safety, especially in the case of high-intensity interval training. Despite the variety of the available rehabilitation programs, the training methodology requires constant improvement, particularly in terms of load dosage and the supervision of training sessions. PMID:26702291

  19. The application of walking training in the rehabilitation of patients after coronary artery bypass grafting

    PubMed Central

    Dylewicz, Piotr

    2015-01-01

    Walking is regarded as one of the most common and utilitarian activities of everyday life. Rehabilitation programs developed on the basis of this form of activity often constitute the primary method of rehabilitating patients after coronary artery bypass grafting. This paper provides a review of literature concerning various forms of walking training, discussing their impact on the parameters of exercise capacity and verifying the training methods with regard to the current guidelines. Attention is drawn to the diversity of the exercise protocols applied during the early and late stages of rehabilitation and pre-rehabilitation programs including: treadmill walking, walking down the corridor, treadmill walking enriched with virtual reality, and walking as an element of training sessions consisting of many different forms of activities. Exercise protocols were also analyzed in terms of their safety, especially in the case of high-intensity interval training. Despite the variety of the available rehabilitation programs, the training methodology requires constant improvement, particularly in terms of load dosage and the supervision of training sessions. PMID:26702291

  20. Passion for Life: Lived Experiences of Patients after Coronary Artery Bypass Graft

    PubMed Central

    Mohammadi, Nooredin; Abbasi, Mohammad; Nikbakht Nasrabadi, Alireza; Salehiomran, Abbas; Davaran, Saeid; Norouzadeh, Reza

    2015-01-01

    Background: Coronary artery bypass graft surgery (CABG) improves the quality of life, increases survival, and influences the patient's mental and emotional aspects. Little information is available on the lived experience of Iranian patients after this surgery. Understanding the lived experiences of patients will help health professionals with better provision of high quality care. Methods: This hermeneutic phenomenological study aimed to understand the lived experience of patients after CABG. Van Manen's method was used to conduct the study. A semi-structured, face-to-face interview technique was employed to explore the experiences of the patients following surgery. Seven men and 4 women between 49 and 80 years old were interviewed. Results: Passion for life was the main theme extracted from the participants’ interviews. This theme comprised the three sub-themes of receiving attention from family, being hopeful, and being spiritually oriented. Conclusion: The results showed that the participants experienced passion for life after their surgery. This finding reveals that patients tend to find a new perspective on life and their health after surgery.

  1. Successful endothelialization and remodeling of a cell-free small-diameter arterial graft in a large animal model.

    PubMed

    Koobatian, Maxwell T; Row, Sindhu; Smith, Randall J; Koenigsknecht, Carmon; Andreadis, Stelios T; Swartz, Daniel D

    2016-01-01

    The large number of coronary artery bypass procedures necessitates development of off-the-shelf vascular grafts that do not require cell or tissue harvest from patients. However, immediate thrombus formation after implantation due to the absence of a healthy endothelium is very likely. Here we present the successful development of an acellular tissue engineered vessel (A-TEV) based on small intestinal submucosa that was functionalized sequentially with heparin and VEGF. A-TEVs were implanted into the carotid artery of an ovine model demonstrating high patency rates and significant host cell infiltration as early as one week post-implantation. At one month, a confluent and functional endothelium was present and the vascular wall showed significant infiltration of host smooth muscle cells exhibiting vascular contractility in response to vaso-agonists. After three months, the endothelium aligned in the direction of flow and the medial layer comprised of circumferentially aligned smooth muscle cells. A-TEVs demonstrated high elastin and collagen content as well as impressive mechanical properties and vascular contractility comparable to native arteries. This is the first demonstration of successful endothelialization, remodeling, and development of vascular function of a cell-free vascular graft that was implanted in the arterial circulation of a pre-clinical animal model. PMID:26561932

  2. Reconstruction of full-thickness lower eyelid defect using superficial temporal artery island flap combined with auricular cartilage graft.

    PubMed

    Yang, Mei; Zhao, Yanyong

    2015-03-01

    Full-thickness lower eyelid defect is one of common surgical diseases, which may lead to exposure keratopathy, corneal ulceration, and blindness. The aim of this study was to investigate the effect of superficial temporal artery island flap combined with auricular cartilage graft on the repair of full-thickness lower eyelid defect.In this study, the reconstructions in 6 patients who had unilateral full-thickness lower eyelid defects due to ocular traumas or surgical resections of malignant tumors were carried out. The island flap of the frontal branch of superficial temporal artery reconstructed the outer layer and the total lower lid was supported with the plane of an auricular cartilage strip, offering a proper contour and physical strength to maintain a normal eyelid height. The follow-up time ranged from 6 to 24 months. No major complications including partial or total flap necrosis, signs of infection, venous congestion, and hematoma were seen in any of the patients, and all cases have been reconstructed well both aesthetically and functionally, showing esthetic eyelid contour, good color, and texture match.Superficial temporal artery island flap combined with auricular cartilage graft is a useful method functionally and cosmetically for the reconstructions of full-thickness lower eyelid defects because of its advantages including rich vascularity based on superficial temporal artery, wide pedicle rotational arc, which could be transferred throughout the face region, good eyelid contour with color and texture match, limited donor-site scar, and minimal postoperative morbidity. PMID:25692897

  3. Using Biomarkers to Improve the Preoperative Prediction of Death in Coronary Artery Bypass Graft Patients

    PubMed Central

    Brown, Jeremiah R.; MacKenzie, Todd A.; Dacey, Lawrence J.; Leavitt, Bruce J.; Braxton, John H.; Westbrook, Benjamin M.; Helm, Robert E.; Klemperer, John D.; Frumiento, Carmine; Sardella, Gerald L.; Ross, Cathy S.; O’Connor, Gerald T.

    2010-01-01

    Abstract: The current risk prediction models for mortality following coronary artery bypass graft (CABG) surgery have been developed on patient and disease characteristics alone. Improvements to these models potentially may be made through the analysis of biomarkers of unmeasured risk. We hypothesize that preoperative biomarkers reflecting myocardial damage, inflammation, and metabolic dysfunction are associated with an increased risk of mortality following CABG surgery and the use of biomarkers associated with these injuries will improve the Northern New England (NNE) CABG mortality risk prediction model. We prospectively followed 1731 isolated CABG patients with preoperative blood collection at eight medical centers in Northern New England for a nested case-control study from 2003–2007. Preoperative blood samples were drawn at the center and then stored at a central facility. Frozen serum was analyzed at a central laboratory on an Elecsys 2010, at the same time for Cardiac Troponin T, N-Terminal pro-Brain Natriuretic Peptide, high sensitivity C-Reactive Protein, and blood glucose. We compared the strength of the prediction model for mortality using multivariable logistic regression, goodness of fit and tested the equality of the receiving operating characteristic curve (ROC) area. There were 33 cases (dead at discharge) and 66 randomly matched controls (alive at discharge). The ROC for the preoperative mortality model was improved from .83 (95% confidence interval: .74–.92) to .87 (95% confidence interval: .80–.94) with biomarkers (p-value for equality of ROC areas .09). The addition of biomarkers to the NNE preoperative risk prediction model did not significantly improve the prediction of mortality over patient and disease characteristics alone. The added measurement of multiple biomarkers outside of preoperative risk factors may be an unnecessary use of health care resources with little added benefit for predicting in-hospital mortality. PMID:21313927

  4. Association of Pre-Operative Albuminuria with Post-Operative Outcomes after Coronary Artery Bypass Grafting

    PubMed Central

    George, Lekha K.; Molnar, Miklos Z.; Lu, Jun L.; Kalantar-Zadeh, Kamyar; Koshy, Santhosh K. G.; Kovesdy, Csaba P.

    2015-01-01

    The effect on post-operative outcomes after coronary artery bypass graft(CABG) surgery is not clear. Among 17,812 patients who underwent CABG during October 1,2006-September 28,2012 in any Department of US Veterans Affairs(VA) hospital, we identified 5,968 with available preoperative urine albumin-creatinine ratio(UACR) measurements. We examined the association of UACR<30, 30–299 and >=300?mg/g with 30/90/180/365-day and overall all-cause mortality, and hospitalization length >10 days, and with acute kidney injury(AKI). Mean?±?SD baseline age and eGFR were 66?±?8 years and 77?±?19?ml/min/1.73?m2, respectively. 788 patients(13.2%) died during a median follow-up of 3.2 years, and 26.8% patients developed AKI(23.1%-Stage 1; 2.9%-Stage 2; 0.8%-Stage 3) within 30 days of CABG. The median lengths of stay were 8 days(IQR: 6–13 days), 10 days(IQR: 7–14 days) and 12 days(IQR: 8–19 days) for groups with UACR < 30?mg/g, 30–299?mg/g and ?300?mg/g, respectively. Higher UACR conferred 72 to 85% higher 90-, 180-, and 365-day mortality compared to UACR<30?mg/g (odds ratio and 95% confidence interval for UACR?300 vs. <30?mg/g: 1.72(1.01–2.95); 1.85(1.14–3.01); 1.74(1.15–2.61), respectively). Higher UACR was also associated with significantly longer hospitalizations and higher incidence of all stages of AKI. Higher UACR is associated with significantly higher odds of mortality, longer post-CABG hospitalization, and higher AKI incidence. PMID:26548590

  5. Coronary artery bypass grafting in Canada: hospital mortality rates, 1992-1995

    PubMed Central

    Ghali, W A; Quan, H; Brant, R

    1998-01-01

    BACKGROUND: Rates of in-hospital death after coronary artery bypass grafting (CABG) have been studied in many regions of Canada as possible indicators of hospital-specific quality of care. This nationwide study examined observed and risk-adjusted death rates for 23 Canadian hospitals performing CABG. METHODS: Hospital discharge data were obtained from the Canadian Institute for Health Information and were used to identify all CABG procedures performed in Canadian hospitals in fiscal years 1992/93 through 1995/96. Cases from Quebec hospitals were not studied because hospitals in that province do not report to the institute. Observed death rates were evaluated, and a logistic regression model was used to calculate a risk-adjusted death rate for each hospital for the 4-year period studied. Changes over time in hospital-specific death rates were also examined. RESULTS: A total of 50,357 CABG cases were studied, with an overall death rate of 3.6%. Interhospital comparisons showed that average severity of illness varied considerably across hospitals. Despite risk adjustment accounting for this variable severity, there was considerable variation in adjusted death rates across the 23 hospitals, from 1.95% to 5.76% (p < 0.001 for difference across hospitals). For some hospitals, death rates decreased between 1992/93 and 1995/96, whereas for others the rates were stable or increased. INTERPRETATION: Risk-adjusted rates of in-hospital death after CABG vary widely across Canadian hospitals. There may be differences in quality of care across hospitals, and focused quality-improvement initiatives may be necessary in some institutions. PMID:9834717

  6. Charts versus Discharge ICD-10 Coding for Sternal Wound Infection Following Coronary Artery Bypass Grafting

    PubMed Central

    Southern, Danielle A.; Doherty, Christopher; De Souza, Michael A.; Quan, Hude; Harrop, A. Robertson; Nickerson, Duncan; Rabi, Doreen

    2015-01-01

    Background Sternal wound infection (SWI) in patients undergoing coronary artery bypass grafting (CABG) can carry a significant risk of morbidity and mortality. The objective of this work is to describe the methods used to identify cases of SWI in an administrative database and to demonstrate the effectiveness of using an International Classification of Diseases, Tenth Revision (ICD-10) coding algorithm for this purpose. Methods ICD-10 codes were used to identify cases of SWI within one year of CABG between April 2002 and November 2009. We randomly chose 200 charts for detailed chart review (100 from each of the groups coded as having SWI and not having SWI) to determine the utility of the ICD-10 coding algorithm. Results There were 2,820 patients undergoing CABG. Of these, 264 (9.4 percent) were coded as having SWI. Thirty-eight cases of SWI were identified by chart review. The ICD-10 coding algorithm of T81.3 or T81.4 was able to identify incident SWI with a positive predictive value of 35 percent and a negative predictive value of 97 percent. The agreement between the ICD-10 coding algorithm and presence of SWI remained fair, with an overall kappa coefficient of 0.32 (95 percent confidence interval, 0.22–0.43). The effectiveness of identifying deep SWI cases is also presented. Conclusions This article describes an effective algorithm for identifying a cohort of patients with SWI following open sternotomy in large databases using ICD-10 coding. In addition, alternative search strategies are presented to suit researchers' needs. PMID:26396556

  7. Effect of Statin Use on Acute Kidney Injury Risk Following Coronary Artery Bypass Grafting

    PubMed Central

    Layton, J. Bradley; Kshirsagar, Abhijit V.; Simpson, Ross J.; Pate, Virginia; Funk, Michele Jonsson; Sturmer, Til; Brookhart, M. Alan

    2013-01-01

    Acute kidney injury (AKI) is a serious complication of cardiovascular surgery. While some non-experimental studies suggest statin use may reduce post-surgical AKI, methodological differences in study designs leave uncertainty regarding the reality or magnitude of the effect. We estimated the effect of pre-operative statin initiation on post-coronary artery bypass graft (CABG) AKI using an epidemiologic approach more closely simulating a randomized controlled trial in a large CABG patient population. We utilized healthcare claims from large, employer-based and Medicare insurance databases for the years 2000 – 2010. To minimize healthy user bias, we identified patients undergoing non-emergency CABG who either newly initiated a statin within 20 days prior to surgery or were unexposed for 200+ days prior to CABG. AKI was identified within 15 days following CABG. We calculated multivariable adjusted risk ratios (RR) and 95% confidence intervals (CI) with Poisson regression. Analyses were repeated using propensity score methods adjusted for clinical and healthcare utilization variables. We identified 17,077 CABG patients. Post-CABG AKI developed in 3.4% of statin initiators and 6.2% of non-initiators. After adjustment, we observed a protective effect of statin initiation on AKI (RR = 0.78, 95% CI 0.63, 0.96). This effect differed by age: ?65 years, RR=0.91 (95% CI: 0.68, 1.20); <65 years, RR=0.62 (95% CI: 0.45, 0.86), although AKI was more common in the older age group (7.7 vs. 4.0%). In conclusion, statin initiation immediately prior to CABG may modestly reduce the risk of post-operative AKI, particularly in younger CABG patients. PMID:23273532

  8. How to perform a coronary artery anastomosis in complete endoscopic fashion with robotic assistance

    PubMed Central

    Canale, Leonardo Secchin; Bonatti, Johannes

    2014-01-01

    Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy). PMID:25714222

  9. Impact of age on improvement in health-related quality of life 5 years after coronary artery bypass grafting.

    PubMed

    Herlitz, J; Wiklund, I; Sjöland, H; Karlson, B W; Karlsson, T; Haglid, M; Hartford, M; Caidahl, K

    2000-03-01

    The aim of this study was to describe the relief of symptoms and improvement in other aspects of health-related quality of life 5 years after coronary artery by-pass grafting in relation to age. Patients in western Sweden were approached with an inquiry prior to surgery and 5 years after the operation. Health-related quality of life was estimated with 3 different instruments: Physical Activity Score (PAS), Nottingham Health Profile (NHP), Psychological General Well-Being Index (PGWB). Prior to surgery patients were approached either in the ward or by post and 5 years after surgery they were approached by post. A total of 1719 patients were available for the survey, of whom 876 (51%) responded to the survey both prior to and after 5 years. Among the 876 respondents 287 were <60 years, 331 were 60-67 years and 258 were >67 years. In terms of physical activity, chest pain and dyspnoea, a similar improvement was observed regardless of age. In terms of health-related quality of life questionnaires, there was an inverse association between age and improvement when using PAS and a similar trend was observed with NHP and PGWB. In conclusion, 5 years after coronary artery bypass grafting relief of symptoms and improvement in physical activity was not associated with age, whereas improvement in other aspects of health-related quality of life tended to be less marked in elderly people. Overall age seemed to have a small impact on the improved well-being 5 years after coronary surgery. However, due to the limited response rate the results may not be applicable to a non-selected coronary artery bypass grafting population. PMID:10782941

  10. Usefulness of the Logistic Clinical Syntax Score in Prediction of Saphenous Vein Graft Failure in Patients Undergoing Coronary Artery Bypass Grafting.

    PubMed

    Ozturk, Derya; Cel?k, Omer; Cakmak, Huseyin Altug; Ak?n, Fatih; Aslan, Serkan; Enhos, As?m; Tasbulak, Omer; Ayca, Burak; Erkanl?, Korhan; Bak?r, ?hsan

    2015-09-01

    We investigated the association between the preoperative logistic clinical syntax score (log CSS), saphenous vein graft (SVG) patency, and major adverse cardiac and cerebrovascular events (MACCEs) after coronary artery bypass surgery (CABG). Of 1875 patients undergoing isolated CABG between 2009 and 2011, 267 patients, who later underwent coronary angiography, were included in the study. The primary end point was at least 1 graft occlusion on the follow-up coronary angiogram. The secondary end point was a composite of MACCE. In multivariate analysis, log CSS was found as a strong predictor of SVG failure (odds ratio [OR] 0.66, 95% confidence interval [CI]: 0.46-0.94, P = .02; and OR: 2.21, 95% CI: 1.02-4.75, P = .04, respectively): log CSS was also associated with MACCE (P = .001 and P < .001, respectively). The addition of clinical parameters to the anatomical SYNTAX score, termed as "log CSS", augmented the accuracy and reliability of the prediction of SVG failure and MACCE in patients undergoing CABG. PMID:25385816

  11. Prevalence and Outcome of Upper Gastrointestinal Bleeding Post-coronary Artery Bypass Graft

    PubMed Central

    Aljarallah, Badr; Wong, Winnie; Modry, Dennis; Fedorak, Richard

    2008-01-01

    Background: Upper gastrointestinal bleeding (UGIB), a potentially fatal occurrence, can sometimes follow coronary artery bypass graft (CABG) surgery. However, little has been published about its prevalence, risk factors, and outcomes. Aim: This study aimed to determine the rate, etiologies, predisposing factors, and outcomes of UGIB following CABG. Method: The authors conducted a retrospective chart review of all UGIBs which followed CABGs performed at the University of Alberta Hospital from January 1, 1998 to December 31, 2002. Results: During the study period, 4,502 CABGs were performed at the UAH. Eighteen patients (0.4%) had a documented major UGIB (defined as evidence of melena, red or coffee-grounds emesis, blood per NG tube, or a decrease of Hgb by > 20 g/l and requiring a confirmation by endoscopy or radiological study). Two of these 18 patients (11%) had a past history of peptic ulcer disease, and one of these patients had had previous UGIB. Three patients (17%) had been taking proton pump inhibitors (PPI) before the UGIB occurred. At the time of UGIB, PPIs were prescribed for 16 patients (89%), and the PPIs achieved effective hemostasis as a single agent for 10 (62.5%). Of the 18 patients, 16 (89%) underwent upper GI endoscopy. Bleeding was found to be due to duodenal ulceration in 9 (56%), esophagitis in 4 (22%) and gastritis in 6 cases (33%); fifty percent of these patients had multiple sites of bleeding. Endoscopic therapeutic intervention was needed by 6 patients (37.5%), and successful hemostasis was achieved for 5 of these patients (83%). One patient had a recurrence of bleeding and required surgery. One patient underwent surgery as the primary hemostatic therapy after a diagnostic endoscopy. The overall surgical rate was 11.1% for this patient cohort. In this cohort, three patients died, two from multi-organ failure, and the third, a surgically managed patient, had a cardiac arrest 72 hours post-surgery. The number of complication increased as both cardiopulmonary bypass and cross clamp time increased. There were no endoscopy-related complications. Conclusions: UGI bleeding following CABGs is relatively infrequent, occurring at a rate of 0.4% in this study. Upper gastrointestinal bleeding post-CABG is most frequently related to a duodenal ulcer, though 50% of the patients had multiple bleeding sites. prolonged bypass and cross clamp time associated with more complications. PMID:21475474

  12. Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection

    SciTech Connect

    Fanelli, Fabrizio Cannavale, Alessandro; Gazzetti, Marianna; Fantozzi, Cristiano; Taurino, Maurizio; Speziale, Francesco

    2013-02-15

    This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient's clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition.

  13. Impact of Intensive Physiotherapy on Cognitive Function after Coronary Artery Bypass Graft Surgery.

    PubMed

    Cavalcante, Elder Dos Santos; Magario, Rosmeiri; Conforti, César Augusto; Cipriano Júnior, Gerson; Arena, Ross; Carvalho, Antonio Carlos C; Buffolo, Enio; Luna Filho, Bráulio

    2014-11-01

    Background: Coronary artery bypass graft (CABG) is a standard surgical option for patients with diffuse and significant arterial plaque. This procedure, however, is not free of postoperative complications, especially pulmonary and cognitive disorders. Objective: This study aimed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG. Methods: Neuropsychological and pulmonary function tests were applied, prior to and following CABG, to 39 patients randomized into two groups as follows: Group 1 (control) - 20 patients underwent one physiotherapy session daily; and Group 2 (intensive physiotherapy) - 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital. Non-paired and paired Student t tests were used to compare continuous variables. Variables without normal distribution were compared between groups by using Mann-Whitney test, and, within the same group at different times, by using Wilcoxon test. The chi-square test assessed differences of categorical variables. Statistical tests with a p value ? 0.05 were considered significant. Results: Changes in pulmonary function were not significantly different between the groups. However, while Group 2 patients showed no decline in their neurocognitive function, Group 1 patients showed a decline in their cognitive functions (P ? 0.01). Conclusion: Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day, providing patients with better psychosocial conditions and less morbidity.Fundamento: A cirurgia de revascularização miocárdica (CRM) é a opção cirúrgica padrão para pacientes com placas arteriais difusas e significativas. Tal procedimento, no entanto, não é desprovido de complicações pós-operatórias, especialmente distúrbios pulmonares e cognitivos. Objetivo: Comparar o impacto de duas abordagens fisioterapêuticas diferentes nas funções pulmonar e cognitiva de pacientes submetidos a CRM. Métodos: Testes de função pulmonar e neuropsicológicos foram aplicados, antes e após CRM, a 39 pacientes randomizados em dois grupos: Grupo 1 - 20 pacientes-controle submetidos a uma sessão de fisioterapia por dia; Grupo 2 - 19 pacientes submetidos a três sessões de fisioterapia por dia durante recuperação no hospital. Testes t de Student pareado e não pareado foram usados para comparar as variáveis contínuas. Variáveis sem distribuição normal foram comparadas entre os grupos usando-se o teste de Mann-Whitney, e, dentro do mesmo grupo em momentos diferentes, usando-se o teste de Wilcoxon. O teste do qui-quadrado avaliou diferenças das variáveis categóricas. Testes estatísticos com p valor ? 0,05 foram considerados significativos. Resultados: As alterações da função pulmonar não diferiram significativamente entre os grupos. Entretanto, o mesmo não ocorreu com a função neurocognitiva, que apresentou declínio no Grupo 1, mas não no Grupo 2 (p ? 0,01). Conclusão: Tais resultados reforçam a importância da fisioterapia após CRM e da realização de múltiplas sessões por dia, o que oferece aos pacientes melhores condições psicossociais e menos morbidade. PMID:25352459

  14. Short- and Long-Term Patient Outcomes From Combined Coronary Endarterectomy and Coronary Artery Bypass Grafting

    PubMed Central

    Wang, Jiayang; Gu, Chengxiong; Yu, Wenyuan; Gao, Mingxin; Yu, Yang

    2015-01-01

    Abstract This meta-analysis aimed to compare the short- and long-term outcomes in patients undergoing combined coronary endarterectomy and coronary artery bypass grafting (CE + CABG) versus isolated CABG, and particularly to examine subgroup patients with high-risk profile and patients with diffuse disease in the left anterior descending artery (LAD). Studies published between January 1, 1970 and May 31, 2015 were searched in the literature databases, including Ovid Medline, Embase, PubMed, and ISI Web of Science. A total of 30 eligible studies including 63,730 patients were analyzed. Five authors extracted data from the included studies independently. Meta-analysis on the total patients revealed that CE + CABG was associated with significantly increased 30-day postoperative all-cause mortality compared with isolated CABG (OR?=?1.86, 95% CI: 1.66–2.08, z?=?10.99, P?

  15. Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries

    SciTech Connect

    England, Andrew; Butterfield, John S.; McCollum, Charles N.; Ashleigh, Raymond J.

    2008-07-15

    The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters <18 mm and 30 (26%) patients had one or more CIA diameters >18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices. Departmental databases and patient records were reviewed to assess outcomes. Technical success, iliac-related outcome, and iliac-related reintervention (IRSI) were analyzed. Patients with EVAR extending into the external iliac artery were excluded. Median (range) follow-up for the study group was 24 (1-84) months. Initial technical success was 98% for CIAs <18 mm and 100% for CIAs {>=}18 mm (p = 0.551). There were three distal type I endoleaks (two in the ectatic group) and six iliac limb occlusions (one in an ectatic patient); there were no statistically significant differences between groups (p = 0.4). There were nine IRSIs (three stent-graft extensions, six femorofemoral crossover grafts); three of these patients had one or both CIAs {>=}18 mm (p = 0.232). One-year freedom from IRSI was 92% {+-} 3% and 84% {+-} 9% for the <18-mm and {>=}18-mm CIA groups, respectively (p = 0.232). We conclude that the treatment of AAA by EVAR in patients with CIAs 18-24 mm appears to be safe and effective, however, it may be associated with more frequent reinterventions.

  16. Magnetic Resonance Angiography of Nonferromagnetic Iliac Artery Stents and Stent-Grafts: A Comparative Study in Sheep

    SciTech Connect

    Schuermann, Karl; Vorwerk, Dierk; Buecker, Arno; Neuerburg, Joerg; Grosskortenhaus, Stefanie; Haage, Patrick; Piroth, Werner; Hunter, David W.; Guenther, Rolf W.

    1999-09-15

    Purpose: To compare nonferromagnetic iliac artery prostheses in their suitability for patency monitoring with magnetic resonance angiography (MRA) using conventional angiography as a reference. Methods: In experiment 1, three Memotherm stents were inserted into the iliac arteries of each of six sheep: two 'tandem' stents on one side and a single stent on the other side. In experiment 2, four prostheses (normal and low-porosity Corvita stent-grafts, Memotherm, ZA-stent) were inserted in each of 11 sheep. Patency was monitored before and 1, 3, and 6 months after insertion with 3D phase-contrast and two 2D time-of-flight sequences (TOF-1: TR/TE = 18/6.9, TOF-2: 13/2.5) with and without contrast at 1.5 T. On 206 coronal MIP images (72 pre-, 134 post-stenting), three readers analyzed 824 iliac segments (206 x 4) for patency and artifacts. Results: There was no difference in the number of artifacts between tandem and single iliac Memotherm stents. The ZA-stent induced significantly fewer artifacts than the other prostheses (p < 0.00001). With MRA, patency of the ZA-stent was correctly diagnosed in 88% of cases, which was almost comparable to nonstented iliac segments (95%), patency of the Memotherm stent in 59%, and of the Corvita stent-grafts in 57% and 55%. The TOF-2 sequence with contrast yielded the best images. Conclusion: MRA compatibility of nonferromagnetic prostheses depends strongly on the design of the device. MRA may be used to monitor the patency of iliac ZA-stents, whereas iliac Memotherm stents and Corvita stent-grafts appear to be less suited for follow-up with MRA.

  17. Can preoperative myocardial perfusion scintigraphy predict changes in left ventricular perfusion and function after coronary artery bypass graft surgery?

    PubMed Central

    Eckardt, Rozy; Kjeldsen, Bo Juel; Johansen, Allan; Grupe, Peter; Haghfelt, Torben; Thayssen, Per; Andersen, Lars Ib; Hesse, Birger

    2012-01-01

    OBJECTIVES We wanted to evaluate whether preoperative myocardial perfusion scintigraphy (MPS) could predict changes in cardiac symptoms and postoperative myocardial perfusion and left ventricular function after coronary artery bypass grafting (CABG). METHODS Ninety-two patients with stable angina pectoris (and at least one occluded coronary artery) underwent MPS before, and 6 months after, undergoing CABG. The result of the MPS was kept secret from the surgeons. RESULTS Before CABG, 90% of the patients had angina. After CABG, 97% of the patients were without symptoms. Overall graft patency was 84%. Before CABG, one patient had normal perfusion; in the rest of them the defects were classified as follows: reversible (60%), partly reversible (27%) and irreversible (12%). Following CABG, 33% had normal perfusion; in the rest the defects were reversible in 29%, partly reversible in 12% and irreversible in 26%. Left ventricular ejection fraction (LVEF), which was normal before operation in 45%, improved in 40% of all patients. The increase in LVEF was not related to the preoperative pattern of perfusion defects. Of 30 patients with normalized perfusion after CABG, 29 (97%) had reversible defects and one patient had partly reversible defects. Of 83 perfusion defects, which were normalized after CABG, 67 were reversible (81%) or partly reversible (12%). Seventy-five percent of all reversible coronary artery territories before CABG were normalized after operation. CONCLUSIONS Our results indicate that reversible or partly reversible perfusion defects at a preoperative MPS have a high chance of normalized myocardial perfusion assessed by MPS 6 months after operation. Normal perfusion is obtained almost exclusively in territories with reversible ischaemia. Symptoms improved in nearly all patients and LVEF in a significant fraction of the patients, not related to preoperative MPS. PMID:22473665

  18. Elevated Pulmonary Artery Pressure Is a Risk Factor for Primary Graft Dysfunction Following Lung Transplantation for Idiopathic Pulmonary Fibrosis

    PubMed Central

    Fang, Adam; Studer, Sean; Kawut, Steven M.; Ahya, Vivek N.; Lee, James; Wille, Keith; Lama, Vibha; Ware, Lorraine; Orens, Jonathan; Weinacker, Ann; Palmer, Scott M.; Crespo, Maria; Lederer, David J.; Deutschman, Clifford S.; Kohl, Benjamin A.; Bellamy, Scarlett; Demissie, Ejigayehu

    2011-01-01

    Background: Idiopathic pulmonary fibrosis (IPF) is often associated with elevations in pulmonary artery pressures. Although primary pulmonary arterial hypertension (PAH) has been associated with primary graft dysfunction (PGD), the role of secondary PAH in mediating PGD risk in patients with IPF is incompletely understood. The purpose of this study was to evaluate the relationship between mean pulmonary artery pressure (mPAP) and PGD among patients with IPF. Methods: We performed a multicenter prospective cohort study of 126 lung transplant procedures performed for IPF between March 2002 and August 2007. The primary outcome was grade 3 PGD at 72 h after lung transplant. The mPAP was measured as the initial reading following insertion of the right-sided heart catheter during lung transplant. Multivariable logistic regression was used to adjust for confounding variables. Results: The mPAP for patients with PGD was 38.5 ± 16.3 mm Hg vs 29.6 ± 11.5 mm Hg for patients without PGD (mean difference, 8.9 mm Hg [95% CI, 3.6-14.2]; P = .001). The increase in odds of PGD associated with each 10-mm Hg increase in mPAP was 1.64 (95% CI, 1.18-2.26; P = .003). In multivariable models, this relationship was independent of confounding by other clinical variables, although the use of cardiopulmonary bypass partially attenuated the relationship. Conclusions: Higher mPAP in patients with IPF is associated with the development of PGD. PMID:20864607

  19. Pelvic Arterial Embolisation in a Trauma Patient with a Pre-Existing Aortobifemoral Graft

    SciTech Connect

    Abulaban, Osama; Hopkins, Jonathan; Willis, Andrew P.; Jones, Robert G.

    2011-02-15

    Pelvic fractures secondary to blunt trauma are associated with a significant mortality rate due to uncontrolled bleeding. Interventional radiology (IR) can play an important and central role in the management of such patients, offering definitive minimally invasive therapy and avoiding the need for high-risk surgery. Rapid access to whole-body computed tomography has been shown to improve survival in polytrauma patients and allows rapid diagnosis of vascular injury and assessment of suitability for endovascular therapy. IR can then target and treat the specific area of bleeding. Embolisation of bleeding pelvic arteries has been shown to be highly effective and should be the treatment of choice in this situation. The branches of the internal iliac artery (IIA) are usually involved, and these arteries are accessed by way of IIA catheterisation after abdominal aortography. Occasionally these arteries cannot be accessed by way of this conventional route because of recent IIA ligation carried out surgically in an attempt to stop the bleeding or because (in the rare situation we describe here) these vessels are excluded secondary to previous aortoiliac repair. In this situation, knowledge of pelvic arterial collateral artery pathways is important because these will continue to supply pelvic structures whilst making access to deep pelvic branches challenging. We describe a rare case, which has not been previously reported in the literature, in which successful embolisation of a bleeding pelvic artery was carried out by way of the collateral artery pathways.

  20. Bypass grafting between the supraceliac aorta and the common hepatic artery during pancreaticoduodenectomy

    PubMed Central

    Liang, Diana H.; Rosenberg, Wade R.; Martinez, Sylvia

    2015-01-01

    Patients with celiac artery stenosis often remain asymptomatic due to formation of extensive collateral pathways. Hepatic or anastomotic ischemia may occur when the gastroduodenal artery and these collaterals are ligated during pancreaticoduodenectomy. Here, we present a patient with severe atherosclerotic disease of the celiac axis who successfully underwent pancreaticoduodenectomy with aorto-hepatic bypass. PMID:26330233

  1. Bypass grafting between the supraceliac aorta and the common hepatic artery during pancreaticoduodenectomy.

    PubMed

    Liang, Diana H; Rosenberg, Wade R; Martinez, Sylvia

    2015-01-01

    Patients with celiac artery stenosis often remain asymptomatic due to formation of extensive collateral pathways. Hepatic or anastomotic ischemia may occur when the gastroduodenal artery and these collaterals are ligated during pancreaticoduodenectomy. Here, we present a patient with severe atherosclerotic disease of the celiac axis who successfully underwent pancreaticoduodenectomy with aorto-hepatic bypass. PMID:26330233

  2. Gender as a Moderator between Having an Anxiety Disorder Diagnosis and Coronary Artery Bypass Grafting Surgery (CABG) Outcomes in Rural Patients

    ERIC Educational Resources Information Center

    Dao, Tam K.; Voelkel, Emily; Presley, Sherine; Doss, Brendel; Huddleston, Cashuna; Gopaldas, Raja

    2012-01-01

    Purpose: This paper examines gender as a moderating variable between having an anxiety disorder diagnosis and coronary artery bypass grafting surgery (CABG) outcomes in rural patients. Methods: Using the 2008 Nationwide Inpatient Sample (NIS) database, 17,885 discharge records of patients who underwent a primary CABG surgery were identified.…

  3. Aneurysm of an Aberrant Right Subclavian Artery Successfully Excluded by a Thoracic Aortic Stent Graft with Supra-aortic Bypass of Three Arch Vessels

    SciTech Connect

    Munneke, Graham J. Loosemore, Thomas M.; Belli, Anna-Maria; Thompson, Matt M.; Morgan, Robert A.

    2005-06-15

    An aberrant right subclavian artery (ARSA) arising from a left-sided aortic arch is the fourth most common aortic arch anomaly. Aneurysmal dilatation of the ARSA requires treatment because of the associated risk of rupture. We present a case where supra-aortic bypass of the arch vessels was performed to facilitate exclusion of the aneurysm by a thoracic aortic stent graft.

  4. Graft Arterial Stenosis in Kidney En Bloc Grafts From Very Small Pediatric Donors: Incidence, Timing, and Role of Ultrasound in Screening.

    PubMed

    Bent, C; Fananapazir, G; Tse, G; Corwin, M T; Vu, C; Santhanakrishnan, C; Perez, R V; Troppmann, C

    2015-11-01

    In previous studies with different donor selection criteria and noncontemporary surgical techniques, graft arterial stenosis (GAS) has been reported to occur more frequently in adult recipients of pediatric en bloc renal allografts (EBKT) as compared to single adult donor allografts. The purpose of our study was to evaluate the incidence of GAS within our EBKT recipient population and to evaluate clinical and imaging features of those cases with GAS. In a retrospective cohort study, we analyzed 182 EBKT performed at a single institution. We identified cases of suspected GAS based on clinical factors, lab results, and noninvasive imaging. Diagnosis of GAS was confirmed by digital subtraction angiography. Two EBKT recipients (1.1% of 182) had angiographically confirmed GAS at 2.5 and 4.5 months after transplant. In both cases, the stenoses were short segment within the proximal (perianastomotic) donor aorta, color Doppler ultrasound demonstrated peak systolic velocities of >400?cm/s, and poststenotic parvus tardus waveforms were present. Both patients underwent angioplasty and demonstrated postintervention improvement in renal function and blood pressure. Restenosis did not occur during follow up. In conclusion, recipients of EBKT have a low incidence of GAS, similar to the lowest reported for adult single allografts. PMID:26153092

  5. Comparing cardiovascular factors in opium abusers and non-users candidate for coronary artery bypass graft surgery

    PubMed Central

    Aghadavoudi, Omid; Eizadi-Mood, Nastaran; Najarzadegan, Mohammad Reza

    2015-01-01

    Background: In some opinions, opium consumption has traditionally been considered to be a means to lower blood lipids and to put off heart diseases. In this study, the relationship between opium consumption and risk factors of coronary artery diseases, hemodynamic factors and cardiac related functions before and after surgery was evaluated. Materials and Methods: In a cross-sectional study 325 patient's candidate for elective coronary artery bypass grafting were enrolled in a period of 6 months. Opium addicted patients were recognized based on taking history from the patients by an anaesthesiologist. Serum lipid profile was determined at the beginning of the study. Frequency and distribution of coronary artery diseases were assessed according to the pre-operative coronary angiography. Results: From 325 patients, 117 patients were opium abusers and 208 patients were not. Mean duration of opium abuse was 12.6 ± 7.7 years. Mean total serum cholesterol levels were not significantly different in abusers and non-users patients (185 ± 47 vs. 190 ± 49, P > 0.05). Mean level of low-density lipoprotein cholesterol was significantly higher in addicted group (121 ± 27 vs. 81 ± 22, P < 0.05). Mean triglyceride level was also higher in addicted patients (203 ± 114 vs. 162 ± 98, P < 0.05). The prevalence of diabetes and glucose levels was considerably lower in opium addicted cases. Mean body mass index was also lower in addicted patients significantly (25.3 ± 3.7 vs. 27.5 ± 4.1, P < 0.05). Conclusion: There may be a relationship between opium abuse and aggravating lipid profile and hypercholesterolemia and coronary artery disease. PMID:25625118

  6. Aspirate from human stented native coronary arteries vs. saphenous vein grafts: more endothelin but less particulate debris.

    PubMed

    Kleinbongard, Petra; Baars, Theodor; Möhlenkamp, Stefan; Kahlert, Philipp; Erbel, Raimund; Heusch, Gerd

    2013-10-15

    Stent implantation into atherosclerotic coronary arteries releases particulate debris and soluble substances that contribute to impaired microvascular perfusion. Here we addressed the potential for microvascular obstruction in patients with stenotic native right coronary arteries (nRCA) compared with saphenous vein grafts on right coronary arteries (SVG-RCA). We enrolled symptomatic, male patients with stable angina pectoris and a flow-limiting stenosis in their nRCA or SVG-RCA (n = 18/18). Plaque volume and composition were analyzed using intravascular ultrasound before stent implantation. Coronary aspirate was retrieved during stent implantation under protection with a distal occlusion/aspiration device and divided into particulate debris and plasma. The release of catecholamines, endothelin, serotonin, thromboxane B2, and tumor necrosis factor-? was measured. The response of rat mesenteric arteries with intact (+E) and denuded (-E) endothelium to aspirate plasma (without and with selective endothelin receptor blockade) was normalized to that by potassium chloride (KClmax = 100%). Plaque volume and composition were not different between nRCA and SVG-RCA. There was less particulate debris (65 ± 8 vs. 146 ± 23 mg; P < 0.05) and more endothelin release (5.8 ± 0.8 vs. 1.3 ± 0.7 pg/ml; P < 0.05) in nRCA than in SVG-RCA, whereas the release of the other mediators was not different. Aspirate from nRCA induced stronger vasoconstriction than that from SVG-RCA [nRCA, 78 ± 6% (+E)/84 ± 5% (-E); SVG-RCA, 59 ± 6% (+E)/68 ± 3% (-E); P < 0.05 nRCA vs. SVG-RCA], which was attenuated by a nonspecific endothelin and a specific endothelin receptor A antagonist. Thus coronary aspirate from stented nRCA is characterized by less debris but more endothelin and stronger vasoconstrictor response than that from SVG-RCA. PMID:23934849

  7. Clinical comparison of percutaneous coronary intervention with domestic drug-eluting stents versus off pump coronary artery bypass grafting in unprotected left main coronary artery disease

    PubMed Central

    Yin, Yong; Xin, Xingli; Geng, Tao; Xu, Zesheng

    2015-01-01

    Objective: The aim of our study was to compare the clinical outcomes of percutaneous coronary intervention (PCI) with domestic drug-eluting stents (DES) and off pump coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery (ULMCA) disease. Methods: A total of 227 patients with ULMCA disease and underwent revascularization was included. One hundred and six patients were treated with PCI with domestic DES implantation and 121 patients with off pump CABG. Clinical outcomes with respect to the major adverse cardiovascular and cerebrovascular events (MACCE) including death any cause, non-fatal myocardial infarction (MI), stroke, and target vessel revascularization (TVR) during hospitalization and at 12-month follow-up were recorded. Results: There was no significant difference between the domestic DES and off pump CABG groups in the risk of death, non-fatal MI, stroke, and TVR during hospitalization and at 12-month follow-up. Overall in-hospital MACCE in PCI versus CABG was 0.94% versus 5.78% (P<0.05). The overall MACCE at 12-month follow up in PCI versus CABG was in 3.77% versus 3.31% (P>0.05). Conclusions: Domestic DES is feasible and safety in the treatment of ULMCA lesions. When compared with off-pump CABG, domestic DES achieved similar completeness of revascularization, similar in-hospital and 12-month follow-up outcomes. A longer follow-up is needed. PMID:26550424

  8. Total i.v. anaesthesia with propofol and alfentanil for coronary artery bypass grafting.

    PubMed

    Manara, A R; Monk, C R; Bolsin, S N; Prys-Roberts, C

    1991-06-01

    The haemodynamic effects of total i.v. anaesthesia with a combination of propofol and alfentanil infusions were studied in eight patients with good left ventricular function undergoing coronary artery bypass surgery. Haemodynamic indices were measured before anaesthesia and at specified intervals before cardiopulmonary bypass. The technique resulted in haemodynamic changes comparable to those reported with opioid-based anaesthesia for coronary artery surgery, and has potential advantages. PMID:2064887

  9. Changes in the Distribution of Hepatic Arterial Blood Flow Following TIPS with Uncovered Stent and Stent-Graft: An Experimental Study

    SciTech Connect

    Keussen, Inger; Song, Ho-Young; Bajc, Marika; Cwikiel, Wojciech

    2002-08-15

    Purpose: To evaluate changes in distribution of hepatic arterial blood flow in the liver following insertion of an uncovered stent and subsequently a stent-graft in the transjugular intrahepatic portosystemic shunt (TIPS) channel.Methods: The experiments were performed in eight healthy pigs under general anesthesia. In a pilot study in one pig, scintigraphic evaluation of arterial perfusion to the liver was done before and after inflation of a balloon in the right hepatic vein. In the other pigs, outflow from the right liver vein was checked repeatedly by contrast injection through a percutaneously inserted catheter. The arterial perfusion through the liver was examined by scintigraphy, following selective injection of macro-aggregate of 99Tcm-labeled human serum albumin 99Tcm-HSA) into the hepatic artery. This examination was done before and after creation of a TIPS with an uncovered stent and subsequently after insertion of a covered stent-graft into the cranial portion of the shunt channel. Results: In the pilot study changes in the arterial perfusion to the liver were easily detectable by scintigraphy. One pig died during the procedure and another pig was excluded due to dislodgement of the hepatic artery catheter. The inserted covered stent obstructed venous outflow from part of the right liver lobe. The 99Tcm-HSA activity in this part remained unchanged after TIPS creation with an uncovered stent. A reduction in activity was seen after insertion of a stent-graft (p0.06).Conclusion: The distribution of the hepaticarterial blood flow is affected by creation of a TIPS with a stent-graft, in the experimental pig model.

  10. Association between mechanics and structure in arteries and veins: theoretical approach to vascular graft confection.

    PubMed

    Salvucci, F P; Bia, D; Armentano, R L; Barra, J G; Craiem, D; Zócalo, Y; Fernández, J D; Baguear, F; Atienza, J M; Rojo, F J; Guinea, G V

    2009-01-01

    Biomechanical and functional properties of tissue engineered vascular grafts must be similar to those observed in native vessels. This supposes a complete mechanical and structural characterization of the blood vessels. To this end, static and dynamic mechanical tests performed in the sheep thoracic and abdominal aorta and the cava vein were contrasted with histological quantification of their main constituents: elastin, collagen and muscle cells. Our results demonstrate that in order to obtain adequate engineered vascular grafts, the absolute amount of collagen fibers, the collagen/elastin ratio, the amount of muscle cells and the muscle cells/elastic fibers ratio are necessary to be determined in order to ensure adequate elastic modulus capable of resisting high stretches, an adequate elastic modulus at low and normal stretch values, the correct viscous energy dissipation, and a good dissipation factor and buffering function, respectively. PMID:19965024

  11. Awake subxyphoid minimally invasive direct coronary artery bypass grafting yielded minimum invasive cardiac surgery for high risk patients.

    PubMed

    Watanabe, Go; Yamaguchi, Shohjiro; Tomiya, Shigeyuki; Ohtake, Hiroshi

    2008-10-01

    Off-pump coronary artery bypass graft (CABG) surgery has become a widely used modality and has received recognized as a minimally invasive surgery with few complications. However, for patients with severely impaired pulmonary function, further considerations have to be given to reduce the complications associated with general anesthesia. We have accumulated experience in awake off-pump surgery combined with high thoracic epidural anesthesia. In this report we describe the use of alternative subxiphoid approach in patients with severe pulmonary dysfunction. A catheter for high thoracic epidural anesthesia was inserted one day before surgery. After obtaining an adequate level of anesthesia, a small subxiphoid incision was made and the pericardium was opened to expose the left anterior descending branch. The conduit for bypass, gastroepiploic artery was accessed through a minilaparotomy, and separated under the same surgical field and anatomozed under beating heart. This procedure was performed in three patients. Patency was confirmed by postoperative angiography in all three cases. All patients were discharged after an uneventful postoperative course. Awake subxiphoid approach has the advantages that both thoracotomy and sternotomy can be avoided thus permitting surgery with extremely low invasiveness. This method is recommended for patients with severe pulmonary dysfunction. PMID:18356282

  12. Transvenous Embolization of a Spontaneous Femoral AVF 5 Years After an Incomplete Treatment with Arterial Stent-Grafts

    SciTech Connect

    Peynircioglu, Bora Ozkan, Murat; Dogan, Omer Faruk; Cil, Barbaros E.; Dogan, Riza

    2008-03-15

    A 66-year-old man with complex left femoral arterio-venous fistula (AVF) was first diagnosed after a deep venous thrombosis incident approximately 5 years ago. Partial treatment was performed by means of endografts along the superficial femoral artery, which remained patent for 5 years. The patient had been doing well until a couple of months ago when he developed severe venous stasis and ulcers of the left cruris, due to a high-flow nonhealing complex AVF with additional iliac vein occlusion. Therefore; the definitive treatment was performed by a unique endovascular technique combined with surgical venous bypass (femoro-femoral crossover saphenous bypass, the Palma operation). A novel percutaneous transvenous technique for occlusion of a complex high-flow AVF is reported with a review of the literature. The case is unique with spontaneous AVF, transvenous embolization with detachable coils and ONYX, and the hybrid treatment technique as well as the long-term patency of superficial femoral artery stent-grafts.

  13. Customized Tapered Stent-Grafts in the Endovascular Management of Internal Iliac Artery Aneurysms: A Useful Adjunct to Conventional Endovascular Options

    SciTech Connect

    Haslam, J. Elizabeth Hardman, John; Horrocks, Michael; Fay, Dominic

    2009-01-15

    The endovascular exclusion of an isolated iliac artery aneurysm is recognized as a safe and favorable alternative to open surgical repair, with low associated morbidity and mortality. It has particular advantages in the treatment of internal iliac artery aneurysm (IIAA) given the technical difficulties associated with open surgical repair deep within the pelvis. We describe the use of customized tapered stent-grafts in the exclusion of wide-necked IIAA in five male patients considered high-risk for conventional surgical repair, in whom the common and external iliac artery morphology precluded the use of standard endovascular devices. In each case, IIAA outflow was selectively embolized and the aneurysm neck excluded by placement of a customized tapered stent-graft across the internal iliac artery origin. This technique was extremely effective, with 100% technical success, no serious associated morbidity, and zero mortality. In all five patients sac size was stable or reduced on computed tomography follow-up of up to 3 years (mean, 24.4 months), with a primary patency rate of 100%. We therefore advocate the use of customized tapered stent-grafts as a further endovascular option in the management of IIAA unsuitable for conventional endovascular repair.

  14. Following-up changes in red blood cell deformability and membrane stability in the presence of PTFE graft implanted into the femoral artery in a canine model

    NASA Astrophysics Data System (ADS)

    Toth, Csaba; Kiss, Ferenc; Klarik, Zoltan; Gergely, Eszter; Toth, Eniko; Peto, Katalin; Vanyolos, Erzsebet; Miko, Iren; Nemeth, Norbert

    2014-05-01

    It is known that a moderate mechanical stress can even improve the red blood cells' (RBC) micro-rheological characteristics, however, a more significant stress causes deterioration in the deformability. In this study, we aimed to investigate the effect of the presence of artificial graft on the RBC deformability and membrane stability in beagles. In the Control group only anesthesia was induced and in the postoperative (p.o.) period blood samplings were carried out. In the Grafted group under general anesthesia, the left femoral artery was isolated, from which a 3.5 cm segment was resected and a PTFE graft (O.D.: 3 mm) of equal in length was implanted into the gap. On the 1st, 3rd, 5th, 7th and 14th p.o. days blood was collected the cephalic veins and RBC deformability was determined ektacytometry (LoRRca MaxSis Osmoscan). Membrane stability test consisted of two deformability measurements before and after the cells were being exposed to mechanical stress (60 or 100 Pa for 300 seconds). Compared to the Control group and the baseline values the red blood cell deformability showed significant deterioration on the 3rd, 5th and mainly on the 7th postoperative day after the graft implantation. The membrane stability of erythrocyte revealed marked inter-group difference on the 3rd, 5th and 7th day: in the Grafted group the deformability decreased and during the membrane stability test smaller difference was observed between the states before and after shearing. We concluded that the presence of a PTFE graft in the femoral artery may cause changes in RBC deformability in the first p.o. week. RBC membrane stability investigation shows a lower elongation index profile for the grafted group and a narrowed alteration in the deformability curves due to mechanical stress.

  15. Calcific aorta and coronary artery: two cases of calcific ascending aorta and descending aorta

    PubMed Central

    Idhrees, A Mohammed; Radhakrishnan, Bineesh K; Panicker, Vargheese T; Pillai, Vivek; Karunakaran, Jayakumar

    2015-01-01

    Calcific aorta is a disease of old age and is an independent risk factor for morbidity and mortality. Here, we present two patients with calcific aorta at different levels. One with a descending porcelain aorta, and modified Bentall's procedure was done. Second is a patient who is having a calcific ascending aorta and coronary artery. Coronary artery bypass grafting from left internal mammary artery to left anterior descending was done for the patient. The calcification and its morbidity had been discussed briefly. PMID:25678909

  16. Coronary artery disease performance measures and statin use in patients with recent percutaneous coronary intervention or recent coronary artery bypass grafting (from the NCDR PINNACLE registry).

    PubMed

    Bandeali, Salman J; Gosch, Kensey; Alam, Mahboob; Kayani, Waleed T; Jneid, Hani; Fiocchi, Fran; Wilson, James M; Chan, Paul S; Deswal, Anita; Maddox, Thomas M; Virani, Salim S

    2015-04-15

    The association between coronary revascularization strategy (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) and compliance with coronary artery disease (CAD) performance measures is not well studied. Our analysis studied patients enrolled in the Practice Innovation and Clinical Excellence registry, who underwent coronary revascularization using PCI or CABG in the 12 months before their most recent outpatient visit in 2011. We compared the attainment of CAD performance measures and statin use in eligible patients with PCI and CABG using hierarchical logistic regression models. Our study cohort consisted of 112,969 patients (80,753 with PCI and 32,216 with CABG). After adjustment for site and patient characteristics, performance measure compliance for tobacco use query (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.76 to 0.86), antiplatelet therapy (OR 0.9; 95% CI 0.86 to 0.94) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy (OR 0.89; 95% CI 0.84 to 0.94) was lower in CABG compared with patients with PCI. Patients who underwent recent CABG had higher rates of ?-blocker (OR 1.25; 95% CI 1.16 to 1.33) and statin treatment (OR 1.37; 95% CI 1.31 to 1.43) compared with patients with PCI. Of the 79 practice sites, 15 (19%) had ?75% of their patients with CAD (CABG or PCI) meeting 75% to 100% of all eligible CAD performance measures. In conclusion, gaps persist in compliance with specific CAD performance measures in patients with recent PCI or CABG, and 1 in 5 practices had ?75% compliance of eligible CAD performance measures in the most of their patients. PMID:25721483

  17. Off-pump coronary artery bypass grafting via median sternotomy in a patient with a history of esophagectomy with substernal gastric tube reconstruction: report of a case.

    PubMed

    Kashiyama, Noriyuki; Toda, Koichi; Miyagawa, Shigeru; Nishi, Hiroyuki; Yoshikawa, Yasushi; Fukushima, Satsuki; Yoshioka, Daisuke; Masashi, Kawamura; Saito, Tetsuya; Sawa, Yoshiki

    2015-09-01

    We performed successful off-pump coronary artery bypass grafting (OPCAB) in a patient with unstable angina caused by triple-vessel disease, who had undergone esophagectomy with substernal gastric tube reconstruction for esophageal cancer 40 years earlier. Preoperative multidetector-row computed tomography was done to evaluate the course of the gastric tube and also that of the gastroepiploic artery, which feeds the gastric tube. Following careful sternal re-entry and adequate dissection, OPCAB was performed safely via a median sternotomy without injuring the gastric tube or causing hemodynamic instability. The patient had an uneventful early postoperative course. PMID:25352011

  18. Endovascular Treatment of a Giant Superior Mesenteric Artery Pseudoaneurysm Using a Nitinol Stent-Graft

    SciTech Connect

    Gandini, Roberto; Pipitone, Vincenzo; Konda, Daniel Pendenza, Gianluca; Spinelli, Alessio; Stefanini, Matteo; Simonetti, Giovanni

    2005-01-15

    A 68-year-old woman presenting with gastrointestinal bleeding (hematocrit 19.3%) and in a critical clinical condition (American Society of Anesthesiologists grade 4) from a giant superior mesenteric artery pseudoaneurysm (196.0 x 131.4 mm) underwent emergency endovascular treatment. The arterial tear supplying the pseudoaneurysm was excluded using a 5.0 mm diameter and 31 mm long monorail expanded polytetrafluoroethylene (ePTFE)-covered self-expanding nitinol stent. Within 6 days of the procedure, a gradual increase in hemoglobin levels and a prompt improvement in the clinical condition were observed. Multislice CT angiograms performed immediately, 5 days, 30 days and 3 months after the procedure confirmed the complete exclusion of the pseudoaneurysm.

  19. Myocardial conditioning techniques in off-pump coronary artery bypass grafting.

    PubMed

    Moscarelli, Marco; Punjabi, Prakash P; Miroslav, Gamov I; Del Sarto, Paolo; Fiorentino, Francesca; Angelini, Gianni D

    2015-01-01

    Off-pump coronary artery bypass surgery by avoiding cardioplegic arrest seems to reduce the risk of ischemic myocardial injury. However, even short-term regional ischemic periods, hemodynamic instability and arrhythmias associated with the procedure can be responsible for myocardial damage. Conditioning, a potential cardio-protective tool during on-pump cardiac surgery, has hardly been investigated in the context of off-pump surgery. There are virtually no large trials on remote ischemic preconditioning and the majority of reports have focused on central ischemic conditioning. Similarly, volatile anesthetic agents with conditioning effect like ischemic preconditioning have been shown to reduce cardiac injury during on-pump procedures but have not been validated in the off-pump scenario. Here, we review the available evidence on myocardial conditioning, either with ischemia/reperfusion or volatile anesthetic agents in patients undergoing off-pump coronary artery surgery. PMID:25599579

  20. Treatment with Aortic Stent Graft Placement for Stanford B-Type Aortic Dissection in a Patient with an Aberrant Right Subclavian Artery

    PubMed Central

    Kawatani, Yohei; Hayashi, Yujiro; Ito, Yujiro; Kurobe, Hirotsugu; Nakamura, Yoshitsugu; Suda, Yuji; Hori, Takaki

    2015-01-01

    A 71-year-old man visited our hospital with the chief complaint of back pain and was diagnosed with acute aortic dissection (Debakey type III, Stanford type B). He was found to have a variant branching pattern in which the right subclavian artery was the fourth branch of the aorta. We performed conservative management for uncomplicated Stanford type B aortic dissection, and the patient was discharged. An ulcer-like projection (ULP) was discovered during outpatient follow-up. Complicated type B aortic dissection was suspected, and we performed thoracic endovascular aortic repair (TEVAR). The aim of operative treatment was ULP closure; thus we placed two stent grafts in the descending aorta from the distal portion of the right subclavian artery. The patient was released without complications on postoperative day 5. Deliberate sizing and examination of placement location were necessary when placing the stent graft, but operative techniques allowed the procedure to be safely completed. PMID:26558132

  1. Management of carotid Dacron patch infection: a case report using median sternotomy for proximal common carotid artery control and in situ polytetrafluoroethylene grafting.

    PubMed

    Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Ceccanei, Gianluca; Pacilè, Maria Antonietta

    2009-01-01

    We report on a 58-year-old male who presented with an enlarging cervical hematoma 3 months following carotid endarterectomy with Dacron patch repair, due to septic disruption of the Dacron patch secondary to presumed infection. The essential features of this case are the control of the proximal common carotid artery gained through a median sternotomy, because the patient was markedly obese with minimal thyromental distance, and the treatment consisting of in situ polytetrafluoroethylene bypass grafting, due to the absence of a suitable autogenous saphenous vein. Median sternotomy is rarely required in case of reintervention for septic false aneurysms and hematomas following carotid endarterectomy but should be considered whenever difficult control of the common carotid artery, when entering the previous cervicotomy, is anticipated. In situ polytetrafluoroethylene grafting can be considered if autogenous vein material is lacking. PMID:19875014

  2. Rare case-series of electrocautery burn following off-pump coronary artery bypass grafting

    PubMed Central

    Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

    2014-01-01

    Abstract: With an increasing number of off-pump coronary artery surgery procedures in high-risk patients with coagulopathy, including renal failure, hepatic failure and anticoagulant drug-using patients, the frequency of related complications such as repeated exploration for bleeding is also increasing. The associated co-morbidity and repeated use of electrocautery in postoperative bleeding leaves patients susceptible to electrocautery ulcers. In this case series, rare cases of cautery burn with unique causative mechanisms are described. PMID:23669602

  3. Heparin-induced thrombocytopenia following coronary artery bypass grafting: a diagnostic dilemma

    PubMed Central

    Khanal, Raju; Karmacharya, Paras; Forman, Daniel A.

    2015-01-01

    The diagnosis of heparin-induced thrombocytopenia (HIT) is a challenge in post-cardiac surgery patients because of the high incidence of non-immune thrombocytopenia and heparin–platelet factor 4 antibodies in these groups. We present a case of HIT in a post coronary artery bypass surgery patient, which was successfully treated with prompt recognition and discontinuation of heparin products. PMID:26486110

  4. Robotically assisted totally endoscopic coronary artery bypass surgery

    PubMed Central

    Canale, Leonardo Secchin; Mick, Stephanie; Mihaljevic, Tomislav; Nair, Ravi

    2013-01-01

    Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the “best of both worlds” from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations. PMID:24251021

  5. Demographic and Socioeconomic Factors of Patients With Coronary Artery Diseases Undertreatment of Coronary Artery Bypass Grafting, Percutaneous Coronary Intervention and Drug Therapy in Mashhad, Iran

    PubMed Central

    Mirzaie, Maryam; Khajedaluee, Mohammad; Falsoleiman, Homa; Mirzaie, Asadollah; Emadzadeh, Mehdi Reza; Erfanian Taghvaei, Majid Reza

    2015-01-01

    Background: Considering the importance of preventing cardiovascular diseases, determining the contributing risk factors for ischemic heart disease which leads to atherosclerotic plaque, could be effective in selecting the required interventions. Objectives: This study aimed to evaluate socioeconomic factors in patients with Coronary Artery Diseases (CAD) in three treatment groups: Coronary Artery Bypass Grafting (CABG), Percutaneous Coronary Intervention (PCI) and drug therapy. By identifying and comparing the underlying factors in treatment groups, we can gather useful information for future planning and policy making in order to reduce and eliminate the contributing factors. Patients and Methods: This cross-sectional study was conducted on 760 patients with CAD referred to cardiovascular health centers in Mashhad, Iran, including Javad-Al-Aeme Heart Hospital, Qaem, Imam Reza and Dr. Shariati educational Hospital. Samples were collected through purposive sampling from January to March 2014. Based on the experts’ opinion, the subjects were categorized into three treatment groups: CABG, PCI, and drug therapy. Results: The mean age of total patients was 58.3 ± 11.5 years (P = 0.09). The proportion of rural patients in the PCI (26.7%) and drug therapy (27.5%) groups was twice as high as the CABG group (11.7%) (P < 0.001). The proportion of patients with higher educational level (higher than high school diploma) in the CABG group (35.9%) was higher than PCI and drug therapy groups (26.7%, 24.3%) (P = 0.006). Smoking, drinking and drug abuse were more common in the drug therapy group (P = 0.03, P = 0.02, and P < 0.001, respectively). One-vessel and three-vessel coronary artery diseases were more common in the drug and CABG groups, respectively (P < 0.001). Conclusions: In total, application of therapeutic approaches in patients with CAD depends on many factors. In our study not only risk factors such as gender, lifestyle, smoking, alcohol abuse, diabetes and hypertension were associated with the incidence of CAD, but also they were highly correlated with the severity of the disease. PMID:26290754

  6. Abdominal Aortic Aneurysm with a Dilated Common Iliac Artery: Treatment Using a Handmade Bifurcated Stent-Graft with a Wide Iliac Limb End

    SciTech Connect

    Miyayama, Shiro; Matsui, Osamu; Akakura, Yukari; Yamamoto, Toru; Nishida, Hiroto; Yoneda, Kenji; Kawai, Keiichi; Murakami, Shinya

    2003-11-15

    The purpose of this study was to evaluate the usefulness of a bifurcated stent-graft with a wide iliac limb end (WILE) in the treatment of abdominal aortic aneurysm (AAA) with a dilated common iliac artery (CIA) to avoid occlusion of the internaliliac artery (IIA). The WILE, covered with an expanded polytetrafluoroethylene graft which was constructed of large diameter stents according to the individual CIA diameter, was connected to a two-piece bifurcated stent-graft covering a polyester graft. The WILE was placed in eight dilated CIAs of six patients. All but one WILE fitted the dilated CIA well. One did not fit, and coil embolization of the leak was needed. All eight IIA derived from the dilated CIA avoided occlusion. Perigraft leak due to other causes was identified in another two patients. Limb kinking was observed in two patients. Our stent is useful in the treatment of AAA with dilated CIA to avoid occlusion of the IIA, and may extend the indication of endoluminal repair of AAA.

  7. A pilot study to assess the effects of a guided imagery audiotape intervention on psychological outcomes in patients undergoing coronary artery bypass graft surgery.

    PubMed

    Stein, Traci R; Olivo, Erin L; Grand, Sandy Hermele; Namerow, Pearila B; Costa, Joseph; Oz, Mehmet C

    2010-01-01

    Depression and anxiety are associated with increased risk of postoperative cardiac events and death in patients who have undergone coronary artery bypass graft surgery. These risks persist even several months after the procedure. Guided imagery has been used with cardiac surgery patients for some time and with numerous anecdotal reports of considerable benefit. In addition, this therapy is low-cost and easy to implement, and the literature holds ample evidence for its efficacy in symptom reduction in various patient populations. It was thus hypothesized that preoperative use of guided imagery would reduce postoperative distress in patients undergoing coronary artery bypass graft. Fifty-six patients scheduled to undergo coronary artery bypass graft at Columbia University Medical Center were randomized into 3 groups: guided imagery, music therapy, and standard care control. Patients in the imagery and music groups listened to audiotapes preoperatively and intraoperatively. All patients completed psychological, complementary medicine therapies use, and other assessments preoperatively and at 1 week and 6 months postoperatively. Only preoperative distress was predictive of postoperative distress at follow-up. Use of complementary medicine therapies was high in all groups and this fact, in addition to the small sample size, may have accounted for the lack of significant relationship between imagery and postoperative distress. Regardless, this complementary and alternative medicine therapy remains palatable to patients. Given its efficacy in other patient populations, it is worth exploring its potential utility for this population with a larger sample. PMID:20588130

  8. Moderate Aortic Stenosis and Coronary Artery Bypass Grafting: Clinical Update for the Perioperative Echocardiographer.

    PubMed

    Maldonado, Yasdet; Singh, Saket; Augoustides, John G; MacKnight, Brenda; Zhou, Elizabeth; Gutsche, Jacob T; Ramakrishna, Harish

    2015-10-01

    Incidental aortic stenosis in the setting of coronary artery bypass surgery may be a perioperative challenge. The accurate assessment of the degree of aortic stenosis remains an important determinant. Although severe aortic stenosis is an indication for valve replacement, current guidelines advise a balanced approach to the management of moderate aortic stenosis in this setting. Multiple factors should be considered in a team discussion to balance risks versus benefits for the various management options in the given patient. The rapid progress in aortic valve technologies also offer alternatives for definitive management of moderate aortic stenosis in this setting that will likely become even safer in the near future. PMID:26275517

  9. Plasma Concentrations Predict Aortic Expression of Growth-Arrest-Specific Protein 6 in Patients Undergoing Coronary Artery Bypass Grafting

    PubMed Central

    Lee, Chien-Hsing; Shieh, Yi-Shing; Tsai, Chien-Sung; Hung, Yi-Jen; Tsai, Yi-Ting; Lin, Chih-Yuan

    2013-01-01

    Aims The tyrosine kinase receptor Axl is expressed in the vasculature, and growth arrest-specific protein 6 (Gas6) is its ligand. Plasma Gas6 levels have been shown to be associated with endothelial dysfunction markers and cardiovascular events. We set out to determine the plasma Gas6 levels in patients undergoing coronary artery bypass grafting (CABG) and investigate the expression of Gas6 and Axl in the aorta. Methods and Results Immunoassays were used to investigate plasma Gas6 levels in CABG patients (n?=?19) and control subjects (n?=?20). The expression of Gas6 and Axl in the injured aorta were examined by reverse transcription-polymerase chain reactions, real-time reverse transcription-polymerase chain reactions, western blotting, and immunohistochemical staining. Plasma Gas6 levels were significantly lower in CABG patients than in matched control subjects. In CABG patients, plasma Gas6 levels were negatively correlated with fasting glucose, E-selectin, and vascular cell adhesion molecule-1 levels. The levels predicted the operative mortality rate and were positively correlated with plasma soluble Axl (sAxl) levels and Gas6 expression in the aorta. Moreover, Gas6 expression was positively correlated with Axl expression in the aorta. Conclusion We concluded that plasma Gas6 is associated with fasting glucose, endothelial dysfunction markers, sAxl values, and vascular Gas6 expression in CABG patients, and it predicts the operative mortality of these patients. These findings suggest that the Gas6/Axl system is crucial in vascular biology. PMID:24236135

  10. Effects of intraoperative external head cooling on short-term cognitive function in patients after coronary artery bypass graft surgery.

    PubMed

    Sirvinskas, E; Usas, E; Mankute, A; Raliene, L; Jakuska, P; Lenkutis, T; Benetis, R

    2014-03-01

    The aim of study was to assess the effects of an intraoperative external head-cooling technique on cognitive dysfunction in the early postoperative period (at the 10th day) in patients after coronary artery bypass graft (CABG) surgery. Patients in Group H (n=25) were cooled with CPB and the intraoperative, external head-cooling technique, patients in Group C (n=25) were cooled only with cardiopulmonary bypass (CPB) to achieve mild hypothermia (33 - 34 °C). Cognitive function was analyzed before the operation and after the surgery using the Mini Mental State Examination (MMSE), the Modified Visual Reproduction Test from the Wechsler Memory Scale, Trail Making (A/B), WAIS--Digit Span (WDS) and WAIS Digit Symbol Substitution Test (WDSST). The incidence of cognitive impairment at the 10th day after the surgery was 36% (n=9) in Group H and 64% (n=16) in Group C (p=0.048). The temperature during the aortic cross-clamp period was associated with a lower rate of cognitive dysfunction (p=0.05, r(2)=0.09). The intraoperative, external head-cooling technique during the aortic cross-clamp period has a neuroprotective effect and leads to less short-term cognitive function impairment after CABG surgery. PMID:23878011

  11. Single vs double antiplatelet therapy in acute coronary syndrome: Predictors of bleeding after coronary artery bypass grafting

    PubMed Central

    Tarzia, Vincenzo; Bortolussi, Giacomo; Buratto, Edward; Paolini, Carla; Dal Lin, Carlo; Rizzoli, Giulio; Bottio, Tomaso; Gerosa, Gino

    2015-01-01

    AIM: To investigate the contribution of anti-platelet therapy and derangements of pre-operative classical coagulation and thromboelastometry parameters to major bleeding post-coronary artery bypass grafting (CABG). METHODS: Two groups of CABG patients were studied: Group A, treated with aspirin alone (n = 50), and Group B treated with aspirin and clopidogrel (n = 50). Both had similar preoperative, clinical, biologic characteristics and operative management. Classic coagulation parameters and rotational thromboelastometry (ROTEM) profiles were determined preoperatively for both groups and the same heparin treatment was administered. ROTEM profiles (INTEM and EXTEM assays) were analyzed, both for traditional parameters, and thrombin generation potential, expressed by area-under-curve (AUC). RESULTS: There was no significant difference between rates of major bleeding between patients treated with aspirin alone, compared with those treated with aspirin and clopidogrel (12% vs 16%, P = 0.77). In the 14 cases of major bleeding, pre-operative classic coagulation and traditional ROTEM parameters were comparable. Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders (5030 ± 1115 Ohm*min) than non-bleeders (6568 ± 548 Ohm*min) (P < 0.0001). CONCLUSION: We observed that patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC, regardless of antiplatelet treatment. This suggests that thrombin generation potential, irrespective of the degree of platelet inhibition, correlates with surgical bleeding. PMID:26413234

  12. Depression, C-reactive protein and length of post-operative hospital stay in coronary artery bypass graft surgery patients.

    PubMed

    Poole, Lydia; Kidd, Tara; Leigh, Elizabeth; Ronaldson, Amy; Jahangiri, Marjan; Steptoe, Andrew

    2014-03-01

    This study aimed to explore the role of C-reactive protein (CRP) in mediating the association between greater pre-operative depression symptoms and longer post-operative length of stay in patients undergoing coronary artery bypass graft (CABG) surgery. We used a sample of 145 elective CABG patients and measured depression symptoms using the Beck Depression Inventory (BDI) prior to surgery and collected baseline measures of CRP. Participants were followed up during their in-hospital stay to measure early (1-3 days post-surgery) and persistent (4-8 days post-surgery) CRP responses to surgery. We found that compared with participants with low depression symptoms, those with elevated depression symptoms (BDI>10) prior to CABG were at increased odds of a hospital stay of greater than one week (OR 3.51, 95% CI 1.415-8.693, p=0.007) and that greater persistent CRP responses mediated this association. Further work is needed to explore the exact physiological pathways through which depression and CRP interact to affect recovery in CABG patients. PMID:24239712

  13. Splenic artery-to-superior mesenteric artery bypass for chronic mesenteric ischemia--a case report.

    PubMed

    Mukherjee, Dipankar; Hendershot, Kimberly M

    2004-01-01

    Chronic mesenteric ischemia (CMI) is a serious vascular condition that if left untreated may progress to acute ischemia resulting in bowel necrosis and high surgical morbidity/mortality rates. Elective intervention has been shown to prevent this progression and relieve symptoms. Current open surgical intervention involves arterial bypass using a vein or synthetic graft conduit with the inflow originating from the aorta or iliac artery. In some circumstances, the splenic artery provides an additional treatment option for revascularization of the superior mesenteric artery. In certain cases, the splenic artery has several advantages over traditional surgical options. The splenic artery is an arterial conduit much like the internal mammary artery used in coronary artery bypass grafting. These grafts are known for their long-term patency and in selected clinical circumstances are preferred over venous grafts. Because the splenic artery has a natural inflow, only a single vascular anastomosis at the outflow vessel (the SMA) is necessary. This lessens the risk of anastomotic stenosis by decreasing the number of anastomoses created and it makes the procedure shorter in duration. The fact that the inflow is provided by the splenic artery makes cross-clamping of the aorta unnecessary, thereby lessening the risk of producing cardiac ischemia and declamping hypotension. A disadvantage is the risk of splenic ischemia with the possible need for splenectomy. The majority of individuals will have adequate collateral supply to the spleen via the short gastric arteries. The risk to the patient of splenectomy versus the benefits of a less complicated arterial reconstruction with avoidance of aortic cross-clamping must be weighed on a case-by-case basis. Preventing the progression to acute mesenteric ischemia with its increased mortality by timely restoration of adequate vascular supply is an important principle in treating patients with CMI. Controversy still exists over the best treatment option for these patients, whether it be antegrade versus retrograde bypass, single-vessel versus multivessel reconstruction, or open surgical repair versus endovascular intervention. In selected patients, the use of the splenic artery can be considered as an additional option for arterial reconstruction of the SMA. PMID:15490046

  14. Anesthetic management of a patient with polycythemia vera undergoing emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting: a case report

    PubMed Central

    Im, Hyeongwoo; Yang, Jaeyoung; Lee, Sangmin Maria; Lee, Jong Hwan

    2015-01-01

    Polycythemia vera is a chronic progressive myeloproliferative disease characterized by increased circulating red blood cells, and the hyperviscosity of the blood can lead to an increased risk of arterial thrombosis. In a previous survey regarding postoperative outcomes in polycythemia vera patients, an increased risk of both vascular occlusive and hemorrhagic complications have been reported. Aortic surgery involving cardiopulmonary bypass may be associated with the development of a coagulopathy, and as a result, the occurrence of thrombotic complications should be avoided after coronary anastomosis. Thus, optimizing the hemostatic balance is an important concern for anesthesiologists. However, only a few cases of anesthetic management in polycythemia vera patients undergoing concomitant aorta and coronary arterial bypass surgery have ever been reported. Here, we experience a polycythemia vera patient who underwent an emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting, and report this case with a review of the relevant literature. PMID:26634086

  15. Hemodynamic Responses to Two Different Anesthesia Regimens in Compromised Left Ventricular Function Patients Undergoing Coronary Artery Bypass Graft Surgery: Etomidate-Midazolam Versus Propofol-Ketamine

    PubMed Central

    Aghdaii, Nahid; Ziyaeifard, Mohsen; Faritus, Seyedeh Zahra; Azarfarin, Rasoul

    2015-01-01

    Background: Various methods have been suggested to prevent hemodynamic instability caused by propofol and adverse effects caused by etomidate induction. The current study evaluated hemodynamic effects of propofol-ketamine mixture in comparison to etomidate-midazolam mixture during anesthesia induction. Objectives: The aim of this study was to evaluate the hemodynamic effects of etomidate-midazolam by comparing it with propofol-ketamine for the induction of anesthesia in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery. Patients and Methods: One-hundred patients aged between 40 and 65 with coronary artery disease and low ejection fraction scheduled for elective coronary artery bypass surgery participated in this study. The patients were randomly allotted to one of the two groups to receive either propofol-ketamine or etomidate-midazolam combination. Two groups were compared for pain on injection and myoclonus, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Cardiac Index (CI) and Systemic Vascular Resistance (SVR), before and one minute after induction of anesthesia, and one, three and five minutes after intubation. Results: Incidence of pain on injection (2 - 4%) and myoclonus (10%) was less in both groups. The hemodynamic response was similar in the two groups for all variables over the time interval, except for CI at one and three minutes after intubation (P = 0.024 and P = 0.048, respectively), and SVR in five minutes after intubation (P = 0.009), with differences being statistically significant. Conclusions: Both anesthetic regimens were acceptable for induction in patients with coronary artery disease and left ventricular dysfunction undergoing coronary artery bypass graft surgery. PMID:26161330

  16. The New Zealand priority criteria project. Part 2: Coronary artery bypass graft surgery.

    PubMed Central

    Hadorn, D. C.; Holmes, A. C.

    1997-01-01

    Priority criteria developed during a national project were used to conduct an audit of all 662 patients on waiting lists for coronary artery bypass surgery in New Zealand during spring 1996. Based on the observed distribution of priority scores, the cost of providing surgery to all patients down to various levels of priority was estimated. Descriptions incorporating life expectancy and quality of life implications of surgery were developed of the kinds of patients who would or would not receive surgery at each of several possible funding levels. Cardiologists and cardiac surgeons agreed that a threshold of 25 points was a reasonable clinical goal but to work with a threshold of 35, which can be sustained with current levels of funding. All agree that the gap between these clinically preferred and currently afforded thresholds is a subject for wider societal dialogue and decision. The ability to measure the size of the gap between clinical desirability and financial sustainability provides a new transparency to the problem of healthcare resource allocation. PMID:9006478

  17. Investigation of the Hemodynamic Effect of Stent Wires on Renal Arteries in Patients with Abdominal Aortic Aneurysms Treated with Suprarenal Stent-Grafts

    SciTech Connect

    Sun Zhonghua; Chaichana, Thanapong

    2009-07-15

    The purpose of the study was to investigate the hemodynamic effect of stent struts (wires) on renal arteries in patients with abdominal aortic aneurysms (AAAs) treated with suprarenal stent-grafts. Two sample patients with AAA undergoing multislice CT angiography pre- and postsuprarenal fixation of stent-grafts were selected for inclusion in the study. Eight juxtarenal models focusing on the renal arteries were generated from the multislice CT datasets. Four types of configurations of stent wires crossing the renal artery ostium were simulated in the segmented aorta models: a single wire crossing centrally, a single wire crossing peripherally, a V-shaped wire crossing centrally, and multiple wires crossing peripherally. The blood flow pattern, flow velocity, wall pressure, and wall shear stress at the renal arteries pre- and post-stent-grafting were analyzed and compared using a two-way fluid structure interaction analysis. The stent wire thickness was simulated with a diameter of 0.4, 1.0, and 2.0 mm, and hemodynamic analysis was performed at different cardiac cycles. The interference of stent wires with renal blood flow was mainly determined by the thickness of stent wires and the type of configuration of stent wires crossing the renal ostium. The flow velocity was reduced by 20-30% in most of the situations when the stent wire thickness increased to 1.0 and 2.0 mm. Of the four types of configuration, the single wire crossing centrally resulted in the highest reduction of flow velocity, ranging from 21% to 28.9% among three different wire thicknesses. Wall shear stress was also dependent on the wire thickness, which decreased significantly when the wire thickness reached 1.0 and 2.0 mm. In conclusion, our preliminary study showed that the hemodynamic effect of suprarenal stent wires in patients with AAA treated with suprarenal stent-grafts was determined by the thickness of suprarenal stent wires. Research findings in our study are useful for follow-up of patients treated with suprarenal stent-grafts to ensure long-term safety of the suprarenal fixation.

  18. Hand Grip Strength and Myocardial Oxygen Consumption Index among Coronary Artery Bypass Grafting Patients

    PubMed Central

    Sokran, Siti Nur Baait Biniti Mohd; Mohan, Vikram; Kamaruddin, Kamaria; Sulaiman, Mohd Daud; Awang, Yahya; Othman, Ida Rosmini Binti; Victor, Smiley Jesu Priya

    2015-01-01

    Background Hand grip strength (HGS) is a reliable indicator of peripheral muscle strength. Although, numerous studies have investigated the strength of hand grip; little attention has been given to coronary artery disease (CAD) patients, exploring the relationship between HGS and myocardial oxygen consumption (MVO2) index. The current study aimed to evaluate the interaction between HGS and MVO2 index findings before and after cardiac surgery. Methods Twenty-seven patients with CAD had HGS were assessed using handheld dynamometer. HGS for each hand were documented. MVO2 index was assessed using rate pressure product (RPP), which is the product of the heart rate (HR) and systolic blood pressure (SBP). Repeated measures MANOVA were carried out to estimate the interaction between both hands HGS and MVO2 index before and after surgery. Results There was significant interactions (P<0.001) for both HGS dominant and non-dominant with large effect sizes (HGS dominant×MVO2 index: hp2=0.44; HGS dominant×RPP: hp2=0.49). This signifies that peripheral muscle strength of the upper limb (HGS dominant and non-dominant) had different effects on MVO2 index before and after surgery. The interaction graph shows that the increase in MVO2 index after surgery was significantly greater for peripheral muscle strength of the dominant hand when compared to non-dominant.  Conclusion Patients with CAD had interactions between HGS and oxygen consumption before and after surgery. Hence, HGS might be used as a predictor to assess oxygen consumption among cardiac patients. PMID:26170520

  19. Platform Technologies for Decellularization, Tunic-Specific Cell Seeding, and In Vitro Conditioning of Extended Length, Small Diameter Vascular Grafts

    PubMed Central

    Fercana, George; Bowser, Devon; Portilla, Margarita; Langan, Eugene M.; Carsten, Christopher G.; Cull, David L.; Sierad, Leslie N.

    2014-01-01

    The aim of this study was to generate extended length, small diameter vascular scaffolds that could serve as potential grafts for treatment of acute ischemia. Biological tissues are considered excellent scaffolds, which exhibit adequate biological, mechanical, and handling properties; however, they tend to degenerate, dilate, and calcify after implantation. We hypothesized that chemically stabilized acellular arteries would be ideal scaffolds for development of vascular grafts for peripheral surgery applications. Based on promising historical data from our laboratory and others, we chose to decellularize bovine mammary and femoral arteries and test them as scaffolds for vascular grafting. Decellularization of such long structures required development of a novel “bioprocessing” system and a sequence of detergents and enzymes that generated completely acellular, galactose-(?1,3)-galactose (?-Gal) xenoantigen-free scaffolds with preserved collagen, elastin, and basement membrane components. Acellular arteries exhibited excellent mechanical properties, including burst pressure, suture holding strength, and elastic recoil. To reduce elastin degeneration, we treated the scaffolds with penta-galloyl glucose and then revitalized them in vitro using a tunic-specific cell approach. A novel atraumatic endothelialization protocol using an external stent was also developed for the long grafts and cell-seeded constructs were conditioned in a flow bioreactor. Both decellularization and revitalization are feasible but cell retention in vitro continues to pose challenges. These studies support further efforts toward clinical use of small diameter acellular arteries as vascular grafts. PMID:24749889

  20. Transfusion and Bleeding in Coronary Artery Bypass Grafting: An On-Pump Versus Off-Pump Comparison

    PubMed Central

    Potger, Kieron C.; McMillan, Darryl; Southwell, Joanne; Connolly, Terry; Smith, Kate Kingsford; BNurs, Mark Ambrose

    2007-01-01

    Abstract: Blood transfusion rates in coronary artery bypass grafting (CABG) surgery using cardiopulmonary bypass (CPB) are typically higher compared with off-pump CABG (OPCAB). However, few studies have specifically examined intraoperative hemodilution as a contributing factor. The aim of this retrospective review was to compare the effect of using CPB or OPCAB on red blood cell (RBC) transfusion and postoperative bleeding. The lowest intraoperative hematocrit (Hct) was used as marker of intraoperative hemodilution. We reviewed the perioperative data of all isolated CABG patients at a metropolitan hospital from January 2003 to June 2005. Stepwise regression analyses were performed to determine whether CPB was an independent predictor of RBC transfusion, reoperation for bleeding, or postoperative chest drainage. Of a total of 1043 patients, there were 433 CPB and 610 off-pump cases. CPB use was not significantly related to increased RBC transfusions (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.63–1.52; p = .921) and was associated with a lower incidence of reoperations for bleeding (OR, 0.4; 95% CI, 0.2–0.8; p = .009). There was less chest drainage over the first 12 hours in patients undergoing CPB (p < .0001); however, total postoperative chest drainage was not significantly related to operative procedure (p = .122). The lowest documented intraoperative Hct was a significant factor in RBC transfusions (OR, 0.89; p < .0001), an increased reoperation rate for bleeding (OR, 0.9; p = .001) and more postoperative chest drainage (log10-transformed: at 12 hours, b = ?0.009, p < .0001; total, b = ?0.006, p < .0001). CPB is not an independent risk factor in the incidence of RBC transfusions and is not associated with increased postoperative bleeding for isolated CABG. However, intraoperative hemodilution is an independent risk factor, with a lower intraoperative Hct associated with more RBC transfusions, increased reoperations for bleeding, and increased postoperative chest drainage. Addressing intraoperative hemodilution is important in minimizing CPB-associated morbidities. PMID:17486870

  1. Coronary artery bypass grafts and diagnosis related groups: patient classification and hospital reimbursement in 10 European countries

    PubMed Central

    2014-01-01

    Background The prospective reimbursement of hospitals through the grouping of patients into a finite number of categories (Diagnosis Related Groups, DRGs), is common to many European countries. However, the specific categories used vary greatly across countries, using different characteristics to define group boundaries and thus those characteristics which result in different payments for treatment. In order to assist in the construction and modification of national DRG systems, this study analyses the DRG systems of 10 European countries. Aims To compare the characteristics used to categorise patients receiving a coronary artery bypass graft (CABG) surgery into DRGs. Further, to compare the structure into which DRGs are placed and the relative price paid for patients across Europe. Method Patients with a procedure of CABG surgery are analysed from Austria, England, Estonia, Finland, France, Germany, Ireland, Poland, Spain and Sweden. Diagrammatic algorithms of DRG structures are presented for each country. The price in Euros of seven typical case vignettes, each made up of a set of a hypothetical patient’s characteristics, is also analysed for each country. In order to enable comparisons across countries the simplest case (index vignette) is taken as baseline and relative price levels are calculated for the other six vignettes, each representing patients with different combinations of procedures and comorbidities. Results European DRG payment structures for CABG surgery vary in terms of the number of different DRGs used and the types of distinctions which define patient categorisation. Based on the payments given to hospitals in different countries, the most resource intensive patient, relative to the index vignette, ranges in magnitude from 1.37 in Poland to 2.82 in Ireland. There is also considerable variation in how much different systems pay for particular circumstances, such as the occurrence of catheterisation or presence of comorbidity. Conclusion Past experience of the construction of DRG systems for CABG patients demonstrates the variety of options available. It also highlights the importance of updating systems as frequently as possible, to incentivise best practice. PMID:24949279

  2. Comparing the Effects of Morphine Sulfate and Diclofenac Suppositories on Postoperative Pain in Coronary Artery Bypass Graft Patients

    PubMed Central

    Imantalab, Vali; Mirmansouri, Ali; Sedighinejad, Abbas; Naderi Nabi, Bahram; Farzi, Farnoush; Atamanesh, Hadi; Nassiri, Nassir

    2014-01-01

    Background: Simple and efficient way of pain management after Coronary Artery Bypass Graft (CABG) surgery is an important aspect of patients' care. Objectives: This study aimed to compare the effects of morphine and diclofenac suppositories on postoperative pain management. Patients and Methods: In this double-blinded clinical trial study, 120 patients aged 30-65 years old, undergone CABG, were equally divided into two groups of A (morphine) and B (diclofenac). All patients were anesthetized with intravenous fentanyl 10 ?g/kg, etomidate 0.2 mg/kg and cisatracurium 0.2 mg/kg. Anesthesia was maintained with oxygen 50% and air 50%, propofol 50 ?g/kg/min, fentanyl 1-2 ?g/kg/h and atracurium 0.6 mg/kg/h. Analgesics were administered after the operation at intensive care unit (ICU) and Visual Analogue Score (VAS) was evaluated in both groups in 4-hour intervals after extubation for 24 hours. After extubation in case of VAS > 3, morphine suppository 10 mg (group A) or diclofenac suppository 50 mg (group B) was administered for patients. Results: No significant statistical relationship was found between the two groups regarding gender, age, BMI, paracetamol consumption, length of operation time, cardiopulmonary bypass pump (CPB) time, and stay time at ICU (P Value ? 0.05). Total dosage of used morphine was 22 ± 8.3 mg in each patient and total dosage of used diclofenac was 94 ± 32.01 mg. Average variation of VAS at measured intervals was significant (P Value ? 0.0001), but these variations were not significantly different when comparing the two groups (P Value = 0.023). Conclusions: Both morphine and diclofenac suppositories reduced pain significantly and similarly after CABG surgery. PMID:25346897

  3. Poor Sleep Quality in Patients after Coronary Artery Bypass Graft Surgery: An Intervention Study Using the PRECEDE-PROCEED Model

    PubMed Central

    Ranjbaran, Soheila; Dehdari, Tahereh; Sadeghniiat-Haghighi, Khosro; Majdabadi, Mahmood Mahmoodi

    2015-01-01

    Abstract Background: Poor sleep quality (SQ) is common among patients after coronary artery bypass graft surgery (CABG). This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG. Methods: This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifestyle training plus designed intervention based on the PRECEDE-PROCEED model) or to the control group (recipient of exercise and lifestyle training). Eight training sessions over 8 weeks were conducted for the intervention group. Predisposing, enabling, and reinforcing factors as well as social support and SQ were measured in the intervention group before and one month after the intervention and compared to those in the control group at the same time points. Results: The mean age of the patients in the intervention (24% women) and control (24% women) groups was 59.3 ± 7.3 and 59.5 ± 9.3 years, respectively. The results showed that the mean scores of SQ (p value < 0.001), knowledge (p value < 0.001), beliefs (p value < 0.001), sleep self-efficacy (p value < 0.001), enabling factors (p value < 0.001), reinforcing factors (p value < 0.001), and social support (p value < 0.001) were significantly different between the intervention and control groups after the intervention. Conclusion: Adding an intervention based on the PRECEDE-PROCEED model to the cardiac rehabilitation program may further improve the SQ of patients. PMID:26157457

  4. Numerical investigation of haemodynamics in a helical-type artery bypass graft using non-Newtonian multiphase model.

    PubMed

    Wen, Jun; Liu, Kai; Khoshmanesh, Khashayar; Jiang, Wentao; Zheng, Tinghui

    2015-01-01

    The classic single-phase Newtonian blood flow model ignores the motion of red blood cells (RBCs) and their interaction with plasma. To address these issues, we adopted a multiphase non-Newtonian model to carry out a comparative study between a helical artery bypass graft (ABG) and a conventional ABG in which the blood flow is composed of plasma and RBCs. The investigation focused on the mechanism of RBC buildup in an ABG but the haemodynamic parameters obtained by single-phase and multiphase models were also compared. The aggregation of RBCs along the inside wall of a conventional ABG and at the heel of its distal anastomosis was predicted while a poor aggregation was observed along the helical ABG. In addition, RBCs were observed to gradually sediment along the gravity direction. However, the computed haemodynamic parameters by multiphase model qualitatively agreed well with those by single-phase model. It was concluded that (1) the single-phase computational fluid dynamics (CFD) is reasonable to do the computation of haemodynamic parameters in ABGs; (2) secondary flow does not definitely produce buildup of RBCs in the inside curvature, its configuration played an important role in the movement of RBCs and the dominating one-way rotating flow in a helical ABG guaranteed no buildup of RBCs on its inside wall and (3) gravity direction is important for the movement of RBCs which may help to explain why doing exercise is good for human health. This study helps to shed light on the migration of RBCs in ABGs, which cannot be explored by single-phase CFD models, and provides more understanding of the underlying flow mechanism for ABG failure. PMID:24156553

  5. Shrunken Pore Syndrome is associated with a sharp rise in mortality in patients undergoing elective coronary artery bypass grafting.

    PubMed

    Dardashti, Alain; Nozohoor, Shahab; Grubb, Anders; Bjursten, Henrik

    2016-02-01

    Shrunken Pore Syndrome was recently suggested for the pathophysiologic state in patients characterized by an estimation of their glomerular filtration rate (GFR) based upon cystatin??C, which is lower or equal to 60% of their estimated GFR based upon creatinine, i.e. when eGFRcystatin??C???60% of eGFRcreatinine. Not only the cystatin??C level, but also the levels of other low molecular mass proteins are increased in this condition. The preoperative plasma levels of cystatin??C and creatinine were measured in 1638 patients undergoing elective coronary artery bypass grafting. eGFRcystatin??C and eGFRcreatinine were calculated using two pairs of estimating equations, CAPA and LMrev, and CKD-EPIcystatin??C and CKD-EPIcreatinine, respectively. The Shrunken Pore Syndrome was present in 2.1% of the patients as defined by the CAPA and LMrev equations and in 5.7% of the patients as defined by the CKD-EPIcystatin??C and CKD-EPIcreatinine equations. The patients were studied over a median follow-up time of 3.5 years (2.0-5.0 years) and the mortality determined. Shrunken Pore Syndrome defined by both pairs of equations was a strong, independent, predictor of long-term mortality as evaluated by Cox analysis and as illustrated by Kaplan-Meier curves. Increased mortality was observed also for the subgroups of patients with GFR above or below 60 mL/min/1.73 m(2). Changing the cut-off level from 60 to 70% for the CAPA and LMrev equations increased the number of patients with Shrunken Pore Syndrome to 6.5%, still displaying increased mortality. PMID:26647957

  6. Influence of Chronic Kidney Disease on Physical Function and Quality of Life in Patients after Coronary Artery Bypass Grafting

    PubMed Central

    Kuo, Yueh-Ting; Chiu, Kuan-Ming; Tsang, Yuk-Ming; Chiu, Cheng-Ming; Chien, Meng-Yueh

    2015-01-01

    Aims The purposes of this study were (1) to compare body composition, physical function, and quality of life (QOL) between patients after coronary artery bypass grafting (CABG) with and without chronic kidney disease (CKD) and (2) to analyze the factors associated with physical function and QOL domains in these patients. Methods Thirty male post-CABG patients with CKD and 30 matched controls were recruited. All subjects underwent dual-energy X-ray absorptiometry for body composition evaluation. Physical function tests included the grip strength test, 30-second chair stand test (30CST), and 6-min walk test (6MWT). Physical activity and QOL were assessed using the long form of the International Physical Activity Questionnaire and the World Health Organization Quality of Life Instrument (WHOQOL)-BREF, respectively. Results Post-CABG patients with CKD exhibited a lower arm lean mass and higher percent leg fat mass than those without CKD (p < 0.05). The patients with CKD also had lower 30CST scores, 6MWT distances, and QOL domain of social relationships scores than those without CKD after adjusting for covariates (p < 0.05). If NYHA class was considered in the model, NYHA class became the most important factor associated with 6MWT distances (? = ?0.647, p < 0.001) and the QOL domains of psychological health (? = ?0.285, p = 0.027) and environment (? = ?0.406, p = 0.001). Conclusion Post-CABG patients with CKD had worse body composition, physical function, and QOL than those without CKD, and this might be associated with a worse NYHA class. PMID:26648940

  7. The Relationships between Fatigue and Early Postoperative Recovery Outcomes Over Time in Elderly Coronary Artery Bypass Graft (CABG) Surgery Patients

    PubMed Central

    Barnason, Susan; Zimmerman, Lani; Nieveen, Janet; Schulz, Paula; Miller, Connie; Hertzog, Melody; Rasmussen, Doris

    2008-01-01

    BACKGROUND Despite successful coronary artery bypass graft (CABG) surgery, some patients continue to experience fatigue following their surgery. OBJECTIVE The purpose of this secondary analysis study was to examine the relationships of fatigue and early recovery outcomes (psychosocial and physiological functioning, and physical activity) over time (6-weeks and 3-months) among older adult subjects, age 65 years and older, following CABG surgery. Comparison groups were those subjects who had fatigue at 3-weeks after surgery and non-fatigued subjects. DESIGN A prospective, comparative design was used for this secondary analysis study. SAMPLE Subjects in this study were drawn from the control group of subjects enrolled in the larger, parent study. Subjects (N=119) were dichotomized into fatigue (n=66) and non-fatigued (n=53) groups based on their 3-week self-report of postoperative fatigue. RESULTS At 6-weeks after surgery, fatigued subjects had significantly (p<.05) more impaired psychosocial functioning, [role-emotional (t=1.9), social (t=2.6), and mental (t=1.9) functioning], based Medical Outcome Study short form-36 (MOS SF-36). They had significantly (p<.005) higher anxiety (t= ?3.6) and depression (t= ?2.9) mean Hospital Anxiety and Depression subscale (HADS) scores. Anxiety (t= ?2.3, p<.05) remained significantly (p<.05) impaired at 3-months. At 6-weeks, role physical functioning, measured by the MOS SF-36, was significantly impaired (t=2.4, p<.01). There were no significant differences in physical activity variables as measured by a RT3® accelerometer and self-report diary. CONCLUSIONS Persistent fatigue can hamper early recovery following CABG surgery. Tailored interventions are needed to address fatigue management and improve patient outcomes. PMID:18620100

  8. Various clinical scenarios leading to development of the string sign of the internal thoracic artery after coronary bypass surgery: the role of competitive flow, a case series

    PubMed Central

    2012-01-01

    Background The left internal mammary artery (LIMA) is the choice for grafting of the left anterior descending coronary artery (LAD). One possible mechanism of the rare graft failure involve the presence of competitive flow. Method 105 patients who had undergone coronary bypass grafting between 1998 and 2000 were included in this observational study. The recatheterizations were performed 28 months after the operations. The rate of patency the LIMA grafts was determined, and the cases with graft failure were analyzed. Results The LIMA graft was patent in 99 patients (94%). Six patients (6%) exhibited diffuse involution of the graft (string sign). The string sign was always associated with competitive flow as the basis of the LIMA graft involution. In one case quantitative re-evaluation of the preoperative coronary angiography revealed merely less than 50% diameter stenosis on the LAD with a nonligated side-branch of the LIMA. At recatheterization in two patients the pressure wire measurements demonstrated only a non-significant decrease of the fractional flow reserve (0.83 and 0.89), despite the 53% and 57% diameter stenosis in the angiogram. Another patient displayeda significant regression of the LAD lesion between the pre- and postoperative coronary angiography (from 76% to 44%) as the cause of the development of the competitive flow. In one instance, a radial artery graft on the LAD during a redo bypass operation resulted in competitive flow in the radial graft due to the greater diameter than that of the LIMA. In a further patient, competitive flow developed from a short sequential part of the LIMA graft between the nonsignificantly stenosed diagonal branch and the LAD, with involution of the main part of the graft to the diagonal branch. Conclusions The most common cause of the development of the string sign of a LIMA graft due to competitive flow is overassessment of the lesion of the LAD. Regression of a previous lesion or some other neighboring graft can also cause the phenomenon. PMID:22289632

  9. Effects of single antegrade hot shot in comparison with no hot shot administration during coronary artery bypass grafting

    PubMed Central

    Mirmohammadsadeghi, Pouya; Mirmohammadsadeghi, Mohsen

    2015-01-01

    BACKGROUND Superior results will be achieved from cardiac surgery by minimizing the effect of ischemia/reperfusion injury during cross-clamping of the aorta. Different cardioplegia solutions have been introduced, but the optimum one is still ambiguous. The aim of this study is to determine the effect of single antegrade hot shot terminal warm blood cardioplegia (TWBC) on patients who had undergone coronary artery bypass grafting (CABG). METHODS In total, 2488 patients who had CABG surgery in Sina Hospital, Isfahan, Iran, from 2003 to 2011 were enrolled in this case-control study. They were divided into two groups, those who received cold cardioplegia only and those who received a hot shot following cold cardioplegia. Demographics, and clinical data, such as; premature atrial contraction (PAC) arrhythmia, diabetes treatment, and left ventricular ejection fraction (EF), were collected and logistic regression analysis was used to analyze the data. RESULTS There were significant differences found between subjects receiving antegrade hot shot based on direct current (DC) shocks, with regard to; female, EF levels, diabetes treatment (P < 0.050). Those who did not receive the hot shot and were not diabetic received more DC shock (P = 0.019). The prevalence of subjects who did no need DC shock was significantly higher among male subjects who had good EF and acceptable diabetic treatment. Multiple logistic regression showed that PAC arrhythmia did not have a significant effect on receiving DC shock during CAGB [0.84 (0.25, 2.85), (P = 0.780)]. Having poor EF increased the risk of receiving DC shock among subjects by 2.81 [(1.69, 4.69), (P ? 0.001)] (P < 0.001). Among the diabetic subjects, receiving insulin decreased the risk of receiving DC shock by 0.54 (0.29, 0.98) (P = 0.042). CONCLUSION It was concluded that single antegrade hot shot following cold cardioplegia was not particularly effective in the CABG group. TWBC will decrease the need for DC shock. PMID:26405451

  10. Potential Effect of L-Carnitine on the Prevention of Myocardial Injury after Coronary Artery Bypass Graft Surgery

    PubMed Central

    Dastan, Farzaneh; Hajhossein Talasaz, Azita; Mojtahedzadeh, Mojtaba; Karimi, Abbasali; Salehiomran, Abbas; Bina, Payvand; Jalali, Arash; Aghaie, Zahra

    2015-01-01

    Background: L-carnitine has been demonstrated to confer cardiac protection against ischemia reperfusion injury in animals. This study evaluates the effects of L-carnitine administration on cardiac biomarkers after coronary artery bypass graft (CABG) surgery. Methods: One hundred thirty-four patients undergoing elective CABG surgery, without a history of myocardial ischemia or previous L-carnitine treatment, were enrolled and randomly assigned to an L-carnitine group ([n = 67], 3000 mg/d, started 2 days preoperatively and continued for 2 days after surgery) or a control group (n = 67). CK-MB (creatine kinase, muscle-brain subunits) and troponin T (TnT) levels were assessed in all the patients before surgery as baseline levels and at 8 and 24 hours postoperatively. Results: Our study included 134 patients (99 [73.8%] males) at a mean ± SD age of 59.94 ± 8.61 years who were candidates for CABG and randomized them into control or L-carnitine groups. The baseline demographic characteristics, including age (60.01 ± 9.23 in the L-carnitine group vs. 59.88 ± 7.98 in the control group) and sex (54 [80.6%] in the L-carnitine group vs. 45 [67.2%] in the control group) did not show any significant differences (p value=0.93 and 0.08, respectively). Patients in the L-carnitine group had lower levels of CK-MB (mean ± SD, 25.06 ± 20.29 in the L-carnitine group vs. 24.26 ± 14.61 in the control group), but the difference was not significant (p value = 0.28). TnT levels also showed no significant differences between the two groups (399.50 ± 378.91 in the L-carnitine group vs. 391.48 ± 222.02 in the control group; p value = 0.34). Conclusion: In this population of intermediate- to high-risk patients undergoing CABG surgery, L-carnitine did not reduce CK-MB and TnT levels. PMID:26110005

  11. Perioperative elafin for ischaemia-reperfusion injury during coronary artery bypass graft surgery: a randomised-controlled trial

    PubMed Central

    Alam, S R; Lewis, S C; Zamvar, V; Pessotto, R; Dweck, M R; Krishan, A; Goodman, K; Oatey, K; Harkess, R; Milne, L; Thomas, S; Mills, N M; Moore, C; Semple, S; Wiedow, O; Stirrat, C; Mirsadraee, S; Newby, D E; Henriksen, P A

    2015-01-01

    Background Elafin is a potent endogenous neutrophil elastase inhibitor that protects against myocardial inflammation and injury in preclinical models of ischaemic-reperfusion injury. We investigated whether elafin could inhibit myocardial ischaemia-reperfusion injury induced during coronary artery bypass graft (CABG) surgery. Methods and results In a randomised double-blind placebo-controlled parallel group clinical trial, 87 patients undergoing CABG surgery were randomised 1:1 to intravenous elafin 200?mg or saline placebo administered after induction of anaesthesia and prior to sternotomy. Myocardial injury was measured as cardiac troponin I release over 48?h (area under the curve (AUC)) and myocardial infarction identified with MRI. Postischaemic inflammation was measured by plasma markers including AUC high-sensitive C reactive protein (hs-CRP) and myeloperoxidase (MPO). Elafin infusion was safe and resulted in >3000-fold increase in plasma elafin concentrations and >50% inhibition of elastase activity in the first 24?h. This did not reduce myocardial injury over 48?h (ratio of geometric means (elafin/placebo) of AUC troponin I 0.74 (95% CI 0.47 to 1.15, p=0.18)) although post hoc analysis of the high-sensitive assay revealed lower troponin I concentrations at 6?h in elafin-treated patients (median 2.4 vs 4.1??g/L, p=0.035). Elafin had no effect on myocardial infarction (elafin, 7/34 vs placebo, 5/35 patients) or on markers of inflammation: mean differences for AUC hs-CRP of 499?mg/L/48 h (95% CI ?207 to 1205, p=0.16), and AUC MPO of 238?ng/mL/48 h (95% CI ?235 to 711, p=0.320). Conclusions There was no strong evidence that neutrophil elastase inhibition with a single-dose elafin treatment reduced myocardial injury and inflammation following CABG-induced ischaemia-reperfusion injury. Trial registration number (EudraCT 2010-019527-58, ISRCTN82061264). PMID:26310261

  12. Predicting target vessel location on robot-assisted coronary artery bypass graft using CT to ultrasound registration

    SciTech Connect

    Cho, Daniel S.; Linte, Cristian; Chen, Elvis C. S.; Bainbridge, Daniel; Wedlake, Chris; Moore, John; Barron, John; Patel, Rajni; Peters, Terry

    2012-03-15

    Purpose: Although robot-assisted coronary artery bypass grafting (RA-CABG) has gained more acceptance worldwide, its success still depends on the surgeon's experience and expertise, and the conversion rate to full sternotomy is in the order of 15%-25%. One of the reasons for conversion is poor pre-operative planning, which is based solely on pre-operative computed tomography (CT) images. In this paper, the authors propose a technique to estimate the global peri-operative displacement of the heart and to predict the intra-operative target vessel location, validated via both an in vitro and a clinical study. Methods: As the peri-operative heart migration during RA-CABG has never been reported in the literatures, a simple in vitro validation study was conducted using a heart phantom. To mimic the clinical workflow, a pre-operative CT as well as peri-operative ultrasound images at three different stages in the procedure (Stage{sub 0}--following intubation; Stage{sub 1}--following lung deflation; and Stage{sub 2}--following thoracic insufflation) were acquired during the experiment. Following image acquisition, a rigid-body registration using iterative closest point algorithm with the robust estimator was employed to map the pre-operative stage to each of the peri-operative ones, to estimate the heart migration and predict the peri-operative target vessel location. Moreover, a clinical validation of this technique was conducted using offline patient data, where a Monte Carlo simulation was used to overcome the limitations arising due to the invisibility of the target vessel in the peri-operative ultrasound images. Results: For the in vitro study, the computed target registration error (TRE) at Stage{sub 0}, Stage{sub 1}, and Stage{sub 2} was 2.1, 3.3, and 2.6 mm, respectively. According to the offline clinical validation study, the maximum TRE at the left anterior descending (LAD) coronary artery was 4.1 mm at Stage{sub 0}, 5.1 mm at Stage{sub 1}, and 3.4 mm at Stage{sub 2}. Conclusions: The authors proposed a method to measure and validate peri-operative shifts of the heart during RA-CABG. In vitro and clinical validation studies were conducted and yielded a TRE in the order of 5 mm for all cases. As the desired clinical accuracy imposed by this procedure is on the order of one intercostal space (10-15 mm), our technique suits the clinical requirements. The authors therefore believe this technique has the potential to improve the pre-operative planning by updating peri-operative migration patterns of the heart and, consequently, will lead to reduced conversion to conventional open thoracic procedures.

  13. A case of left main coronary artery disease in an octogenarian treated surgically and complicated by myocardial infarction: decisions, techniques, rescue and final outcome.

    PubMed

    Kossaify, Antoine; Grollier, Gilles

    2013-01-01

    We report on an octogenarian patient presenting with an acute coronary syndrome due to significant left main coronary artery disease and severe ostial stenosis of the left anterior descending artery disease. Emergent bypass graft performed with "beating heart" consisted of left internal mammary graft to the mid left anterior descending artery with an "over-stent" anastomosis. The immediate post-operative phase was simple, however the patient presented on post-operative day 8 with extensive anterior myocardial infarction and cardiogenic shock. Emergent coronary angiogram showed subocclusive anastomotic stenosis. Percutaneous coronary intervention was performed on left main, proximal left anterior descending, and proximal circumflex arteries. Subsequently, the patient restored a satisfactory hemodynamic condition. A focus on the importance of decision for management of left main disease especially in octogenarian is presented, along with a review of the pertinent literature. PMID:23641159

  14. Flow and wall shear stress in end-to-side and side-to-side anastomosis of venous coronary artery bypass grafts

    PubMed Central

    Frauenfelder, Thomas; Boutsianis, Evangelos; Schertler, Thomas; Husmann, Lars; Leschka, Sebastian; Poulikakos, Dimos; Marincek, Borut; Alkadhi, Hatem

    2007-01-01

    Purpose Coronary artery bypass graft (CABG) surgery represents the standard treatment of advanced coronary artery disease. Two major types of anastomosis exist to connect the graft to the coronary artery, i.e., by using an end-to-side or a side-to-side anastomosis. There is still controversy because of the differences in the patency rates of the two types of anastomosis. The purpose of this paper is to non-invasively quantify hemodynamic parameters, such as mass flow and wall shear stress (WSS), in end-to-side and side-to-side anastomoses of patients with CABG using computational fluid dynamics (CFD). Methods One patient with saphenous CABG and end-to-side anastomosis and one patient with saphenous CABG and side-to-side anastomosis underwent 16-detector row computed tomography (CT). Geometric models of coronary arteries and bypasses were reconstructed for CFD analysis. Blood flow was considered pulsatile, laminar, incompressible and Newtonian. Peri-anastomotic mass flow and WSS were quantified and flow patterns visualized. Results CFD analysis based on in-vivo CT coronary angiography data was feasible in both patients. For both types of CABG, flow patterns were characterized by a retrograde flow into the native coronary artery. WSS variations were found in both anastomoses types, with highest WSS values at the heel and lowest WSS values at the floor of the end-to-side anastomosis. In contrast, the highest WSS values of the side-to-side anastomosis configuration were found in stenotic vessel segments and not in the close vicinity of the anastomosis. Flow stagnation zones were found in end-to-side but not in side-to-side anastomosis, the latter also demonstrating a smoother stream division throughout the cardiac cycle. Conclusion CFD analysis of venous CABG based on in-vivo CT datasets in patients was feasible producing qualitative and quantitative information on mass flow and WSS. Differences were found between the two types of anastomosis warranting further systematic application of the presented methodology on multiple patient datasets. PMID:17897460

  15. Sleep Quality and Emotional Correlates in Taiwanese Coronary Artery Bypass Graft Patients 1 Week and 1 Month after Hospital Discharge: A Repeated Descriptive Correlational Study

    PubMed Central

    Yang, Pei-Lin; Huang, Guey-Shiun; Tsai, Chien-Sung; Lou, Meei-Fang

    2015-01-01

    Background Poor sleep quality is a common health problem for coronary artery bypass graft patients, however few studies have evaluated sleep quality during the period immediately following hospital discharge. Purpose The aim of this study was to investigate changes in sleep quality and emotional correlates in coronary artery bypass graft patients in Taiwan at 1 week and 1 month after hospital discharge. Methods We used a descriptive correlational design for this study. One week after discharge, 87 patients who had undergone coronary artery bypass surgery completed two structured questionnaires: the Pittsburgh Sleep Quality Index and the Hospital Anxiety and Depression Scale. Three weeks later (1 month after discharge) the patients completed the surveys again. Pearson correlations, t-tests, ANOVA and linear multiple regression analysis were used to analyze the data. Results A majority of the participants had poor sleep quality at 1 week (82.8%) and 1 month (66.7%) post-hospitalization, based on the global score of the Pittsburgh Sleep Quality Index. Despite poor sleep quality at both time-points the sleep quality at 1 month was significantly better than at 1-week post hospitalization. Poorer sleep quality correlated with older age, poorer heart function, anxiety and depression. The majority of participants had normal levels of anxiety at 1 week (69.0%) and 1 month (88.5%) as measured by the Hospital Anxiety and Depression Scale. However, some level of depression was seen at 1 week (78.1%) and 1 month (59.7%). Depression was a significant predictor of sleep quality at 1 week; at 1 month after hospital discharge both anxiety and depression were significant predictors of sleep quality. Conclusion Sleep quality, anxiety and depression all significantly improved 1 month after hospital discharge. However, more than half of the participants continued to have poor sleep quality and some level of depression. Health care personnel should be encouraged to assess sleep and emotional status in patients after coronary artery bypass surgery and offer them appropriate management strategies to improve sleep and reduce anxiety and depression. PMID:26291524

  16. Compliant electrospun silk fibroin tubes for small vessel bypass grafting.

    PubMed

    Marelli, Benedetto; Alessandrino, Antonio; Farè, Silvia; Freddi, Giuliano; Mantovani, Diego; Tanzi, Maria Cristina

    2010-10-01

    Processing silk fibroin (SF) by electrospinning offers a very attractive opportunity for producing three-dimensional nanofibrillar matrices in tubular form, which may be useful for a biomimetic approach to small calibre vessel regeneration. Bypass grafting of small calibre vessels, with a diameter less than 6mm, is performed mainly using autografts, like the saphenous vein or internal mammary artery. At present no polymeric grafts made of SF are commercially available, mainly due to inadequate properties (low compliance and lack of endothelium cells). The aim of this work was to electrospin SF into tubular structures (Ø=6mm) for small calibre vessel grafting, characterize the morphological, chemico-physical and mechanical properties of the electrospun SF structures and to validate their potential to interact with cells. The morphological properties of electrospun SF nanofibres were investigated by scanning electron microscopy. Chemico-physical analyses revealed an increase in the crystallinity of the structure of SF nanofibres on methanol treatment. Mechanical tests, i.e. compliance and burst pressure measurements, of the electrospun SF tubes showed that the inner pressure to radial deformation ratio was linear for elongation up to 15% and pressure up to 400 mm Hg. The mean compliance value between 80 and 120 mm Hg was higher than the values reported for both Goretex(R) and Dacron(R) grafts and for bovine heterografts, but still slightly lower than those of saphenous and umbilical vein, which nowadays represent the gold standard for the replacement of small calibre arteries. The electrospun tubes resisted up to 575+/-17 mmHg, which is more than four times the upper physiological pressure of 120 mmHg and more than twice the pathological upper pressures (range 180-220 mmHg). The in vitro tests showed a good cytocompatibility of the electrospun SF tubes. Therefore, the electrospun SF tubes developed within this work represent a suitable candidate for small calibre blood vessel replacement. PMID:20466080

  17. Effect of anti-platelet factor-4/heparin antibody induction on early saphenous vein graft occlusion after coronary artery bypass surgery

    PubMed Central

    GLUCKMAN, T. J.; SEGAL, J. B.; SCHULMAN, S. P.; SHAPIRO, E. P.; KICKLER, T. S.; PRECHEL, M. M.; CONTE, J. V.; WALENGA, J. M.; SHAFIQUE, I.; RADE, J. J.

    2010-01-01

    Summary Background Antibodies to complexes of heparin and platelet factor 4 (PF4) are capable of causing heparin-induced thrombocytopenia (HIT). Recent evidence suggests that anti-PF4/heparin antibodies may be prothrombogenic even in the absence of thrombocytopenia and clinically-recognized HIT. Objectives To determine if induction of anti-PF4/heparin antibodies is an independent risk factor for early saphenous vein graft (SVG) occlusion or adverse clinical outcome after coronary artery bypass graft (CABG) surgery. Patients/Methods Anti-PF4/heparin antibody titers were measured in 368 patients prior to and then 4 days, 6 weeks and 6 months after CABG surgery. Serotonin release assay (SRA) and antibody isotype analysis were also performed on 6-week samples. SVG patency was determined in 297 patients 6 months after surgery by multidetector computed tomography coronary angiography. Results Six weeks after surgery, 52% of patients were anti-PF4/heparin seropositive and 9% were SRA positive. Six months after surgery, neither the percentage of occluded SVG (19% vs. 20%, P = NS), the percentage of patients with an occluded SVG (33% vs. 33%, P = NS) nor the incidence of adverse clinical events (21% vs. 24%, P = NS) differed between seropositive and seronegative groups. Neither IgG isotype nor SRA positivity was additionally predictive of SVG occlusion or adverse clinical outcome. Conclusion Induction of anti-PF4/heparin antibodies, even those capable of heparin-dependent platelet activation, is not independently associated with early SVG occlusion or adverse clinical outcomes after CABG surgery. PMID:19552638

  18. Implantation of transcatheter aortic valve prosthesis through the ascending aorta concomitant with coronary artery bypass grafting without cardiopulmonary bypass

    PubMed Central

    Leal, João Carlos Ferreira; Avanci, Luis Ernesto; Abelaira Filho, Achilles; Almeida, Thiago Faria; Braile, Domingo Marcolino

    2014-01-01

    Introdution The transcatheter aortic valve implantation in the treatment of high-risk symptomatic aortic stenosis has increased the number of implants every year. The learning curve for transcatheter aortic valve implantation has improved since the last 12 years, allowing access alternatives. Objective The aim of this study is to approach the implantation of transcatheter aortic valve through transaortic via associated with off-pump cardiopulmonary bypass surgery in a 67-year-old man, with chronic obstructive pulmonary disease, arterial hypertension and kidney transplant. Methods Off-pump coronary artery bypass surgery was performed and the valve in the aortic position was released successfully. Results There were no complications in the intraoperative and postoperative period. Gradient reduction, effective orifice increasing of the prosthesis and absence of valvular regurgitation after implantation were observed by transesophageal echocardiography. Conclusion Procedural success demonstrates that implantation of transcatheter aortic valve through the ascending aorta associated with coronary artery bypass surgery without CPB is a new option for these patients. PMID:25714221

  19. Neurological Complications Comparing Endoscopically vs. Open Harvest of the Radial Artery

    ClinicalTrials.gov

    2015-02-28

    Complications Due to Coronary Artery Bypass Graft; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Heart Diseases; Cardiovascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases

  20. [The use of the Export Catheter device in a patient with acute myocardial infarction for thrombotic occlusion of the venous graft on the left anterior descending coronary artery: a case report].

    PubMed

    Romano, Michele; Buffoli, Francesca; Lettieri, Corrado; Rosiello, Renato; Aroldi, Marco; Kuwornu, Helène; Tomasi, Luca; Baccaglioni, Nicola; Zanini, Roberto

    2005-06-01

    Coronary angioplasty, eventually followed by stent implantation, represents the gold standard of acute myocardial infarction (AMI) treatment. Optimal reperfusion implies both patency of the infarct-related artery and a good myocardial microrevascularization with normal tissue reperfusion. The so called no-reflow phenomenon mainly occurs in the presence of highly thrombotic lesions, especially during primary angioplasty and it represents a negative prognostic factor of the outcome of AMI patients treated with angioplasty. A 77-year-old high-risk male patient, previous coronary artery bypass graft with the saphenous vein graft to the left anterior descending coronary artery for post-AMI angina in 1984, aided by 118 ambulance for anterior AMI was admitted to our cath-lab for primary coronary angioplasty. During the transport he was given aspirin i.v. 300 mg, heparin 5000 IU and abciximab (9.4 ml bolus plus infusion for 12 hours). The time of treatment (from symptom onset to first inflation) was about 90 min. Coronary angiography showed a massive thrombus occlusion of the vein graft with TIMI 0 distal flow. We employed the Export Catheter for mechanical aspiration of the occluding thrombus. The procedure was completed with direct stent implantation with good angiographic outcome. The use of thrombus aspiration and protection devices (filters or occlusive balloons) associated or not with the use of glycoprotein IIb/IIIa receptor blockers, has reduced the risk of distal embolization and of no-reflow phenomenon. PMID:16013434

  1. Time-driven activity-based costing of multivessel coronary artery bypass grafting across national boundaries to identify improvement opportunities: study protocol

    PubMed Central

    Erhun, F; Mistry, B; Platchek, T; Milstein, A; Narayanan, V G; Kaplan, R S

    2015-01-01

    Introduction Coronary artery bypass graft (CABG) surgery is a well-established, commonly performed treatment for coronary artery disease—a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32?201±$23?059. The same operation reportedly costs less than $2000 to produce in India. The goals of the proposed study are to (1) identify the difference in the costs incurred to perform CABG surgery by three Joint Commission accredited hospitals with reputations for high quality and efficiency and (2) characterise the opportunity to reduce the cost of performing CABG surgery. Methods and analysis We use time-driven activity-based costing (TDABC) to quantify the hospitals’ costs of producing elective, multivessel CABG. TDABC estimates the costs of a given clinical service by combining information about the process of patient care delivery (specifically, the time and quantity of labour and non-labour resources utilised to perform each activity) with the unit cost of each resource used to provide the care. Resource utilisation was estimated by constructing CABG process maps for each site based on observation of care and staff interviews. Unit costs were calculated as a capacity cost rate, measured as a $/min, for each resource consumed in CABG production. Multiplying together the unit costs and resource quantities and summing across all resources used will produce the average cost of CABG production at each site. We will conclude by conducting a variance analysis of labour costs to reveal opportunities to bend the cost curve for CABG production in the USA. Ethics and dissemination All our methods were exempted from review by the Stanford Institutional Review Board. Results will be published in peer-reviewed journals and presented at scientific meetings. PMID:26307621

  2. Transradial Coronary Intervention Versus Coronary Artery Bypass Grafting for Unprotected Left Main and/or Multivessel Disease in Patients With Acute Coronary Syndrome.

    PubMed

    Gao, Fei; Zhou, Yu Jie; Wang, Zhi Jian; Yan, Zhen Xian; Liu, Xiao Li; Shen, Hua

    2016-01-01

    The overall safety and efficacy of transradial coronary intervention (TRI) versus coronary artery bypass grafting (CABG) for patients with unprotected left main (UPLM) disease and/or multivessel coronary disease (MVD) presenting with acute coronary syndrome (ACS) have not been established. Consecutive patients with ACS undergoing TRI with drug-eluting stent (n = 1431) or CABG (n = 651) for UPLM and/or MVD were included. A propensity-score matching was performed to adjust for differences in baseline characteristics between the 2 cohorts, yielding 524 pairs of matched patients. Median clinical follow-up was 32 months. After propensity-score adjustment, no significant difference was observed between the TRI and CABG groups in all-cause mortality (4.0% vs 5.2%; P = .375). Transradial coronary intervention was favored by a significant increase in the incidence of stroke in the CABG group (0.4% vs 1.9%; P = .020), whereas a significantly increased target vessel revascularization rate (16.8% vs 6.3%; P < .0001) observed in the TRI group favored CABG. Composite outcome (death/myocardial infarction/stroke) was comparable between the TRI and the CABG groups (8.0% vs 11.5%; P = .061). Clinical outcomes of TRI on UPLM and/or MVD for patients with ACS are comparable to CABG in composite safety outcomes with the advantage to TRI for avoiding a stroke. PMID:25818105

  3. Proteomic analysis of plasma from patients undergoing coronary artery bypass grafting reveals a protease/antiprotease imbalance in favor of the serpin alpha1-antichymotrypsin.

    PubMed

    Banfi, Cristina; Parolari, Alessandro; Brioschi, Maura; Barcella, Simona; Loardi, Claudia; Centenaro, Chiara; Alamanni, Francesco; Mussoni, Luciana; Tremoli, Elena

    2010-05-01

    We used proteomics to identify systematic changes in the plasma proteins of patients undergoing coronary artery bypass grafting (CABG) by means of cardiopulmonary bypass surgery. It is known that, after CABG, a complex systemic inflammatory responses ensues that favors the occurrence of adverse postoperative complications frequently recognizing inflammation itself and/or thrombosis as the underlying mechanism. We found a marked and persistent postoperative increase in the levels of the serpin-protease inhibitor alpha(1)-antichymotrypsin (alpha(1)-ACT) that fully maintains the inhibitory activity blunting its protease substrate cathepsin G. An intraoperative increase followed by a rapid decline in proteases activation was documented, accompanied by a substantial induction of leucine-rich-alpha-2-glycoprotein, a protein involved in neutrophilic granulocyte differentiation. Finally, a time-dependent alteration in the expression of haptoglobin, transthyretin, clusterin, and apoE was observed. In conclusion, we showed that after CABG, a protease/antiprotease imbalance occurs with early cathepsin G activation and a more delayed increase in alpha(1)-ACT. As cathepsin G is a serpin involved both in inflammation and coagulation activation, this confirms and expands the concept of a marked dysregulation of both inflammatory and hemostatic balances occurring after CABG. The pharmacologic modulation of this imbalance may be a new therapeutic target to reduce postoperative complications. PMID:20302328

  4. Optimism measured pre-operatively is associated with reduced pain intensity and physical symptom reporting after coronary artery bypass graft surgery

    PubMed Central

    Ronaldson, Amy; Poole, Lydia; Kidd, Tara; Leigh, Elizabeth; Jahangiri, Marjan; Steptoe, Andrew

    2014-01-01

    Objective Optimism is thought to be associated with long-term favourable outcomes for patients undergoing coronary artery bypass graft (CABG) surgery. Our objective was to examine the association between optimism and post-operative pain and physical symptoms in CABG patients. Methods We assessed optimism pre-operatively in 197 adults undergoing CABG surgery, and then followed them up 6–8 weeks after the procedure to measure affective pain, pain intensity, and physical symptom reporting directly pertaining to CABG surgery. Results Greater optimism measured pre-operatively was significantly associated with lower pain intensity (? = ? 0.150, CI = ? 0.196 to ? 0.004, p = .042) and fewer physical symptoms following surgery (? = ? 0.287, CI = ? 0.537 to ? 0.036, p = .025), but not with affective pain, after controlling for demographic, clinical and behavioural covariates, including negative affectivity. Conclusions Optimism is a modest, yet significant, predictor of pain intensity and physical symptom reporting after CABG surgery. Having positive expectations may promote better recovery. PMID:25129850

  5. Preoperative factors affecting cost and length of stay for isolated off-pump coronary artery bypass grafting: hierarchical linear model analysis

    PubMed Central

    Shinjo, Daisuke; Fushimi, Kiyohide

    2015-01-01

    Objective To determine the effect of preoperative patient and hospital factors on resource use, cost and length of stay (LOS) among patients undergoing off-pump coronary artery bypass grafting (OPCAB). Design Observational retrospective study. Settings Data from the Japanese Administrative Database. Participants Patients who underwent isolated, elective OPCAB between April 2011 and March 2012. Primary outcome measures The primary outcomes of this study were inpatient cost and LOS associated with OPCAB. A two-level hierarchical linear model was used to examine the effects of patient and hospital characteristics on inpatient costs and LOS. The independent variables were patient and hospital factors. Results We identified 2491 patients who underwent OPCAB at 268 hospitals. The mean cost of OPCAB was $40?665 ±7774, and the mean LOS was 23.4±8.2?days. The study found that select patient factors and certain comorbidities were associated with a high cost and long LOS. A high hospital OPCAB volume was associated with a low cost (?6.6%; p=0.024) as well as a short LOS (?17.6%, p<0.001). Conclusions The hospital OPCAB volume is associated with efficient resource use. The findings of the present study indicate the need to focus on hospital elective OPCAB volume in Japan in order to improve cost and LOS. PMID:26576810

  6. Chlamydophila pneumonia: Specific mRNA in aorta ascendens in patients undergoing coronary artery by-pass grafting.

    PubMed

    Nyström-Rosander, Christina; Edvinsson, Marie; Thelin, Stefan; Hjelm, Eva; Friman, Göran

    2006-01-01

    The objective of this prospective study was to investigate if Chlamydophila pneumoniae (Cp)-specific DNA and mRNA are present in tissue samples from the wall of aorta ascendens in patients undergoing by-pass surgery for coronary artery disease (CAD) that includes stable angina pectoris (SAP, 25 patients) and acute coronary syndrome (ACS, 19 patients). Viable Cp was detected in 8/44 (18%) patients using reversed transcriptase PCR (RT-PCR) against bacterial mRNA with detection of cDNA using real-time PCR against the MOMP gene. Cp DNA was detected by nested PCR in 22/44 (50%) patients and by real-time PCR in 13/44 (30%) patients. In total, 24/44 (55%) patients were positive for Cp nucleic acid in any PCR. Antibodies to Cp were detected in 13/24 (54%) Cp PCR-positive and in 15/20 (75%) Cp PCR-negative patients. Nested PCR was run on throat swabs from all patients. No significant differences were noted between SAP and ACS patients regarding PCR results or serology. It has been suggested that Cp may be a 'silent passenger' picked up by the atherosclerotic plaque. Our findings of viable and metabolically active bacteria in aortic tissue add further support to the hypothesis that Cp may have an active role in the pathogenesis of atherosclerosis. PMID:16938728

  7. The effect of detergent-based decellularization procedures on cellular proteins and immunogenicity in equine carotid artery grafts.

    PubMed

    Böer, Ulrike; Lohrenz, Andrea; Klingenberg, Melanie; Pich, Andreas; Haverich, Axel; Wilhelmi, Mathias

    2011-12-01

    Decellularized equine carotid arteries (dEAC) may represent a reasonable alternative to alloplastic materials in vascular replacement therapy. Acellularity of the matrix is standardly evaluated by DNA quantification what however may not record sufficiently the degree of matrix immunogenicity. Thus, our aim was to analyze dEAC with a low DNA content for residual cellular proteins. A detergent-based decellularization protocol including endonuclease treatment resulted in dEAC with 0.6 ± 0.15 ng DNA/mg dry weight representing 0.33 ± 0.14% of native tissue DNA content. In contrast, when matrices were homogenized and extracted by high detergent concentrations westernblot analyses revealed cytosolic and cytosceleton proteins like GAPDH and smooth muscle actin which were depleted to 4.1 ± 1.9% and 13.8 ± 0.55%, resp. Also putative immunogenic MHC I complexes and the alpha-Gal epitop were reduced to only 14.8 ± 1.2% and 15.1 ± 2.05%. Mass spectrometry of matrix extracts identified 306 proteins belonging to cytosol, organelles, nucleus and cell membrane. Moreover, aqueous matrix extracts evoked a pronounced antibody formation when administered in mice and thus display high immunogenic potential. Our data indicate that an established decellularization protocol which results in acellular matrices evaluated by low DNA content reduces but not eliminates cellular components which may contribute to its immunogenic potential in vivo. PMID:21944468

  8. Comparison of Outcome of Transcatheter Aortic Valve Implantation With Versus Without Previous Coronary Artery Bypass Grafting (from the FRANCE 2 Registry).

    PubMed

    Castellant, Philippe; Didier, Romain; Bezon, Eric; Couturaud, Francis; Eltchaninoff, Hélène; Iung, Bernard; Donzeau-Gouge, Patrick; Chevreul, Karine; Fajadet, Jean; Leprince, Pascal; Leguerrier, Alain; Lievre, Michel; Prat, Alain; Teiger, Emmanuel; Laskar, Marc; Boschat, Jacques; Gilard, Martine

    2015-08-01

    Previous coronary artery bypass grafting (CABG) increases operative risk in conventional valve replacement. Transcatheter aortic valve implantation (TAVI) has been shown to be successful in high-risk patient subgroups. The present study compared outcome and overall survival in patients who underwent TAVI with and without history of CABG. From January 2010 to December 2011, 683 of the 3,761 patients selected for TAVI in 34 French centers (18%) had a history of CABG. Outcomes (mortality and complications) were collected prospectively according to the Valve Academic Research Consortium (VARC) criteria. Patients with previous CABG were younger, with higher rates of diabetes and vascular disease and higher logistic European System for Cardiac Operative Risk Evaluation (29.8 ± 16.4 vs 20.1 ± 13.0, p <0.001) but lower rates of pulmonary disease. Two types of valve (Edwards SAPIEN and Medtronic CoreValve) were implanted in equal proportions in the 2 groups. The 30-day and 1-year mortality rates from all causes on Kaplan-Meier analysis (9.2% vs 9.7%, p = 0.71; and 19.0% vs 20.2%, p = 0.49, respectively) did not differ according to the history of CABG. There were no significant differences in the Valve Academic Research Consortium complications (myocardial infarction, stroke or vascular, and bleeding complications). On multivariate analysis, CABG was not associated with greater 1-year post-TAVI mortality. In conclusion, previous CABG did not adversely affect outcome in patients who underwent TAVI, which may be an alternative to surgery in high-risk patients with severe aortic stenosis and history of CABG. PMID:26071993

  9. Predicting reintubation, prolonged mechanical ventilation and death in post-coronary artery bypass graft surgery: a comparison between artificial neural networks and logistic regression models

    PubMed Central

    Mendes, Renata G.; de Souza, César R.; Machado, Maurício N.; Correa, Paulo R.; Di Thommazo-Luporini, Luciana; Arena, Ross; Myers, Jonathan; Pizzolato, Ednaldo B.

    2015-01-01

    Introduction In coronary artery bypass (CABG) surgery, the common complications are the need for reintubation, prolonged mechanical ventilation (PMV) and death. Thus, a reliable model for the prognostic evaluation of those particular outcomes is a worthwhile pursuit. The existence of such a system would lead to better resource planning, cost reductions and an increased ability to guide preventive strategies. The aim of this study was to compare different methods – logistic regression (LR) and artificial neural networks (ANNs) – in accomplishing this goal. Material and methods Subjects undergoing CABG (n = 1315) were divided into training (n = 1053) and validation (n = 262) groups. The set of independent variables consisted of age, gender, weight, height, body mass index, diabetes, creatinine level, cardiopulmonary bypass, presence of preserved ventricular function, moderate and severe ventricular dysfunction and total number of grafts. The PMV was also an input for the prediction of death. The ability of ANN to discriminate outcomes was assessed using receiver-operating characteristic (ROC) analysis and the results were compared using a multivariate LR. Results The ROC curve areas for LR and ANN models, respectively, were: for reintubation 0.62 (CI: 0.50–0.75) and 0.65 (CI: 0.53–0.77); for PMV 0.67 (CI: 0.57–0.78) and 0.72 (CI: 0.64–0.81); and for death 0.86 (CI: 0.79–0.93) and 0.85 (CI: 0.80–0.91). No differences were observed between models. Conclusions The ANN has similar discriminating power in predicting reintubation, PMV and death outcomes. Thus, both models may be applicable as a predictor for these outcomes in subjects undergoing CABG. PMID:26322087

  10. Predicting emergency coronary artery bypass graft following PCI: application of a computational model to refer patients to hospitals with and without onsite surgical backup

    PubMed Central

    Syed, Zeeshan; Moscucci, Mauro; Share, David; Gurm, Hitinder S

    2015-01-01

    Background Clinical tools to stratify patients for emergency coronary artery bypass graft (ECABG) after percutaneous coronary intervention (PCI) create the opportunity to selectively assign patients undergoing procedures to hospitals with and without onsite surgical facilities for dealing with potential complications while balancing load across providers. The goal of our study was to investigate the feasibility of a computational model directly optimised for cohort-level performance to predict ECABG in PCI patients for this application. Methods Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry data with 69 pre-procedural and angiographic risk variables from 68?022 PCI procedures in 2004–2007 were used to develop a support vector machine (SVM) model for ECABG. The SVM model was optimised for the area under the receiver operating characteristic curve (AUROC) at the level of the training cohort and validated on 42?310 PCI procedures performed in 2008–2009. Results There were 87 cases of ECABG (0.21%) in the validation cohort. The SVM model achieved an AUROC of 0.81 (95% CI 0.76 to 0.86). Patients in the predicted top decile were at a significantly increased risk relative to the remaining patients (OR 9.74, 95% CI 6.39 to 14.85, p<0.001) for ECABG. The SVM model optimised for the AUROC on the training cohort significantly improved discrimination, net reclassification and calibration over logistic regression and traditional SVM classification optimised for univariate performance. Conclusions Computational risk stratification directly optimising cohort-level performance holds the potential of high levels of discrimination for ECABG following PCI. This approach has value in selectively referring PCI patients to hospitals with and without onsite surgery. PMID:26688738

  11. Emotional Processes in Patients Undergoing Coronary Artery Bypass Graft Surgeries with Extracorporeal Circulation in View of Selected Indicators of the Inflammatory Condition

    PubMed Central

    P?otek, W?odzimierz; Pielok, Joanna; Cybulski, Marcin; Samborska, Regina

    2015-01-01

    Background The aim of this study was to describe positive and negative emotions in patients undergoing coronary artery bypass graft (CABG) surgeries with extracorporeal circulation and the correlations between emotions and basic indicators of the inflammatory condition: C-reactive protein (CRP) concentration, body temperature, and leukocyte count. Material/Methods Standardized tools were used to select 52 patients (aged 47–63 years, 6 women – 11.5% and 46 men – 88.5%) without dementia or depression. The Positive and Negative Affect Schedule (PANAS) was used to examine positive affect (PA) and negative affect (NA) and the State-Trait Anxiety Inventory (STAI X1 and X2) was used to examine the anxiety level. The patients underwent CABG surgery according to a common anesthesia protocol and for 5 consecutive days they were observed in the ward, where selected indicators of the inflammatory condition were monitored. Results A detailed description of the results of examinations of emotions was presented. The patients with low PA-trait level, high NA-trait level, and high anxiety-trait level (STAI X2) exhibited statistically significantly higher body temperatures than the other patients in the postoperative period. The patients with high NA-trait and anxiety-state levels (STAI X1) had statistically significantly lower CRP levels in the postoperative period than the patients with low NA-trait and anxiety-state levels (STAI X1). Conclusions Patients undergoing CABG operations express both positive and negative affects. The changes in the inflammatory markers are expressed mostly by CRP concentration. There exist relationships between the result of tests assessing emotions and the markers of the inflammatory condition. PMID:25573296

  12. Intravenous Patient-Controlled Remifentanil Versus Paracetamol in Post-Operative Pain Management in Patients Undergoing Coronary Artery Bypass Graft Surgery

    PubMed Central

    Jahangiri Fard, Alireza; Babaee, Touraj; Alavi, Seyed Mostafa; Nasiri, Ali Akbar; Ghoreishi, Seyed Mohamad Mehran; Noori, Noor Mohammad; Mahjoubifard, Maziar

    2014-01-01

    Background: Pain management after cardiac surgery has been based on parenteral long-acting opioids such as morphine. The other alternatives are paracetamol and remifentanil. Objectives: In this prospective, double-blind, randomized study, we compared the efficacy of intravenous patient-controlled analgesia (IV-PCA) paracetamol and remifentanil for post cardiac surgery pain relief. Materials and Methods: One-hundred patients scheduled for elective coronary artery bypass grafting from May to October 2011, were randomized into two groups after the surgery. For the first group (group R, n = 50, with mean age of 58.16 ± 11.80), the IV-PCA protocol was remifentanil infusion 100 ?g/h; bolus of 25 ?g and lockout time of 15 minutes. In the second group (group P, n = 50, with mean age of 53.8 ± 15.08), patients received paracetamol 15 mg/kg as a bolus at the end of surgery and then IV-PCA protocol was 100 ?g/h, bolus of 25 ?g; and lockout time of 15 minutes. Pain was assessed with visual analog scale score (VAS) in the first 24 hours after surgery for seven times. Results: The trend of pain scores did not have any significantly difference between group R and group P except for hour 8 and hour 18 after surgery that VAS was significantly lower in group P than group R (P = 0.031, P = 0.023, respectively). Respiratory rate (RR) was also statistically lower in group R comparing to group P in all seven evaluating times. The groups were similar in terms of hemodynamic, ABG results (except for PaO2, which was significantly lower in group R than group P at 6 evaluating times), intubation time, renal function tests, and incidences of atelectasis, myocardial infarction or adverse effects. Conclusions: Both PCA techniques provided effective pain scores (< 3) after cardiac surgery; but generally, PCA-paracetamol infusion has a better analgesic effect. PMID:25729675

  13. Evaluation of brain lesions in patients after coronary artery bypass grafting using MRI with the emphasis on susceptibility-weighted imaging

    PubMed Central

    Furmanek, Mariusz Ireneusz; Smaga, El?bieta; Juraszy?ski, Zbigniew; Zieli?ski, Tomasz; Che?stowska, Sylwia; Ku?mierczyk, Mariusz; Szpakowski, Eugeniusz; Mierzy?ska, Anna; Walecki, Jerzy Micha?

    2015-01-01

    Introduction Patients undergoing coronary artery bypass grafting (CABG) are at risk of strokes and neurocognitive disorders. The aim of the study The aim of the study was to assess the clinical utility of susceptibility-weighted imaging (SWI) MRI in detection of new brain lesions in patients after CABG. We assessed the incidence and types of brain lesions and correlated the data with neurological examinations in groups of patients who underwent on-pump and off-pump CABG. Material and methods Patients underwent a neurological examination and MRI before, 6-20 days after and 6 months after the CABG. Fifty-one patients (43 men, mean age 63.12 years) were analyzed. Results Fifteen (29.4%) patients underwent on-pump CABG, 36 (70.6%) off-pump CABG. On postoperative scans new lesions were detected in 12 (23.5%) patients. Ischemic lesions (visible on diffusion-weighted imaging [DWI]) were detected in 4 patients, in 6 lesions were visible on SWI, in 1 case lesions were visible on SWI and DWI. Hemorrhagic stroke was observed in 1 patient. In the group of patients who underwent on-pump CABG, new brain lesions were observed in 60.0% of patients vs. 8.3% of those who underwent off-pump CABG (p < 0.0001); these changes more frequently were multiple (p < 0.0013) and located infratentorially (p < 0.0218). Lesions visible on SWI were observed only in patients undergoing on-pump CABG (p = 0.00005). In all patients (except for 1 with stroke), lesions visible in MRI were clinically silent. Conclusions The use of SWI enables one to detect lesions occurring in the brain after CABG, invisible in other sequences. On-pump CABG is associated with a greater risk of clinically silent brain damage compared to off-pump CABG. PMID:26336470

  14. The protective effect of topical rifamycin treatment against sternal wound infection in diabetic patients undergoing on-pump coronary artery bypass graft surgery

    PubMed Central

    Aygun, Fatih; Kuzgun, Ahmet; Ulucan, Seref; Keser, Ahmet; Akpek, Mahmut; Kaya, Mehmet G

    2014-01-01

    Summary Objectives The aim of this study was to investigate the protective effect of topical rifamycin SV treatment against sternal wound infection (SWI) in diabetic patients undergoing on-pump coronary artery bypass graft (CABG) surgery. Methods One hundred and fifty-nine diabetic patients who were scheduled to undergo isolated on-pump CABG surgery were included. Eight were excluded for various reasons. Of the 151 patients, 51 were on insulin therapy and 100 were on oral anti-diabetics. The risk of mediastinitis was assessed using the American College of Cardiology/American Heart Association 2004 guideline update for CABG surgery. According to the risk scores, patients were divided into two comparable groups: the rifamycin group (n = 78) received topical rifamycin treatment after on-pump CABG surgery, and the control group (n = 73) received no topical treatment. Results Deep sternal wound infection (mediastinitis) was not observed in either group (0/78 vs 0/73, p = 1.0). No superficial sternal wound infection was observed in the rifamycin group, however, it did occur in one patient in the control group (0/78 vs 1/73, p = 0.303). Wound culture was performed and coagulase-negative staphylococci were observed. The infection regressed on initiation of antibiotic therapy against isolated bacteria and the patient was discharged after a full recovery. Conclusion Although the difference in rate of superficial sternal wound infection (SSWI) in the rifamycin and control groups was not statistically significant, locally applied rifamycin SV during closure of the sternum in the CABG operation may have had a protective affect against SWI. PMID:24687038

  15. ApcMin, A Mutation in the Murine Apc Gene, Predisposes to Mammary Carcinomas and Focal Alveolar Hyperplasias

    NASA Astrophysics Data System (ADS)

    Moser, Amy Rapaich; Mattes, Ellen M.; Dove, William F.; Lindstrom, Mary J.; Haag, Jill D.; Gould, Michael N.

    1993-10-01

    ApcMin (Min, multiple intestinal neoplasia) is a point mutation in the murine homolog of the APC gene. Min/+ mice develop multiple intestinal adenomas, as do humans carrying germ-line mutations in APC. Female mice carrying Min are also prone to develop mammary tumors. Min/+ mammary glands are more sensitive to chemical carcinogenesis than are +/+ mammary glands. Transplantation of mammary cells from Min/+ or +/+ donors into +/+ hosts demonstrates that the propensity to develop mammary tumors is intrinsic to the Min/+ mammary cells. Long-term grafts of Min/+ mammary glands also gave rise to focal alveolar hyperplasias, indicating that the presence of the Min mutation also has a role in the development of these lesions.

  16. CT Study of the Relationship Between the Common Iliac Artery and Vein and Their Juxtaposition: Implications for Conduit Construction Prior to Endosvascular Stent-Graft Repair of Aortic Aneurysms

    SciTech Connect

    Lenton, James; Homer-Vanniasinkam, Shervanthi; Kent, Patrick; Nicholson, Tony

    2008-11-15

    The objective of this study was to determine the anatomical relationship and juxtaposition between the common iliac artery and vein in a population of patients with aortic aneurysmal disease and a population clinically and radiologically free of atheroma. It was a retrospective study of 100 consecutive patients undergoing computed tomographic assessment of abdominal aortic aneurysm prior to endovascular or open surgical repair and 100 patients undergoing computed tomographic assessment for other pathologies who did not have clinical or imaging signs of aorto-iliac atheroma. In both groups the anatomical relationship between the right and left iliac artery and vein was studied, and the thickness of the fat plane separating the artery from the vein measured. The right iliac vein was posterolateral to the artery at the level of the common iliac artery bifurcation in 95% of patients in both groups. At the same level the left iliac vein was posterior in 23% (p {<=} 0.001). Eighty-three percent of patients in the aneurysm group had a fat plane between the right artery and vein that measured 0 mm (no visible fat plane = 52%) to 1 mm (= 31%). Ninety-eight percent of patients in the aneurysm group had a measurable fat plane between the left iliac artery and vein of up to 5 mm (p = 0.001). Six percent of the control group demonstrated no visible fat plane between the right iliac artery and vein (p {<=} 0.001), while the fat plane measured more than 1 mm (1-5 mm) on the left in 100%. We conclude that in patients where conduit construction is required for aortic stent-graft access, the anatomical configuration and intimate relationship of the iliac arteries and veins should be assessed and taken into account at CT scan evaluation. The distal right common iliac artery should not be used, as venous damage can be predicted from the anatomical and intimate relationship of the iliac artery and vein at this level in patients with atheroma and the difficulties this relationship presents if venous repair is necessary.

  17. Plasma Levels of MicroRNA-499 Provide an Early Indication of Perioperative Myocardial Infarction in Coronary Artery Bypass Graft Patients

    PubMed Central

    Yao, Youxiu; Du, Juan; Cao, Xiaoqing; Wang, Yang; Huang, Yaohua; Hu, Shengshou; Zheng, Zhe

    2014-01-01

    Background Recent studies indicated that microRNAs (miRNAs, miRs) were important for many biological and pathological processes, and they might be potential biomarkers for cardiovascular diseases. The present study aims to determine the release patterns of miRNAs in cardiac surgery and to analyze the ability of miRs to provide early prediction of perioperative myocardial infarction (PMI) in patients undergoing coronary artery bypass graft (CABG) surgery. Methodology/Principal Findings Thirty on-pump CABG patients were recruited in this study; and miR-499, miR-133a and miR-133b, cardiac troponin I (cTnI) were selected for measurement. Serial plasma samples were collected at seven perioperative time points (preoperatively, and 1, 3, 6, 12, 24, and 48 hours after declamping) and were tested for cTnI and miRs levels. Importantly, miR levels peaked as early as 1–3 hours, whereas cTnI levels peaked at 6 hours after declamping. Peak plasma concentrations of miRs correlated significantly with cTnI (miR-499, r?=?0.583, P?=?0.001; miR-133a, r?=?0.514, P?=?0.006; miR-133b, r?=?0.437, P?=?0.05), indicating the degree of myocardial damage. In addition, 30 off-pump CABG patients were recruited; miR-499 and miR-133a levels were tested, which were significantly lower in off-pump group than in on-pump group. A prospective cohort of CABG patients (n?=?120) was recruited to study the predictive power of miRs for PMI. The diagnosis of PMI strictly adhered to the principles of universal definition of myocardial infarction. The data analysis revealed that miR-499 had higher sensitivity and specificity than cTnI, and indicated that miR-499 could be an independent risk factor for PMI. Conclusion Our results demonstrate that circulating miR-499 is a novel, early biomarker for identifying perioperative myocardial infarction in cardiac surgery. PMID:25111390

  18. The Effect of Reciting the Word “Allah” on Pain Severity After Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial Study in Iran

    PubMed Central

    Nasiri, Morteza; Fayazi, Sadigheh; Ghaderi, Musab; Naseri, Marjan; Adarvishi, Sara

    2014-01-01

    Background: One of the most expressed complains following coronary artery bypass graft (CABG) surgery is chest wall pain. Due to side effects of opioids used commonly for pain relief after heart surgeries, it is important to use low-cost and non-pharmacological methods independently or combined with palliatives to alleviate pain and consequently prevent undesirable drug adverse e?ects. Objectives: This study aimed to investigate the effect of Hazrate Zahra’s praises, which is one of the most known praises among Muslims in which the word “Allah” is repeated 100 times, on pain severity after CABG surgery. Patients and Methods: This randomized clinical trial study was performed on 80 patients in Busheher Bentolhoda Hospital, Iran, in 2013. Data was collected by a researcher-made questionnaire and Visual Analogue Scale (VAS). Patients were randomly assigned into intervention (n = 40) and control (n = 40) groups. In intervention group, we asked patients to recite Hazrate Zahra’s praises (AS) as one of the most known praises among Muslims in which the word “Allah” is repeated 100 times. In the control group, patients received routine procedures of hospital. Pain was assessed before and immediately after the intervention in three days after the operation in the both groups. Data was analyzed by SPSS 19 software using descriptive and analytic (Chi-square and independent and paired sample t test) statistical methods. Results: There was a significant difference regarding pain severity after the intervention between the two groups during three days after the operation (respectively P ? 0.001, P ? 0.001 and P ? 0.003), but no significant difference was found between the two studied groups before the intervention. Moreover, a significant difference was seen before and after recitation in the intervention group during three days after the operation (for three days P ? 0.001), while in control group no significant difference was revealed before and after the intervention (respectively P = 0.493, P = 0.541 and P = 0.119). Conclusions: Reciting the word “Allah” as a non-pharmacological, low-cost and non-invasive method with no side effects can be effective on pain relief after CABG surgery. PMID:25729678

  19. Coronary vein graft disease: Pathogenesis and prevention

    PubMed Central

    Parang, Pirouz; Arora, Rohit

    2009-01-01

    Not long after coronary artery bypass grafting surgery was described, several reports presented follow-up angiographic data on large cohorts of patients, demonstrating that approximately one-half of saphenous vein grafts fail within 10 to 15 years of surgery and that graft failure is associated with worse clinical outcomes. Three processes are responsible for vein graft failure. Thrombosis, intimal hyperplasia and accelerated atherosclerosis contribute to graft failure in the acute, subacute and late postoperative periods, respectively. Studies have shown that perioperative antiplatelet therapy can reduce early thrombosis and graft failure. As in native coronaries, intensive lipid lowering can attenuate the process of atherosclerosis in vein grafts. Intimal hyperplasia in the vein graft is thought to be an adaptation of the vein to higher pressures in the arterial circulation. This process is further promoted by the loss of inhibition from the endothelial layer, which is injured during surgery. A new ‘no-touch’ technique for harvesting grafts may be effective in preventing disruption to the endothelial layer, and subsequent intimal hyperplasia and graft loss. Off-pump surgery and endoscopic vein harvesting, which are known to reduce surgical morbidity, have been shown to be no worse than on-pump surgery and open vein harvesting, respectively, in terms of vein graft patency. Various gene therapies can prevent intimal hyperplasia in animal models, but human data obtained so far have been disappointing. Placing an external stent around a vein graft may reduce tangential wall stress and subsequent intimal hyperplasia. PMID:19214303

  20. Oversized vein grafts develop advanced atherosclerosis in hypercholesterolemic minipigs

    PubMed Central

    2012-01-01

    Background Accelerated atherosclerosis is the main cause of late aortocoronary vein graft failure. We aimed to develop a large animal model for the study of pathogenesis and treatment of vein graft atherosclerosis. Methods An autologous reversed jugular vein graft was inserted end-to-end into the transected common carotid artery of ten hypercholesteroemic minipigs. The vein grafts were investigated 12-14 weeks later with ultrasound and angiograpy in vivo and microscopy post mortem. Results One minipig died during follow up (patent vein graft at autopsy), and one vein graft thrombosed early. In the remaining eight patent vein grafts, the mean (standard deviation) intima-media thickness was 712 ?m (276 ?m) versus 204 ?m (74 ?m) in the contralateral control internal jugular veins (P < .01). Advanced atherosclerotic plaques were found in three of four oversized vein grafts (diameter of graft > diameter of artery). No plaques were found in four non-oversized vein grafts (P < .05). Conclusions Our model of jugular vein graft in the common carotid artery of hypercholesterolemic minipigs displayed the components of human vein graft disease, i.e. thrombosis, intimal hyperplasia, and atherosclerosis. Advanced atherosclerosis, the main cause of late failure of human aortocoronary vein grafts was only seen in oversized grafts. This finding suggests that oversized vein grafts may have detrimental effects on patient outcome. PMID:22463679

  1. Skin Graft

    PubMed Central

    Shimizu, Ruka; Kishi, Kazuo

    2012-01-01

    Skin graft is one of the most indispensable techniques in plastic surgery and dermatology. Skin grafts are used in a variety of clinical situations, such as traumatic wounds, defects after oncologic resection, burn reconstruction, scar contracture release, congenital skin deficiencies, hair restoration, vitiligo, and nipple-areola reconstruction. Skin grafts are generally avoided in the management of more complex wounds. Conditions with deep spaces and exposed bones normally require the use of skin flaps or muscle flaps. In the present review, we describe how to perform skin grafting successfully, and some variation of skin grafting. PMID:22570780

  2. The experience of totally endoscopic coronary bypass grafting with the robotic system «Da Vinci» in Russia

    NASA Astrophysics Data System (ADS)

    Efendiev, V. U.; Alsov, S. A.; Ruzmatov, T. M.; Mikheenko, I. L.; Chernyavsky, A. M.; Malakhov, E. S.

    2015-11-01

    A new technology - a thoracoscopic coronary bypass grafting with the use of Da Vinci robotic system in Russia is represented by the experience of NRICP. The technology was introduced in Russia in 2011. Overall, one hundred endoscopic coronary artery bypass procedures were performed. We have compared and analyzed results of coronary artery stenting vs minimally invasive coronary artery bypass grafting. According to the results, totally endoscopic coronary artery bypass grafting has several advantages over alternative treatment strategies.

  3. Plant grafting.

    PubMed

    Melnyk, Charles W; Meyerowitz, Elliot M

    2015-03-01

    Since ancient times, people have cut and joined together plants of different varieties or species so they would grow as a single plant - a process known as grafting (Figures 1 and 2). References to grafting appear in the Bible, ancient Greek and ancient Chinese texts, indicating that grafting was practised in Europe, the Middle East and Asia by at least the 5(th) century BCE. It is unknown where or how grafting was first discovered, but it is likely that natural grafting, the process by which two plants touch and fuse limbs or roots in the absence of human interference (Figure 3), influenced people's thinking. Such natural grafts are generally uncommon, but are seen in certain species, including English ivy. Parasitic plants, such as mistletoe, that grow and feed on often unrelated species may have also contributed to the development of grafting as a technique, as people would have observed mistletoe growing on trees such as apples or poplars. PMID:25734263

  4. Radiogenic neoplasia in thyroid and mammary clonogens

    SciTech Connect

    Clifton, K.H.

    1991-05-31

    We have developed rat thyroid and mammary clonogen transplantation systems for the study of radiogenic cancer induction at the target cell level in vivo. The epithelial cell populations of both glands contain small subpopulations of cells which are capable of giving rise to monoclonal glandular structures when transplanted and stimulated with appropriate hormones. During the end of the last grant year and the first half of the current grant year, we have completed analyses and summarized for publication: investigations on the relationship between grafted thyroid cell number and the rapidity and degree of reestablishment of the thyroid-hypothalamicpituitary axis in thyroidectomized rats maintained on a normal diet or an iodine deficient diet; studies of the persistence of, and the differentiation potential and functional characteristics of, the TSH- (thyrotropin-) responsive sub-population of clonogens during goitrogenesis, the plateau-phase of goiter growth, and goiter involution; studies of changes in the size of the clonogen sub-population during goitrogenesis, goiter involution and the response to goitrogen rechallenge; and the results of the large carcinogenesis experiment on the nature of the grafted thyroid cell number-dependent suppression of promotion/progression to neoplasia in grafts of radiation-initiated thyroid cells. We are testing new techniques for the culture, cytofluorescent analysis and characterization mammary epithelial cells and of clonogens in a parallel project, and plan to apply similar technology to the thyroid epithelial cells and clonogen population. Data from these studies will be used in the design of future carcinogenesis experiments on neoplastic initiation by high and low LET radiations and on cells interactions during the neoplastic process.

  5. Primary Stenting of Subclavian and Innominate Artery Occlusive Disease: A Single Center's Experience

    SciTech Connect

    Brountzos, E. N. Petersen, B.; Binkert, C.; Panagiotou, I.; Kaufman, J. A.

    2004-11-15

    Purpose: To review immediate and midterm results of primary stenting for innominate and subclavian artery occlusive lesions. Methods: Retrospective data were collected from 48 consecutive symptomatic patients (27 men and 21 women, median age 64 years) having 49 subclavian and innominate artery lesions treated with stenting. Of the patients 52% had concomitant ischemic heart disease, and 30% had carotid and/or vertebral artery disease. Indication for treatment was vertebrobasilar insufficiency (VBI) in 16.6% of the patients; upper limb ischemia (ULI) in 31.3%; VBI and ULI in 12.5%; transient ischemic attack in 16.7%; angina in 12.5% before or after left internal mammary artery-to-coronary artery bypass grafting; and leg claudication in 10.4% before or after axillofemoral bypass grafting. Balloon-expandable stents were used in 44 lesions and self-expandable stents in 5 lesions. In total, 53 stents were placed in 48 patients. Results: Technical success was 96%, and clinical success 94%. We encountered four complications (two puncture site hematomas, one distal hand embolization and one transient cerebral ischemia). Two patients died within 30 days from other causes, and seven patients were lost to follow-up. Mean follow-up time was 16.7 months (range 0.3 to 68.2). Five patients had recurrent lesions treated by surgical (n = 2) or endovascular (n = 3) means. Cumulative primary patency rate was 91.7% and 77% at 12 and 24 months, respectively. Cumulative secondary patency rate was 96.5% and 91.7% at 12 and 24 months, respectively. Conclusion: Stenting of subclavian and innominate artery lesions resulted in immediate resolution of patients' symptoms with durable midterm effect and few complications in a larger patient group with serious comorbid conditions.

  6. Rule-Based Model of Vein Graft Remodeling Minki Hwang1

    E-print Network

    Garbey, Marc

    Rule-Based Model of Vein Graft Remodeling Minki Hwang1 , Marc Garbey2 , Scott A. Berceli3 Abstract When vein segments are implanted into the arterial system for use in arterial bypass grafting forces, such as shear stress and wall tension, and are believed to be the foundation for later vein graft

  7. Preoperative levosimendan decreases mortality and the development of low cardiac output in high-risk patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting with cardiopulmonary bypass

    PubMed Central

    Levin, Ricardo; Degrange, Marcela; Del Mazo, Carlos; Tanus, Eduardo; Porcile, Rafael

    2012-01-01

    BACKGROUND: The calcium sensitizer levosimendan has been used in cardiac surgery for the treatment of postoperative low cardiac output syndrome (LCOS) and difficult weaning from cardiopulmonary bypass (CPB). OBJECTIVES: To evaluate the effects of preoperative treatment with levosimendan on 30-day mortality, the risk of developing LCOS and the requirement for inotropes, vasopressors and intra-aortic balloon pumps in patients with severe left ventricular dysfunction. METHODS: Patient with severe left ventricular dysfunction and an ejection fraction <25% undergoing coronary artery bypass grafting with CPB were admitted 24 h before surgery and were randomly assigned to receive levosimendan (loading dose 10 ?g/kg followed by a 23 h continuous infusion of 0.1?g/kg/min) or a placebo. RESULTS: From December 1, 2002 to June 1, 2008, a total of 252 patients were enrolled (127 in the levosimendan group and 125 in the control group). Individuals treated with levosimendan exhibited a lower incidence of complicated weaning from CPB (2.4% versus 9.6%; P<0.05), decreased mortality (3.9% versus 12.8%; P<0.05) and a lower incidence of LCOS (7.1% versus 20.8%; P<0.05) compared with the control group. The levosimendan group also had a lower requirement for inotropes (7.9% versus 58.4%; P<0.05), vasopressors (14.2% versus 45.6%; P<0.05) and intra-aortic balloon pumps (6.3% versus 30.4%; P<0.05). CONCLUSION: Patients with severe left ventricle dysfunction (ejection fraction <25%) undergoing coronary artery bypass grafting with CPB who were pretreated with levosimendan exhibited lower mortality, a decreased risk for developing LCOS and a reduced requirement for inotropes, vasopressors and intra-aortic balloon pumps. Studies with a larger number of patients are required to confirm whether these findings represent a new strategy to reduce the operative risk in this high-risk patient population. PMID:23620700

  8. Facial nerve reconstruction using a vascularized lateral femoral cutaneous nerve graft based on the superficial circumflex iliac artery system: an application of the inferolateral extension of the groin flap.

    PubMed

    Kashiwa, Katsuhiko; Kobayashi, Seiichiro; Nasu, Wakako; Kuroda, Takashi; Higuchi, Hirofumi

    2010-11-01

    The use of an inferolateral extension technique of a groin flap has previously been reported. This technique involves harvesting an extended portion from the anterolateral thigh, including the lateral femoral cutaneous nerve (LFCN) and its accompanying vessels, attached to a groin flap via communications between the LFCN-accompanying vessels and the superficial circumflex iliac artery (SCIA) system. In this study, we used this technique involving a vascularized LFCN combined with a groin flap to reconstruct a facial nerve defect. The patient was a 58-year-old man with a salivary duct carcinoma in the left parotid gland. Tumor ablation resulted in a defect of the skin and soft tissue including all branches of the facial nerve. A free groin flap was harvested based on the SCIA system, composed of the LFCN and a small monitoring flap, which were nourished by the LFCN-accompanying vessels and by communication with the SCIA system. The LFCN was transplanted into the gaps in the facial nerve branches as a cable graft, and the skin flap was used to cover and fill the soft tissue defect. The postoperative course was uneventful and satisfactory facial animation was obtained. This represents a possible technique for nerve reconstruction using a vascularized nerve graft. PMID:20697990

  9. Mammary Glands: Developmental Changes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The mammary gland progresses from the accumulation of a few cells in the embryonic ectoderm to a highly arborescent tubulo-alveolar gland capable of secreting a highly nutritious product for consumption. Throughout this progression, various changes occur during each developmental stage: prenatal, pr...

  10. Endovascular Stent Graft for Post-traumatic Superficial Femoral Artery Pseudoaneurysms with Arteriovenous Fistula: 6 Months Follow-Up of 2 Cases

    PubMed Central

    Rathod, Jawahar Rajusingh; Dhomne, Sachin; Taori, Kishor; Prasad, Krishna Premnath; Guha, Amrita

    2011-01-01

    Pseudoaneurysms are common vascular abnormalities due to disruption of the vessel wall. Pseudoaneurysm with arteriovenous fistula is a rare presentation. Complications associated with them develop unpredictably and carry a high mortality rate. Traditionally pseudoaneurysms have been treated surgically. However, with the advent of new interventional techniques, management using endovascular approach have gained popularity in treating pseudoaneurysms. Here, we present two cases of large pseudoaneurysms with arteriovenous fistula treated by percutaneous stent graft. Present studies on pseudoaneurysms are all either iatrogenic or secondary to nephrologic dialysis treatment and only few present studies exist describing such large post-traumatic femoral pseudoaneurysms with arteriovenous fistulas were treated successfully by stent grafting through femoral approach, with good patency at 6 months follow up. PMID:22470771

  11. Mapping of Autogenous Saphenous Veins as an Imaging Adjunct to Peripheral MR Angiography in Patients with Peripheral Arterial Occlusive Disease and Peripheral Bypass Grafting: Prospective Comparison with Ultrasound and Intraoperative Findings

    PubMed Central

    Jah-Kabba, Ann-Marie Bintu Munda; Kukuk, Guido Matthias; Hadizadeh, Dariusch Reza; Träber, Frank; Koscielny, Arne; Kabba, Mustapha Sundifu; Verrel, Frauke; Schild, Hans Heinz; Willinek, Winfried Albert

    2014-01-01

    Background Mapping of the great saphenous vein is very important for planning of peripheral and coronary bypass surgery. This study investigated mapping of the great saphenous vein as an adjunct to peripheral MR angiography using a blood pool contrast agent in patients who were referred for evaluation of peripheral arterial occlusive disease and bypass surgery. Methods 38 patients with peripheral arterial occlusive disease (21 men; mean age: 71 years, range, 44–88 years) underwent peripheral MR angiography using the blood pool contrast agent Gadofosveset trisodium. Apart from primary arterial assessment images were evaluated in order to determine great saphenous vein diameters at three levels: below the saphenofemoral junction, mid thigh and 10 cm above the knee joint (usability: diameter range: >3 and <10 mm at one level and >3.5 and <10 mm at a neighboring level). Duplex ultrasound was performed by an independent examiner providing diameter measurements at the same levels. Additionally, vessel usability was determined intraoperatively by the vascular surgeon during subsequent bypass surgery. Results Mean venous diameters for MR angiography/duplex ultrasound were 5.4±2.6/5.5±2.8 mm (level 1), 4.7±2.7/4.6±2.9 mm (level 2) and 4.4±2.2/4.5±2.3 mm (level 3), respectively, without significant differences between the modalities (P?=?0.207/0.806/0.518). Subsequent surgery was performed in 27/38 patients. A suitable saphenous vein was diagnosed in 25 and non-usability was diagnosed in 2 of the 27 patients based on MR angiography/duplex ultrasound, respectively. Usability was confirmed by intraoperative assessment in all of the 24 patients that received a venous bypass graft in subsequent bypass surgery. In 1 case, in which the great saphenous vein was assessed as useable by both MR angiography and duplex ultrasound, it was not used during subsequent bypass surgery due to the patients clinical condition and comorbidities. Conclusion Simultaneous mapping of the great saphenous vein as an imaging adjunct to peripheral MR angiography with a blood pool contrast agent is an alternative to additive duplex ultrasound in patients undergoing subsequent peripheral bypass grafting. PMID:25405867

  12. Alternative option in patients with multisegmental left anterior descending coronary artery disease for providing complete myocardial revascularization

    PubMed Central

    Gucu, Arif; Goncu, Tu?rul; Yavuz, Senol; Ozluk, Ozlem Arican; Eris, Cuneyt; Turk, Tamer; Ozyaz?c?oglu, Ahmet; Vural, Hakan

    2014-01-01

    Objectives: The basic aim of surgical interventions in patients with coronary artery disease is to complete myocardial revascularization. In such patients, however, complementary revascularization techniques may require in patients with multisegmental left anterior descending disease. Among the different procedures, we performed an alternative option in patients with multisegmental lad disease for providing complete myocardial revascularization. Methods: This study consists of retrospective analysis of consecutive eight patients between january 2008 and august 2013. In all patients, the surgical procedure consisted of standard aortic and right atrial cannulations followed by coronary artery bypass grafting with cardiopulmonary bypass. At the lesions of non-lad vessels distal anastomoses were performed with saphenous vein graft. After that lad arteriotomies were performed at the proximal and the distal segment of coronary stenosis, and a bridge was formed with a short segment valveless svg. The left internal mammary artery was anastomosed on the bridge. Results: This innovative technique was performed successfully in all the patients. There were no morbidity and in-hospital mortality. At follow-up 1 year control, all the patients have no complications. In 2 patients, control angiogram showed a patent lima to a bridge anastomosis. Conclusions: Although our series has a small group population, we advocate that this is a safe, easy, and efficient technique for providing complete revascularization in multisegmental lad disease. This technique could be performed with the good result and easy implementation. It perfuses both the proximal and the distal segments of the multisegmental lad stenoses. PMID:24482700

  13. Human Umbilical Cord Mesenchymal Stromal Cell Transplantation in Myocardial Ischemia (HUC-HEART Trial). A Study Protocol of a Phase 1/2, Controlled and Randomized Trial in Combination with Coronary Artery Bypass Grafting.

    PubMed

    Can, Alp; Ulus, Ahmet Tulga; Cinar, Ozgur; Topal Celikkan, Ferda; Simsek, Erdal; Akyol, Mesut; Canpolat, Ugur; Erturk, Murat; Kara, Fadil; Ilhan, Osman

    2015-10-01

    Mesenchymal stem cells (MSCs), which may be obtained from the bone marrow, have been studied for more than a decade in the setting of coronary artery disease (CAD). Adipose tissue-derived MSCs have recently come into focus and are being tested in a series of clinical trials. MSC-like cells have also been derived from a variety of sources, including umbilical cord stroma, or HUC-MSCs. The HUC-HEART trail (ClinicalTrials.gov Identifier: NCT02323477) is a phase 1/2, controlled, multicenter, randomized clinical study of the intramyocardial delivery of allogeneic HUC-MSCs in patients with chronic ischemic cardiomyopathy. A total of 79 patients (ages 30-80) with left ventricle ejection fractions ranging between 25 and 45% will be randomized in a 2:1:1 pattern in order to receive an intramyocardial injection of either HUC-MSCs or autologous bone marrow-derived mononuclear cells (BM-MNCs) in combination with coronary arterial bypass grafting (CABG) surgery. The control group of patients will receive no cells and undergo CABG alone. Human HUC-MSCs will be isolated, propagated and banked in accordance with a cGMP protocol, whereas the autologous BM-MNCs will be isolated via aspiration from the iliac crest and subsequently process in a closed-circuit cell purification system shortly before cell transplantation. The cell injections will be implemented in 10 peri-infarct areas. Baseline and post-transplantation outcome measures will be primarily utilized to test both the safety and the efficacy of the administered cells for up to 12 months. PMID:26123356

  14. Radiogenic neoplasia in thyroid and mammary clonogens

    SciTech Connect

    Clifton, K.H.

    1992-05-20

    We have developed rat thyroid and mammary clonogen transplantation systems for the study of radiogenic cancer induction at the target cell level in vivo. The epithelial cell populations of both glands contain small subpopulations of cells which are capable of giving rise to monoclonal glandular structures when transplanted and stimulated with appropriate hormones. Previous results indicated that these clonogens are the precursor cells of radiogenic cancer, and that initiation, is common event at the clonegenic cell level. Detailed information on the physiologic control of clonogen proliferation, differentiation, and total numbers is thus essential to an understanding of the carcinogenic process. We report here studies on investigations on the relationships between grafted thyroid cell number and the rapidity and degree of reestablishment of the thyroid-hypothalamus-pituitary feedback axis in thyroidectomized rats maintained on a normal diet or an iodine deficient diet; studies of the persistence of, and the differentiation potential and functional characteristics of, the TSH-(thyrotropin-) responsive sub- population of clonogens during goitrogenesis, the plateau-phase of goiter growth, and goiter involution; studies of changes in the size of the clonogen sub-population during goitrogenesis, goiter involution and the response to goitrogen rechallenge; and a large carcinogenesis experiment on the nature of the grafted thyroid cell number-dependent suppression of promotion/progression to neoplasia in grafts of radiation-initiated thyroid cells. Data from these studies will be used in the design of future carcinogenesis experiments on neoplastic initiation by high and low LET radiations and on cell interactions during the neoplastic process.

  15. Engineering of arteries in vitro

    PubMed Central

    Huang, Angela H.; Niklason, Laura E.

    2014-01-01

    This review will focus on two elements that are essential for functional arterial regeneration in vitro: the mechanical environment and the bioreactors used for tissue growth. The importance of the mechanical environment to embryological development, vascular functionality, and vascular graft regeneration will be discussed. Bioreactors generate mechanical stimuli to simulate the biomechanical environment of the arterial system. This system has been used to reconstruct arterial grafts with appropriate mechanical strength for implantation by controlling the chemical and mechanical environments in which the grafts are grown. Bioreactors are powerful tools to study the effect of mechanical stimuli on extracellular matrix (ECM) architecture and the mechanical properties of engineered vessels. Hence biomimetic systems enable us to optimize chemo-biomechanical culture conditions to regenerate engineered vessels with physiological properties similar to those of native arterial vessels. In addition, this review will introduce and examine various approaches and techniques that have been used to engineer biologically-based vascular grafts, including collagen-based grafts, fibrin-gel grafts, cell sheet engineering, biodegradable polymers, and decellularization of native vessels. PMID:24399290

  16. [In hospital observation of patients with acute coronary syndrome without ST elevation and multivessels coronary artery disease treated with early invasive strategy. Comparison of results of percutaneous coronary intervention and coronary artery by-pass grafting].

    PubMed

    Szygu?a-Jurkiewicz, Bozena; Wilczek, Krzysztof; Szafron, Bartosz; Przybylski, Roman; Chudzik, Bartosz; Osuch, Marcin; Zebala, Marian; Polo?ski, Lech

    2004-08-01

    Acute coronary syndromes (ACS) without persistent ST-segment elevation are the main cause of hospitalization, morbidity and mortality. The objective of this study was to compare clinical and angiographic parameters as well as in-hospital results of treating 307 consecutive patients with ACS without persistent ST-segment elevation with either PCI or CABG. Inclusion criteria were: rest angina within the last 24 hours, ST-segment depression (> 0.5 mm), T-wave inversion (> 1 mm) in at least two leads, positive serum cardiac markers. PCI was performed in 75.9% of patients and 24.1% of patients underwent CABG. Both groups did not differ as to age, sex, history of diabetes, arterial hypertension, heart failure, smoking and ejection fraction. Positive troponin was significantly more frequent in the PCI group. 51% of PCI patients and 80% of CABG patients had complete revascularization (p = 0.00001). Independent predictors of in-hospital death in the CABG group were: inability to determine culprit vessel during coronary angiography due to lesions' severity (OR 13.65; 95% CI 9.40-15.20; p = 0.007) and heart failure (OR 15.58; 95% CI 12.29-18.01; p = 0.003). In the PCI group these independent predictors were: Braunwald's IIIC unstable angina (OR 5.48; 95% CI 3.10-7.17; p = 0.04) and diabetes (OR 2.22; 95% CI 1.07-3.90; p = 0.003). In-hospital mortality rate was significantly higher in the CABG group (8.1% vs 1.7% p < 0.01). Patients with multivessel coronary artery disease and ACS without ST-segment elevation treated with PCI have better in-hospital outcome than patients assigned to CABG, but the rate of complete revascularization is lower. PMID:15675265

  17. Nine-year experience of recurrent anastomotic pseudoaneurysms after thoracoabdominal aneurysm graft replacement in a patient with Behçet disease.

    PubMed

    Ohira, Suguru; Masuda, Shinsuke; Matsushita, Tsutomu

    2014-10-01

    A 47 year-old woman with Behçet disease presented with back pain. Computed tomography showed an extent IV thoracoabdominal aneurysm. Graft replacement with reconstruction of all visceral arteries was performed. At five years postoperatively, anastomotic pseudoaneurysm of the left renal artery occurred, and it was reconstructed with an 8-mm graft. Two years after the second reconstruction, anastomotic pseudoaneurysms of the abdominal aorta developed. Y-shaped graft replacement was performed. There has been no recurrence for one year since the last operation. In situ graft reconstruction for recurrent pseudoaneurysms in a Behçet disease patient more than five years after graft replacement with reconstruction of all visceral arteries is rare. PMID:25017043

  18. TECAB - Totally Endoscopic Coronary Artery Bypass

    MedlinePLUS Videos and Cool Tools

    ... completely endoscopic coronary artery bypass grafting procedure using robotics. We call this operation a “TECAB,” “Totally Endoscopic ... scrub nurse, also a lot of experience with robotics now. And Dr. Atiq Rahman, fellow here for ...

  19. The Effect of Massage Therapy by Patients’ Companions on Severity of Pain in the Patients Undergoing Post Coronary Artery Bypass Graft Surgery: A Single-Blind Randomized Clinical Trial

    PubMed Central

    Najafi, Sied Saeed; Rast, Fazlola; Momennasab, Marzieh; Ghazinoor, Mahmood; Dehghanrad, Fereshteh; Mousavizadeh, Sied Ali

    2014-01-01

    Background: Pain on mid sternotomy incision site after Coronary Artery Bypass  Graft  Surgery (CABG) is a common problem that causes sleep disturbance, delayed wound healing, and increased use of analgesic drugs. Massage therapy which is mostly performed by healthcare providers is a non-pharmacological approach for managing this pain. The present study aimed to determine the effect of massage therapy by patient’s companion on the severity of pain in post CABG patients. Methods: In this randomized single-blind clinical trial, 70 post CABG patients were randomly divided into an intervention and a control group. The intervention group received massage by one of their relatives who was trained by an expert nurse. The control group, on the other hand, received routine care. The pain intensity was assessed by Visual Analogue Scale (VAS) before and immediately, 30, 60, and 120 minutes after the intervention. Then, the data were entered into the SPSS statistical software (version 16) and analyzed using repeated measures ANOVA and post-hoc test (Scheffe). Results: At the beginning of the study, no significant difference was found between the two groups regarding the pain severity. In the intervention group, the pain severity significantly decreased in all the four time points after the intervention (P=0.001). However, no significant difference was observed in this regard in the control group. Conclusion: Massage therapy by patient’s companion trained by a nurse was an effective strategy for pain management in post CABG patients. This could also promote the patient’s family participation in the process of care. Trial Registration Number: IRCT201208218505N3. PMID:25349854

  20. Insulin receptors in the mammary gland

    SciTech Connect

    Smith, D.H.

    1986-01-01

    Insulin binding studies were conducted using mammary membrane preparations to further the authors understanding of insulin's role in regulating mammary metabolism, particularly ruminant mammary metabolism. Specific objectives were to: (1) characterize insulin binding to bovine mammary microsomes and determine if the specificity and kinetics of binding indicate the presence of insulin receptors in bovine mammary gland; (2) examine and compare insulin binding by liver and mammary microsomes of the pig and dairy cow; (3) examine insulin binding to bovine milk fat globule membranes (MFGM) and evaluate this model's usefulness in assessing insulin receptor regulation in the mammary gland of the cow; (4) examine the effect of dietary fat in insulin binding by rat mammary and liver microsomes. The specificity and kinetics of /sup 125/I-insulin binding of bovine mammary microsomes indicated the presence of insulin receptors in bovine mammary gland. Bovine liver and mammary microsomes specifically bound less /sup 125/I-insulin than did the corresponding porcine microsomes, and mammary microsomes, regardless of species, specifically bound less /sup 125/I-insulin than did liver microsomes. These differences in binding suggest differences in insulin responsiveness between pigs and cattle, as well as between the liver and mammary glands.

  1. Design and development of multilayer vascular graft

    NASA Astrophysics Data System (ADS)

    Madhavan, Krishna

    2011-07-01

    Vascular graft is a widely-used medical device for the treatment of vascular diseases such as atherosclerosis and aneurysm as well as for the use of vascular access and pediatric shunt, which are major causes of mortality and morbidity in this world. Dysfunction of vascular grafts often occurs, particularly for grafts with diameter less than 6mm, and is associated with the design of graft materials. Mechanical strength, compliance, permeability, endothelialization and availability are issues of most concern for vascular graft materials. To address these issues, we have designed a biodegradable, compliant graft made of hybrid multilayer by combining an intimal equivalent, electrospun heparin-impregnated poly-epsilon-caprolactone nanofibers, with a medial equivalent, a crosslinked collagen-chitosan-based gel scaffold. The intimal equivalent is designed to build mechanical strength and stability suitable for in vivo grafting and to prevent thrombosis. The medial equivalent is designed to serve as a scaffold for the activity of the smooth muscle cells important for vascular healing and regeneration. Our results have shown that genipin is a biocompatible crosslinker to enhance the mechanical properties of collagen-chitosan based scaffolds, and the degradation time and the activity of smooth muscle cells in the scaffold can be modulated by the crosslinking degree. For vascular grafting and regeneration in vivo, an important design parameter of the hybrid multilayer is the interface adhesion between the intimal and medial equivalents. With diametrically opposite affinities to water, delamination of the two layers occurs. Physical or chemical modification techniques were thus used to enhance the adhesion. Microscopic examination and graft-relevant functional characterizations have been performed to evaluate these techniques. Results from characterization of microstructure and functional properties, including burst strength, compliance, water permeability and suture strength, showed that the multilayer graft possessed properties mimicking those of native vessels. Achieving these FDA-required functional properties is essential because they play critical roles in graft performances in vivo such as thrombus formation, occlusion, healing, and bleeding. In addition, cell studies and animal studies have been performed on the multilayer graft. Our results show that the multilayer graft support mimetic vascular culture of cells and the acellular graft serves as an artery equivalent in vivo to sustain the physiological conditions and promote appropriate cellular activity. In conclusion, the newly-developed hybrid multilayer graft provides a proper balance of biomechanical and biochemical properties and demonstrates the potential for the use of vascular tissue engineering and regeneration.

  2. Influence of milk source on transplantability of histocompatible mammary tumours in mice.

    PubMed Central

    Oth, D.; Sabolovic, D.

    1977-01-01

    It is confirmed that C3H mammary tumours are much more easily transplantable in histocompatible recipients when these have been reared on C3H milk, than when they have been reared on milk from the inbred Swiss/B strain. By contrast, A.CA mammary tumours transplanted in histocompatible hosts reared on A.CA or Swiss/B milk, grow almost equally well in both sorts of recipient. Thus, rearing on Swiss/B milk has different effects on the transplantability of mammary tumours of C3H and A.CA. On the other hand, recipients which were reared on C3H or A.CA milks accept grafts of C3H mammary tumours about equally, suggesting that milks from A.CA and C3H have the same effect on the transplantability of C3H mammary tumours. The different action of Swiss/B milk on tumours of C3H and A.CA seems best attributed to differences between C3H and A.CA tumours or between mouse strain genotypes. By contrast, the transplantability of C3H mammary tumours is significantly changed when the recipients were reared on milk from the RIII strain instead of C3H. These facts suggest that the milk from RIII has an action which differs from that of both C3H and A.CA in this respect. The data are discussed on the basis of a differential tollerance-inducing action of mammary tumour viruses (MTVs) which infect C3H, A.CA and RIII, and have an important role in tumour induction. PMID:326285

  3. Systemic Artery to Pulmonary Artery Fistula Associated with Mitral Regurgitation: Successful Treatment with Endovascular Embolization

    SciTech Connect

    Iwazawa, Jin; Nakamura, Kenji; Hamuro, Masao; Nango, Mineyoshi; Sakai, Yukimasa; Nishida, Norifumi

    2008-07-15

    We present the case of a 60-year-old woman with symptomatic mitral regurgitation caused by a left-to-right shunt via anastomoses consisting of microfistulae, most likely of inflammatory origin, between the right subclavian artery and the right pulmonary artery. The three arteries responsible for fistulous formation, including the internal mammary, thyrocervical, and lateral thoracic arteries, were successfully occluded by transcatheter embolization using superabsorbent polymer microsphere (SAP-MS) particles combined with metallic coils. No complications have been identified following treatment with SAP-MS particles. This approach significantly reduced the patient's mitral regurgitation and she has remained asymptomatic for more than 4 years.

  4. Coronary Arteries

    MedlinePLUS

    ... and animations for grades K-6. The Coronary Arteries | Share Coronary Circulation The heart muscle, like every ... into two main coronary blood vessels (also called arteries). These coronary arteries branch off into smaller arteries, ...

  5. [Mammary duct ectasia in children].

    PubMed

    Iester, A; Debbia, C; Franzone, G; Scribanis, R; Puleo, M G; Buzzanca, C; Di Bella, E; Alpigiani, M G

    1995-10-01

    Authors describe two uncommon cases of infantile mammary duct ectasia (EDM). This disease, first reported in 1983, is characterized by dilatation of the subareolar duct system, and by phlogistic reaction and fibrosis. In the medical literature only 8 cases have been reported, but probably its frequency is undervalued due to the scarce general knowledge of this pathology. The differential diagnosis is reviewed. PMID:8569642

  6. The history of arterial revascularization: from Kolesov to Tector and beyond

    PubMed Central

    Galvin, Sean D.

    2013-01-01

    Coronary artery bypass grafting (CABG) is the one of the most effective revascularization strategies for patients with obstructive coronary artery disease. Total arterial revascularization using one or both internal thoracic and radial arteries has been shown to improve early outcomes and reduce long-term cardiovascular morbidity. Although CABG has evolved from an experimental procedure in the early 1900’s to become one of the most commonly performed surgical procedures, there is still significant variation in grafting strategies amongst surgeons. We review the history and development of CABG with a particular emphasis on the early pioneers and the evolution of arterial grafting. PMID:23977617

  7. What Is Coronary Artery Bypass Grafting (CABG)?

    MedlinePLUS

    ... to die. This is a "heart attack" or myocardial infarction . WHAT CAN HAPPEN WHEN BLOCKAGES OCCUR IN THE ... pectoris , or ultimately even a heart attack or myocardial infarction . In some cases, particularly in individuals with diabetes ...

  8. Electrostrictive Graft Elastomers

    NASA Technical Reports Server (NTRS)

    Su, Ji (Inventor); Harrison, Joycelyn S. (Inventor); St.Clair, Terry L. (Inventor)

    2003-01-01

    An electrostrictive graft elastomer has a backbone molecule which is a non-crystallizable, flexible macromolecular chain and a grafted polymer forming polar graft moieties with backbone molecules. The polar graft moieties have been rotated by an applied electric field, e.g., into substantial polar alignment. The rotation is sustained until the electric field is removed. In another embodiment, a process for producing strain in an elastomer includes: (a) providing a graft elastomer having a backbone molecule which is a non-crystallizable, flexible macromolecular chain and a grafted polymer forming polar graft moieties with backbone molecules; and (b) applying an electric field to the graft elastomer to rotate the polar graft moieties, e.g., into substantial polar alignment.

  9. Left ventricular assist device outflow graft: alternative sites

    PubMed Central

    Aftab, Muhammad; Singh, Steve K.; Mallidi, Hari R.; Frazier, Oscar H.

    2014-01-01

    We describe three alternative approaches for the left ventricular assist device (LVAD) outflow graft during implantation of the LVAD. The supraceliac abdominal aorta, innominate artery and left axillary artery were employed as alternative sites for the LVAD outflow graft in the setting of a heavily calcified ascending aorta or a hostile chest wall and mediastinum. The first approach involved the use of the supraceliac abdominal aorta. Given that the patient had a history of multiple previous breast surgeries and chest wall radiation for breast cancer treatment, a left subcostal incision was employed as a sternotomy-sparing approach. The second approach was the use of the innominate artery in a patient with a porcelain ascending aorta. The patient underwent pulmonary valve replacement, right ventricle outflow tract reconstruction and tricuspid valve annuloplasty in addition to the LVAD implantation. The third approach was the use of the left axillary artery. This patient had a history of LVAD implantation and subsequently developed infection with pseudoaneurysm formation at the aortic anastomosis of the outflow graft. We conclude that the supraceliac abdominal aorta, the innominate artery and the left axillary artery are potential alternative routes for the LVAD outflow graft in the settings of heavily calcified ascending aorta or a hostile chest wall and mediastinum. Although the described alternative approaches are safe and viable options, we highly recommend utilizing these approaches only in selected patients with significantly higher risks and hazards to the standard surgical approach. PMID:25452918

  10. Coronary arteriovenous fistula between left circumflex artery and superior vena cava.

    PubMed

    Khulbey, Sanjeev Kumar; Agarwal, Sanjay; Dikshit, Vijay

    2015-09-01

    A 52-year old man presented with exertional angina and shortness of breath and was diagnosed with double-vessel coronary artery disease with a large coronary artery fistula between the left circumflex artery and superior vena cava. He was managed with off-pump coronary artery bypass grafting with closure of the fistula. PMID:26034225

  11. [Regular thermal waves in female mammary glands].

    PubMed

    Kliukin, L M; Namiot, V A

    2015-01-01

    During experimental studies of thermal regime of female mammary glands tissues the existence of periodic thermal waves was discovered. At the same time, the space-amplitude relief of such waves can mask the space-amplitude relief of the thermal profile, projected to the skin surface of mammary glands by tumor, hidden in the thickness of the gland. The phenomenon observed would be taken into account upon diagnosing pathological states of mammary glands. PMID:25868357

  12. Connexin43 Inhibition Prevents Human Vein Grafts Intimal Hyperplasia

    PubMed Central

    Longchamp, Alban; Allagnat, Florent; Alonso, Florian; Kuppler, Christopher; Dubuis, Céline; Ozaki, Charles-Keith; Mitchell, James R.; Berceli, Scott; Corpataux, Jean-Marc

    2015-01-01

    Venous bypass grafts often fail following arterial implantation due to excessive smooth muscle cells (VSMC) proliferation and consequent intimal hyperplasia (IH). Intercellular communication mediated by Connexins (Cx) regulates differentiation, growth and proliferation in various cell types. Microarray analysis of vein grafts in a model of bilateral rabbit jugular vein graft revealed Cx43 as an early upregulated gene. Additional experiments conducted using an ex-vivo human saphenous veins perfusion system (EVPS) confirmed that Cx43 was rapidly increased in human veins subjected ex-vivo to arterial hemodynamics. Cx43 knock-down by RNA interference, or adenoviral-mediated overexpression, respectively inhibited or stimulated the proliferation of primary human VSMC in vitro. Furthermore, Cx blockade with carbenoxolone or the specific Cx43 inhibitory peptide 43gap26 prevented the burst in myointimal proliferation and IH formation in human saphenous veins. Our data demonstrated that Cx43 controls proliferation and the formation of IH after arterial engraftment. PMID:26398895

  13. Refractory Vascular Spasm Associated with Coronary Bypass Grafting

    PubMed Central

    Kim, Young Sam; Yoon, Yong Han; Kim, Jeoung Taek; Shinn, Helen Ki; Woo, Seong Ill; Baek, Wan Ki

    2014-01-01

    Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management. PMID:25346903

  14. Patient-Derived Endothelial Progenitor Cells Improve Vascular Graft Patency in Rodent Model

    PubMed Central

    Stroncek, JD; Ren, LC; Klitzman, B; Reichert, WM

    2011-01-01

    Late outgrowth endothelial progenitor cells (EPCs) derived from the peripheral blood of patients with significant coronary artery disease were sodded into the lumens of small diameter expanded polytetrafluoroethylene (ePTFE) vascular grafts. Grafts (1 mm inner diameter) were denucleated and sodded either with native EPCs or with EPCs transfected with an adenoviral vector containing the gene for human thrombomodulin (EPC+AdTM). EPC+AdTM was shown to increase the in vitro rate of graft activated protein C (APC) production 4-fold over grafts sodded with untransfected EPCs (p<0.05). Unsodded control and EPC-sodded and EPC+AdTM-sodded grafts were implanted bilaterally into the femoral arteries of athymic rats for 7 or 28 days. Unsodded control grafts, both with and without denucleation treatment, each exhibited 7-day patency rates of 25%. Unsodded grafts showed extensive thrombosis and were not tested for patency over 28 days. In contrast, grafts sodded with untransfected EPCs or EPC+AdTM both had 7-day patency rates of 88-89% and 28-day patency rates of 75-88%. Intimal hyperplasia was observed near both the proximal and distal anastomoses in all sodded graft conditions but did not appear to be the primary occlusive failure event. This in vivo study suggests autologous EPCs derived from the peripheral blood of patients with coronary artery disease may improve the performance of synthetic vascular grafts, although no differences were observed between untransfected EPCs and TM transfected EPCs. PMID:21945828

  15. Reimplantation of left coronary artery from pulmonary artery in a 65-year-old.

    PubMed

    Mitchell, Julia; Lemaire, Anaïs; Henaine, Roland; Metton, Olivier; Ninet, Jean

    2016-01-01

    Anomalous left coronary artery to the pulmonary artery is a rare pathology with a mortality rate of 90% in the first year of life, directly related to left ventricular function and coronary perfusion, although several adult cases have been reported. Surgical correction consists of ligation of the anomalous left coronary artery associated with coronary artery bypass grafting. We describe the exceptional case of a 65-year-old woman who underwent reimplantation of the left coronary artery in the anatomical position without bridging. PMID:24948780

  16. A Large Posttraumatic Subclavian Artery Aneurysm Complicated by Artery Occlusion and Arteriobronchial Fistula Successfully Treated Using a Covered Stent

    SciTech Connect

    Stefanczyk, Ludomir; Czeczotka, Jaroslaw; Elgalal, Marcin; Sapieha, Michal; Rowinski, Olgierd

    2011-02-15

    The treatment of posttraumatic aneurysms of peripheral arteries using covered stents is increasingly commonplace. We present the case of a 10-year-old girl with a pseudoaneurysm of the subclavian artery complicated by an arteriobronchial fistula with hemorrhaging into the bronchial tree and distal subclavian artery occlusion. Despite the lack of artery patency, endovascular stent graft implantation was successful. Pseudoaneurysm exclusion and involution was achieved, together with a patent implant and maintained collateral circulation patency.

  17. Long Segmental Reconstruction of Diffusely Diseased Left Anterior Descending Coronary Artery Using Left Internal Thoracic Artery with Extensive Endarterectomy.

    PubMed

    Heo, Woon; Min, Ho-Ki; Kang, Do Kyun; Lee, Sung Kwang; Jun, Hee Jae; Hwang, Youn-Ho

    2015-08-01

    In coronary artery bypass grafting, a diffusely diseased left anterior descending coronary artery (LAD) is an obstacle to achieving complete revascularization, consequently leading to the possibility of a poor prognosis. Long segmental reconstruction with or without endarterectomy is a revascularization method for treating diffusely diseased coronary arteries. Herein, we report a successful case of long segmental reconstruction of a diffusely diseased LAD using a left internal thoracic artery onlay patch after endarterectomy. PMID:26290842

  18. Long Segmental Reconstruction of Diffusely Diseased Left Anterior Descending Coronary Artery Using Left Internal Thoracic Artery with Extensive Endarterectomy

    PubMed Central

    Heo, Woon; Min, Ho-Ki; Kang, Do Kyun; Lee, Sung Kwang; Jun, Hee Jae; Hwang, Youn-Ho

    2015-01-01

    In coronary artery bypass grafting, a diffusely diseased left anterior descending coronary artery (LAD) is an obstacle to achieving complete revascularization, consequently leading to the possibility of a poor prognosis. Long segmental reconstruction with or without endarterectomy is a revascularization method for treating diffusely diseased coronary arteries. Herein, we report a successful case of long segmental reconstruction of a diffusely diseased LAD using a left internal thoracic artery onlay patch after endarterectomy. PMID:26290842

  19. Evo-devo of the mammary gland.

    PubMed

    Oftedal, Olav T; Dhouailly, Danielle

    2013-06-01

    We propose a new scenario for mammary evolution based on comparative review of early mammary development among mammals. Mammary development proceeds through homologous phases across taxa, but evolutionary modifications in early development produce different final morphologies. In monotremes, the mammary placode spreads out to form a plate-like mammary bulb from which more than 100 primary sprouts descend into mesenchyme. At their distal ends, secondary sprouts develop, including pilosebaceous anlagen, resulting in a mature structure in which mammary lobules and sebaceous glands empty into the infundibula of hair follicles; these structural triads (mammolobular-pilo-sebaceous units or MPSUs) represent an ancestral condition. In marsupials a flask-like mammary bulb elongates as a sprout, but then hollows out; its secondary sprouts include hair and sebaceous anlagen (MPSUs), but the hairs are shed during nipple formation. In some eutherians (cat, horse, human) MPSUs form at the distal ends of primary sprouts; pilosebaceous components either regress or develop into mature structures. We propose that a preexisting structural triad (the apocrine-pilo-sebaceous unit) was incorporated into the evolving mammary structure, and coupled to additional developmental processes that form the mammary line, placode, bulb and primary sprout. In this scenario only mammary ductal trees and secretory tissue derive from ancestral apocrine-like glands. The mammary gland appears to have coopted signaling pathways and genes for secretory products from even earlier integumentary structures, such as odontode (tooth-like) or odontode-derived structures. We speculate that modifications in signal use (such as PTHrP and BMP4) may contribute to taxonomic differences in MPSU development. PMID:23681303

  20. Intraarterial 9-beta-methyl carbacyclin improves canine polytetrafluoroethylene graft patency

    SciTech Connect

    Dacey, L.J.; Hees, P.S.; Cronenwett, J.L.

    1988-07-01

    This study examined the effect of 9-beta-methyl carbacyclin, a synthetic, stable prostacyclin analog, on canine polytetrafluoroethylene (PTFE) graft patency. Twenty-five dogs had 4 mm x 7 cm PTFE grafts implanted bilaterally into the femoral arteries. A subcutaneous infusion pump was used to deliver either saline solution (control) or 9-beta-methyl carbacyclin (Ciprostine) at 100 (CARB-100) or 200 ng/kg/min (CARB-200) through a femoral artery branch just proximal to one of the femoral grafts, with the contralateral graft serving as a noninfused control. Graft-platelet deposition (with /sup 111/In-labeled platelets) was measured between the fifth and seventh days, with patency determined on the seventh day. Dogs were classified as aggregators (AGG (+)) if the preoperative epinephrine-enhanced sodium arachidonate platelet aggregation was greater than 20%. CARB-200 infusion significantly improved ipsilateral graft patency (80%) compared with noninfused grafts (50%, p less than 0.05), or grafts in control and CARB-100 dogs (43%, p less than 0.05). Anastomotic platelet deposition was decreased bilaterally in CARB-200 dogs by 45% to 59% compared with CARB-100 and control dogs (p less than 0.05). With the exception of grafts infused with CARB-200, AGG (+) dogs had significantly lower graft patency (26%) than nonaggregator AGG (-) dogs (71%, p less than 0.01). CARB-200 infusion significantly improved graft patency in AGG (+) dogs (71%), compared with control and CARB-100-infused grafts (19%, p less than 0.025). Intra-arterial 9-beta-methyl carbacyclin improved early PTFE graft patency and inhibited platelet deposition in a severe canine model, independent of baseline platelet aggregation status, which also had an important effect on graft patency.

  1. Viscoelastic behaviour of a small calibre vascular graft made from a POSS-nanocomposite.

    PubMed

    Ahmed, Maqsood; Hamilton, George; Seifalian, Alexander M

    2010-01-01

    Small calibre (?6mm) polytetrafluoroethylene (PTFE) bypass grafts have poor medium and long term patency due to the development of neointimal hyperplasia at the distal anastomosis. The inelasticity of PTFE is implicated in this mechanism of failure. We have developed a novel polyhedral oligomeric silsesquioxane (POSS) nanocage incorporated into a poly(carbonate)urethane (PCU) biomaterial with enhanced biostability and improved antithrombogenicity making it ideal for cardiovascular applications. In this study the compliance and viscous component of a POSS-PCU small calibre graft was measured using a biomimetic pulsatile flow circuit and wall tracking ultrasound. A POSS-PCU graft displays elastic and viscous behaviour similar to the native artery. Furthermore, platelet adhesion and activation studies suggest POSS-PCU is a more biocompatible material than current industry favourite ePTFE. Alleviating the thrombogenicity of grafts and the mechanical mismatch between artery and graft is encouraging for the short and long term patency of the POSS-PCU graft. PMID:21096748

  2. Functional abnormalities of experimental autogenous vein graft neoendothelium.

    PubMed Central

    Cross, K S; el-Sanadiki, M N; Murray, J J; Mikat, E M; McCann, R L; Hagen, P O

    1988-01-01

    When a vein is grafted into the arterial circulation, the endothelium of the graft is damaged. Regeneration of an intact neoendothelium occurs, but the functional properties of this surface have not been clarified. In this study, the functional integrity of the neoendothelium of veins grafted into the carotid artery of the rabbit was assessed through the use of acetylcholine and histamine to stimulate the production of the important endothelium-derived relaxing factor (EDRF). Control veins, precontracted with norepinephrine [10(-5) M], relaxed after exposure to acetylcholine [( 10(-7) M], 42.4% +/- 6.4%, p = 0.008) and histamine [( 10(-6) M], 30.6% +/- 4.3%, p = 0.03). This relaxation response was abolished after mechanical removal of the endothelium. By contrast, neither acetylcholine nor histamine caused an endothelium-dependent relaxation in the vein grafts, even though scanning electron microscopy demonstrated the presence of a morphologically intact endothelium. However, addition of stabilized EDRF purified from cultured endothelial cells induced relaxation of the vein grafts (35.8% +/- 3.6%, p = 0.002). These data indicate that vein graft endothelium is unable to produce EDRF in response to exposure to acetylcholine or histamine. The inability to produce this potent smooth muscle cell relaxing factor and anti-aggregatory substance may be a predisposition to vein graft failure. Images Figs. 4A-C. Fig. 4. (Continued) Fig. 4. (Continued) Figs. 5A-C. Fig. 5. (Continued) Fig. 5. (Continued) Fig. 6. PMID:3263843

  3. Thromboembolic potential of synthetic vascular grafts in baboons

    SciTech Connect

    Schneider, P.A.; Kotze, H.F.; Heyns, A.D.; Hanson, S.R.

    1989-07-01

    We have compared in baboons the capacity of two types of synthetic vascular grafts to accumulate thrombus, activate circulating platelets, and generate occlusive platelet microemboli. Grafts were incorporated into femoral arterial-arterial shunts placed unilaterally in 10 baboons; the unoperated contralateral limbs served as controls. The accumulation of indium 111 (111In)-labeled platelets onto the grafts (expanded polytetrafluoroethylene (ePTFE) or knitted Dacron, 4 mm inner diameter) and the appearance of 111In radioactivity in distal microcirculatory beds (calf and foot) were quantified by dynamic scintillation camera imaging. After 1 hour total platelet deposition per graft was higher with Dacron (49.0 +/- 8.0 x 10(9) platelets) than with ePTFE (3.7 +/- 0.6 x 10(9) platelets, p less than 0.01). Platelet counts decreased and beta-thromboglobulin levels increased with Dacron graft placement but were unaffected by ePTFE graft placement (p less than 0.05 and p less than 0.01, respectively). Emboli shed from Dacron grafts were detected as multifocal, irregular, and changing deposits in the calves and feet. Indium 111 platelet activity in the feet distal to the Dacron grafts increased 81.1% +/- 21.4% from baseline values over 1 hour, whereas the activities in the feet distal to the ePTFE grafts were unchanged (p less than 0.05). The increase 111In-platelet radioactivity above the control limb values (excess radioactivity) was higher for the Dacron graft group than for the ePTFE group in both the feet (139.6% +/- 46.9% vs 6.2%, p less than 0.05) and the calves (86.7% +/- 21.7% vs 7.3% +/- 3.6%, p less than 0.05).

  4. 9 CFR 310.17 - Inspection of mammary glands.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Inspection of mammary glands. 310.17... INSPECTION AND CERTIFICATION POST-MORTEM INSPECTION § 310.17 Inspection of mammary glands. (a) Lactating mammary glands and diseased mammary glands of cattle, sheep, swine, and goats shall be removed...

  5. 9 CFR 310.17 - Inspection of mammary glands.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Inspection of mammary glands. 310.17... INSPECTION AND CERTIFICATION POST-MORTEM INSPECTION § 310.17 Inspection of mammary glands. (a) Lactating mammary glands and diseased mammary glands of cattle, sheep, swine, and goats shall be removed...

  6. 9 CFR 310.17 - Inspection of mammary glands.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Inspection of mammary glands. 310.17... INSPECTION AND CERTIFICATION POST-MORTEM INSPECTION § 310.17 Inspection of mammary glands. (a) Lactating mammary glands and diseased mammary glands of cattle, sheep, swine, and goats shall be removed...

  7. 9 CFR 310.17 - Inspection of mammary glands.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Inspection of mammary glands. 310.17... INSPECTION AND CERTIFICATION POST-MORTEM INSPECTION § 310.17 Inspection of mammary glands. (a) Lactating mammary glands and diseased mammary glands of cattle, sheep, swine, and goats shall be removed...

  8. 9 CFR 310.17 - Inspection of mammary glands.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Inspection of mammary glands. 310.17... INSPECTION AND CERTIFICATION POST-MORTEM INSPECTION § 310.17 Inspection of mammary glands. (a) Lactating mammary glands and diseased mammary glands of cattle, sheep, swine, and goats shall be removed...

  9. Porcine radial artery decellularization by high hydrostatic pressure.

    PubMed

    Negishi, Jun; Funamoto, Seiichi; Kimura, Tsuyoshi; Nam, Kwangoo; Higami, Tetsuya; Kishida, Akio

    2015-11-01

    Many types of decellularized tissues have been studied and some have been commercially used in clinics. In this study, small-diameter vascular grafts were made using HHP to decellularize porcine radial arteries. One decellularization method, high hydrostatic pressure (HHP), has been used to prepare the decellularized porcine tissues. Low-temperature treatment was effective in preserving collagen and collagen structures in decellularized porcine carotid arteries. The collagen and elastin structures and mechanical properties of HHP-decellularized radial arteries were similar to those of untreated radial arteries. Xenogeneic transplantation (into rats) was performed using HHP-decellularized radial arteries and an untreated porcine radial artery. Two weeks after transplantation into rat carotid arteries, the HHP-decellularized radial arteries were patent and without thrombosis. In addition, the luminal surface of each decellularized artery was covered by recipient endothelial cells and the arterial medium was fully infiltrated with recipient cells. Copyright © 2012 John Wiley & Sons, Ltd. PMID:23233238

  10. B-MODE IMAGES OF SPONTANEOUS RAT MAMMARY TUMORS ENHANCED BY ESTIMATED SCATTERER PARAMETERS

    E-print Network

    Illinois at Urbana-Champaign, University of

    mammary tumors. Tumors were diagnosed microscopically as mammary gland fibroadenomas. Two-dimensional BB-MODE IMAGES OF SPONTANEOUS RAT MAMMARY TUMORS ENHANCED BY ESTIMATED SCATTERER PARAMETERS Michael

  11. Successful Endovascular Treatment of a Left Common Carotid Artery Aneurysm Following Failed Surgery of a Right Common Carotid Artery Aneurysm

    SciTech Connect

    Cil, Barbaros E. Ucar, Ibrahim; Ozsoy, Fatma; Arat, Anil; Yorgancioglu, Cem; Boeke, Erkmen

    2005-04-15

    Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.

  12. Heart bypass surgery

    MedlinePLUS Videos and Cool Tools

    ... great vein will be used to bypass the blocked arteries in the heart. The venous graft is ... and to the affected coronary artery past the blocked site. The internal mammary artery from the chest ...

  13. Mammary and extramammary Paget's disease*

    PubMed Central

    Lopes, Lauro Lourival; Lopes, Ione Maria Ribeiro Soares; Lopes, Lauro Rodolpho Soares; Enokihara, Milvia M. S. S.; Michalany, Alexandre Osores; Matsunaga, Nobuo

    2015-01-01

    Paget's disease, described by Sir James Paget in 1874, is classified as mammary and extramammary. The mammary type is rare and often associated with intraductal cancer (93-100% of cases). It is more prevalent in postmenopausal women and it appears as an eczematoid, erythematous, moist or crusted lesion, with or without fine scaling, infiltration and inversion of the nipple. It must be distinguished from erosive adenomatosis of the nipple, cutaneous extension of breast carcinoma, psoriasis, atopic dermatitis, contact dermatitis, chronic eczema, lactiferous ducts ectasia, Bowen's disease, basal cell carcinoma, melanoma and intraductal papilloma. Diagnosis is histological and prognosis and treatment depend on the type of underlying breast cancer. Extramammary Paget's disease is considered an adenocarcinoma originating from the skin or skin appendages in areas with apocrine glands. The primary location is the vulvar area, followed by the perianal region, scrotum, penis and axillae. It starts as an erythematous plaque of indolent growth, with well-defined edges, fine scaling, excoriations, exulcerations and lichenification. In most cases it is not associated with cancer, although there are publications linking it to tumors of the vulva, vagina, cervix and corpus uteri, bladder, ovary, gallbladder, liver, breast, colon and rectum. Differential diagnoses are candidiasis, psoriasis and chronic lichen simplex. Histopathology confirms the diagnosis. Before treatment begins, associated malignancies should be investigated. Surgical excision and micrographic surgery are the best treatment options, although recurrences are frequent. PMID:25830993

  14. Use of polycaprolactone grafts for small-diameter blood vessels.

    PubMed

    Sevost'ianova, V V; Elgudin, Ia A; Glushkova, T V; Wnek, G; Liubysheva, T; Emancipator, S; Kudriavtseva, Iu A; Borisov, V V; Golovkin, A S; Barbarash, L S

    2015-01-01

    Current trends are toward actively developing approaches of tissue engineering, aimed at creating vascular grafts of small diameter. This is due to the existing in cardiovascular surgery demand for prostheses to be used in coronary artery bypass grafting. The present work was undertaken in order to assess possibilities of using smalldiameter vascular grafts made of biodegradable polymer polycaprolactone by means of electrospinning. The authors studied physico-mechanical properties and structure of polycaprolactone grafts, as well as their thromboresistance and patency after implantation into the vascular bed of rats. The obtained results demonstrated optimal physicomechanical properties of the vascular grafts, their biocompatibility, endothelialisation of the internal surface, and infiltration of the graft's wall by cells with the formation of new tissue, accompanied and followed by the development of an extensive intimal layer in the zones of the anastomoses. Hence, the study showed possibilities of using polycaprolactone grafts as vascular prostheses, however requiring their further modification which would promote and contribute to a decrease in hyperplasia of connective tissue in the graft's lumen. PMID:25757165

  15. Progesterone signaling in mammary gland development.

    PubMed

    Conneely, O M; Mulac-Jericevic, B; Arnett-Mansfield, R

    2007-01-01

    The mammary gland undergoes extensive epithelial expansion and differentiation during pregnancy, leading ultimately to the development of functional milk-producing alveolar lobules. This phase of mammary gland remodeling is controlled primarily by the cooperative interplay between hormonal signals initiated by both progesterone and prolactin. Abrogation of mammary epithelial expression of receptors for either one of the hormones results in failure of alveologenesis and an absence of pregnancy-induced tertiary ductal side branches in the case of progesterone receptor-null (PRKO) mammary glands. By combining gene array approaches to identify PR- and prolactin (PRL)-dependent downstream signaling pathways and by using genetic mouse models to address the consequences of abrogation and/or misexpression of potential downstream genes, recent studies have begun to illuminate key signaling pathways that mediate the morphogenic effects of these hormones during pregnancy-induced mammary gland remodeling. Analysis of deregulated expression of PR-dependent gene transcripts in PRKO mammary glands has revealed that convergence between progesterone and prolactin signaling occurs in part through progesterone-dependent induction of mammary epithelial PRL receptors to prime the mammary epithelium to respond to PRL. Additional genes activated by PRs encode epithelial paracrine growth factor signals that regulate ductal and alveolar epithelial proliferation and survival, lineage-restricted transcription factors that control luminal and alveolar cell fate establishment and maintenance, and gap junction proteins that play a critical role in alveolar morphogenesis by establishment of epithelial cell polarity. Finally, two distinct isoforms of PRs (PR-A and PR-B) are coexpressed in the mammary gland and display extensively overlapping but partially distinct gene regulatory properties in relaying the progesterone signal. PMID:18543434

  16. Patient-specific simulation of stent-graft deployment within an abdominal aortic aneurysm

    E-print Network

    Perrin, David; Avril, Stéphane; Albertini, Jean-Noël; Orgéas, Laurent; Geindreau, Christian; Dumenil, Aurélien; Goksu, Cemil

    2014-01-01

    In this study, finite element analysis is used to simulate the surgical deployment procedure of a bifurcated stent-graft on a real patient's arterial geometry. The stent-graft is modeled using realistic constitutive properties for both the stent and most importantly for the graft. The arterial geometry is obtained from pre-operative imaging exam. The obtained results are in good agreement with the post-operative imaging data. As the whole computational time was reduced to less than 2 hours, this study constitutes an essential step towards predictive planning simulations of aneurysmal endovascular surgery

  17. Endovascular Exclusion of Renal Artery Aneurysm

    SciTech Connect

    Andersen, Poul Erik Rohr, Nils

    2005-06-15

    A patient who was operated for an abdominal aortic aneurysm 7 years earlier presented with recently discovered iliac and renal artery aneurysms. The renal artery had an angulation of 90{sup o}, but the aneurysm was successfully excluded using a covered vascular stent graft placed over an extrastiff guidewire. Even in cases of complex anatomy of a renal aneurysm, endovascular treatment should be considered. With development of more flexible and low-profile endoprosthesis with accurate deployment, these have become more usable.

  18. Stenting in Acute Lower Limb Arterial Occlusions

    SciTech Connect

    Raja, Jowad; Munneke, Graham; Morgan, Robert; Belli, Anna-Maria

    2008-07-15

    Management of critical limb ischemia of acute onset includes surgical embolectomy, bypass grafting, aspiration thrombectomy, thrombolysis, and mechanical thrombectomy followed by treatment of the underlying cause. We present our experience with the use of stents to treat acute embolic/thrombotic occlusions in one iliac and three femoropopliteal arteries. Although this is a small case series, excellent immediate and midterm results suggest that stenting of acute occlusions of the iliac, superficial femoral, and popliteal arteries is a safe and effective treatment option.

  19. Does PGA external stenting reduce compliance mismatch in venous grafts?

    E-print Network

    Teng, Zhong-zhao; Ji, Guang-yu; Chu, Hong-jun; Li, Zhi-Yong; Zou, Liang-jian; Xu, Zhi-yun; Huang, Sheng-dong

    2007-04-16

    :427-433. 31. Hinrichs WL, Zweep HP, Satoh S, Feijen J, Wildevuur CR: Support- ing, microporous, elastomeric, degradable prostheses to improve the arterialization of autologous vein grafts. Bioma- terials 1994, 15:83-91. 32. Liu SQ: Prevention of focal intimal...

  20. Tri-layered vascular grafts composed of polycaprolactone, elastin, collagen, and silk: Optimization of graft properties.

    PubMed

    McClure, Michael J; Simpson, David G; Bowlin, Gary L

    2012-06-01

    The purpose of this study was to create seamless, acellular, small diameter bioresorbable arterial grafts that attempt to mimic the extracellular matrix and mechanical properties of native artery using synthetic and natural polymers. Silk fibroin, collagen, elastin, and polycaprolactone (PCL) were electrospun to create a tri-layered structure for evaluation. Dynamic compliance testing of the electrospun grafts ranged from 0.4-2.5%/100 mmHg, where saphenous vein (1.5%/100 mmHg) falls within this range. Increasing PCL content caused a gradual decrease in medial layer compliance, while changes in PCL, elastin, and silk content in the adventitial layer had varying affects. Mathematical modeling was used to further characterize these results. Burst strength results ranged from 1614-3500 mmHg, where some exceeded the capacity of the pressure regulator. Four week degradation studies demonstrated no significant changes in compliance or burst strength, indicating that these grafts could withstand the initial physiological conditions without risk of degradation. Overall, we were able to manufacture a multi-layered graft that architecturally mimics the native vascular wall and mechanically matches the gold standard of vessel replacement, saphenous vein. PMID:22520418

  1. Surgical and Antimicrobial Treatment of Prosthetic Vascular Graft Infections at Different Surgical Sites: A Retrospective Study of Treatment Outcomes

    PubMed Central

    Elzi, Luigia; Gurke, Lorenz; Battegay, Manuel; Widmer, Andreas F.; Weisser, Maja

    2014-01-01

    Objective Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome. Methods This was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection. Results Characterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate. Conclusions We recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the grafts and that rifampicin-based antimicrobial regimens be evaluated in clinical trials involving vascular graft infections caused by staphylococci. PMID:25393400

  2. The accelerated atherogenesis of venous grafts might be attributed to aggravated concentration polarization of low density lipoproteins: a numerical study.

    PubMed

    Fan, Zhenmin; Sun, Anqiang; Liu, Xiao; Fan, Yubo; Zhao, Ping; Deng, Xiaoyan

    2013-09-27

    We hypothesize that after implantation the much elevated water filtration rate of venous grafts may cause aggravated concentration polarization of low density lipoproteins (LDLs), in turn lead to the accelerated atherogenesis of the grafts. To verify the hypothesis, we numerically simulated the transport of LDLs in various models of arterial bypasses with different grafts (veins or arteries) and geometrical configurations. The results showed that the venous grafts might endure abnormally high lipid infiltration/accumulation within the vessel wall due to severely elevated luminal surface LDL concentration. When compared to the conventional bypass models, the S-type bypass had the lowest luminal surface LDL concentration along its host artery floor, but the highest degree of risk to develop atherosclerotic lesions in its venous graft. Among the three conventional bypass models, the one with 30° anastomosis had the lowest risk to develop atherosclerosis in the venous graft. In conclusion, when compared with the bypass models with arterial grafts, the venous bypass models had rather high levels of LDL concentration polarization (cw) in the vein grafts, especially at the early stages of implantation. This might result in high infiltration/accumulation of LDLs within the walls of the venous grafts, leading to a fast genesis/development of atherosclerosis there. PMID:23972425

  3. Failure and Success of Percutaneous Angioplasty in a Hypertensive Child with Bilateral Renal Artery Stenosis

    SciTech Connect

    Giavroglou, Constantinos; Tsifountoudis, Ioannis; Boutzetis, Theodoros; Kiskinis, Dimitrios

    2009-01-15

    We describe the clinical course of a 5-year-old girl with severe arterial hypertension that was uncontrollable with antihypertensive medication. Renal angiography revealed bilateral renal artery stenoses. Because percutaneous transluminal renal angioplasty (PTRA) failed to dilate the stenotic lesions, a renal artery bypass grafting in both renal arteries was performed. The patient remained normotensive for 7 months, and after that the arterial pressure increased again. Digital subtraction angiography demonstrated stenosis at the peripheral and central anastomosis of the vein graft that was used for revascularization of the left kidney. PTRA was decided on and successful patency was achieved. The patient has now been normotensive for a period of 5 years.

  4. Endovascular Placement of an Extraluminal Femoropopliteal Bypass Graft in Human Cadavers

    SciTech Connect

    Maynar, Manuel; Llorens, Rafael; Lopez-Sanchez, Carmen; Garcia-Martinez, Virginio; Qian Zhong; Lopera, Jorge; Castaneda, Wilfrido R.

    2005-04-15

    Purpose. A method to create an extraluminal femoropopliteal bypass graft using endovascular techniques was evaluated in situ on cadaver extremities in an attempt to develop a minimally invasive alternative technique for the management of infrainguinal occlusive arterial disease. Methods. The endovascular placement of an extraluminal femoropopliteal bypass graft was undertaken in 5 cadaver legs. Following percutaneous access to the popliteal artery (PA) or common femoral artery (CFA), a Rosch-Uchida needle was used to perforate the vascular wall, followed by the creation of an extraluminal tract using a looped wire and catheter. Once the desired level was reached the needle was again used to perforate the vascular wall of the proximal superficial femoral artery (SFA) or PA depending on the access used. Self-expanding expanded polytetrafluoroethylene (ePTFE) stent-grafts were then deployed to establish the extraluminal femoropopliteal bypass connecting the two arterial puncture sites. Following dilatation of the stent-graft, angiography was performed to assess the endoprostheses and to look for contrast leaks. Results. Technical success was achieved in all 5 legs. Procedure time varied from 15 to 30 min. The angiographic studies performed immediately after completion of the bypass procedure showed patency of the grafts with no evidence of kinking or leakage in any of the cases. Conclusion. This study has proved that the endovascular placement of an extraluminal femoropopliteal bypass graft in human cadaver legs using endovascular techniques under fluoroscopic control is technically feasible.

  5. Patient Specific Multiscale Simulations of Blood Flow in Coronary Artery Bypass Surgery

    NASA Astrophysics Data System (ADS)

    Bangalore Ramachandra, Abhay; Sankaran, Sethuraman; Kahn, Andrew M.; Marsden, Alison L.

    2013-11-01

    Coronary artery bypass surgery is performed to revascularize blocked coronary arteries in roughly 400,000 patients per year in the US.While arterial grafts offer superior patency, vein grafts are used in more than 70% of procedures, as most patients require multiple grafts. Vein graft failure (approx. 50% within 10 years) remains a major clinical issue. Mounting evidence suggests that hemodynamics plays a key role as a mechano-biological stimulus contributing to graft failure. However, quantifying relevant hemodynamic quantities (e.g. wall shear stress) invivo is not possible directly using clinical imaging techniques. We numerically compute graft hemodynamics in a cohort of 3-D patient specific models using a stabilized finite element method. The 3D flow domain is coupled to a 0D lumped parameter circulatory model. Boundary conditions are tuned to match patient specific blood pressures, stroke volumes & heart rates. Results reproduce clinically observed coronary flow waveforms. We quantify differences in multiple hemodynamic quantities between arterial & venous grafts & discuss possible correlations between graft hemodynamics & clinically observed graft failure.Such correlations will provide further insight into mechanisms of graft failure and may lead to improved clinical outcomes.

  6. Gordon Research Conference on Mammary Gland Biology

    SciTech Connect

    Not Available

    1989-01-01

    The 1989 conference was the tenth in the series of biennial Gordon Research Conferences on Mammary Gland Biology. Traditionally this conference brings together scientists from diverse backgrounds and experience but with a common interest in the biology of the mammary gland. Investigators from agricultural and medical schools, biochemists, cell and molecular biologists, endocrinologists, immunologists, and representatives from the emerging biotechnology industries met to discuss current concepts and results on the function and regulation of the normal and neoplastic mammary gland in a variety of species. Of the participants, approximately three-fourths were engaged in studying the normal mammary gland function, whereas the other quarter were engaged in studying the neoplastic gland. The interactions between scientists, clinicians, veterinarians examining both normal and neoplastic cell function serves to foster the multi-disciplinary goals of the conference and has stimulated many cooperative projects among participants in previous years.

  7. Percutaneous Angioplasty and Stenting of left Subclavian Artery Lesions for the Treatment of Patients with Concomitant Vertebral and Coronary Subclavian Steal Syndrome

    SciTech Connect

    Filippo, Ferrara Francesco, Meli; Francesco, Raimondi; Corrado, Amato; Chiara, Mina; Valentina, Cospite; Giuseppina, Novo; Salvatore, Novo

    2006-06-15

    Objective. To evaluate the efficacy of subclavian stenosis percutaneous transfemoral angioplasty (PTA)-treatment in patients with intermittent or complete subclavian steal syndrome (SSS), and coronary-subclavian steal syndrome (C-SSS) after left internal mammary artery-interventricular anterior artery (LIMA-IVA) by pass graft. Methods. We studied 42 patients with coronary subclavian steal syndrome subdivided in two groups; the first group consisted of 15 patients who presented an intermittent vertebral-subclavian steal, while the second group consisted of 27 patients with a complete vertebral-subclavian steal. All patients were treated with angioplasty and stent application and were followed up for a period of 5 years by echocolordoppler examination to evaluate any subclavian restenosis. Results. Subclavian restenosis was significantly increased in patients with a complete subclavian steal syndrome. The restenosis rate was 6.67% in the first group and 40.75% in the second group, These patients had 9.1 fold-increase risk (CI confidence interval 0.95-86.48) in restenosis. Conclusion. Patients with a complete subclavian and coronary steal syndrome present a higher risk of subclavian restenosis.

  8. Tissue-engineered acellular small diameter long-bypass grafts with neointima-inducing activity.

    PubMed

    Mahara, Atsushi; Somekawa, Shota; Kobayashi, Naoki; Hirano, Yoshiaki; Kimura, Yoshiharu; Fujisato, Toshiya; Yamaoka, Tetsuji

    2015-07-01

    Researchers have attempted to develop efficient antithrombogenic surfaces, and yet small-caliber artificial vascular grafts are still unavailable. Here, we demonstrate the excellent patency of tissue-engineered small-caliber long-bypass grafts measuring 20-30 cm in length and having a 2-mm inner diameter. The inner surface of an acellular ostrich carotid artery was modified with a novel heterobifunctional peptide composed of a collagen-binding region and the integrin ?4?1 ligand, REDV. Six grafts were transplanted in the femoral-femoral artery crossover bypass method. Animals were observed for 20 days and received no anticoagulant medication. No thrombogenesis was observed on the luminal surface and five cases were patent. In contrast, all unmodified grafts became occluded, and severe thrombosis was observed. The vascular grafts reported here are the first successful demonstrations of short-term patency at clinically applicable sizes. PMID:25941782

  9. Current PTFE grafts: a biomechanical, scanning electron, and light microscopic evaluation.

    PubMed Central

    Hanel, K C; McCabe, C; Abbott, W M; Fallon, J; Megerman, J

    1982-01-01

    Two currently available brands of PTFE grafts (Goretex and Impra) were studied in a canine femoral artery model to determine whether changes in the manufacturing processes of the two grafts, which increased their strength, had altered the biophysical properties and the histological reactivity of either graft. Both grafts were found to be similar except for differences in their suturability. Their in vivo dynamic compliances were almost identical (1.2 +/- 0.35 vs. 1.2 +/- 0.45). (Scanning electron microscopy showed endothelialization of the grafts only adjacent to the anastomoses, and light microscopy demonstrated similar degrees of histologic incorporation by the host tissues, though of slower tempo than that previously described. These results are examined and discussed with regard to the suitability of this model for characterizing new arterial prostheses of small to medium diameter. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. PMID:7065749

  10. Functional stimulation of graft nerves has minor effects on insulin release from transplanted rat pancreatic islets

    PubMed Central

    Kampf, Caroline; Källskog, Örjan

    2013-01-01

    Introduction. Morphological evidence for reinnervation of pancreatic islet grafts is plentiful. However, to what extent intra-graft nerves influence the endocrine functions of the islet transplant is largely unknown. We therefore aimed to directly stimulate nerves leading to islet grafts with electrodes and measure insulin secretion in response to this. Methods. We implanted syngeneic islets under the renal capsule of rats, and examined them 1 or 7–9 months later. In anesthetized rats blood samples were collected from the renal vein and femoral artery, respectively, during electrode stimulation of the nerves leading to the islet grafts. Results. As expected, nerve stimulation decreased renal blood flow. However, serum insulin concentrations in samples derived from the renal vein or femoral artery changed in concert with one another, both during normoglycemia and acute hyperglycemia. Conclusion. Reinnervation which occurs after islet transplantation under the renal capsule has minor effects on graft endocrine function. PMID:23977866

  11. Calcar bone graft

    SciTech Connect

    Bargar, W.L.; Paul, H.A.; Merritt, K.; Sharkey, N.

    1986-01-01

    A canine model was developed to investigate the use of an autogeneic iliac bone graft to treat the calcar deficiency commonly found at the time of revision surgery for femoral component loosening. Five large male mixed-breed dogs had bilateral total hip arthroplasty staged at three-month intervals, and were sacrificed at six months. Prior to cementing the femoral component, an experimental calcar defect was made, and a bicortical iliac bone graft was fashioned to fill the defect. Serial roentgenograms showed the grafts had united with no resorption. Technetium-99 bone scans showed more uptake at three months than at six months in the graft region. Disulfine blue injection indicated all grafts were perfused at both three and six months. Thin section histology, fluorochromes, and microradiographs confirmed graft viability in all dogs. Semiquantitative grading of the fluorochromes indicated new bone deposition in 20%-50% of each graft at three months and 50%-80% at six months. Although the calcar bone graft was uniformly successful in this canine study, the clinical application of this technique should be evaluated by long-term results in humans.

  12. Autogenous bone grafting.

    PubMed

    Hofbauer, M H; Delmonte, R J; Scripps, M L

    1996-01-01

    Complex, out-of-the-ordinary problems are often encountered when evaluating patients for reconstructive foot and ankle surgery. Salvage of these complex problems in the foot and ankle often requires the use of autogenous bone grafts. This article provides a brief overview of autografts including indications, healing, graft types, and perioperative management. PMID:8915859

  13. The new technique of using the epigastric arteries in renal transplantation with multiple renal arteries.

    PubMed

    Amirzargar, Mohammad Ali; Babolhavaeji, Hooshang; Hosseini, Shahriar Amir; Bahar, Habibmousavi; Gholyaf, Mahmood; Dadras, Farahnaz; Khoshjoo, Farhad; Yavangi, Mahnaz; Amirzargar, Nasibeh

    2013-03-01

    The most common anatomic variant seen in the donor kidneys for renal transplantation is multiple renal arteries (MRA), which can cause an increased risk of complications. We describe the long-term outcomes of 16 years of experience in 76 kidney transplantations with MRAs. In a new reconstruction technique, we remove arterial clamps after anastomosing the donor to the recipient's main renal vessels, which cause backflow from accessory arteries to prevent thrombosis. By this technique, we reduce the ischemic times as well as the operating times. Both in live or cadaver donor kidneys, lower polar arteries were anastomosed to the inferior epigastric artery and upper polar arteries were anastomosed to the superior epigastric arteries. Injection of Papaverine and ablation of sympathic nerves of these arteries dilate and prevent them from post-operative spasm. Follow-up DTPA renal scan in all patients showed good perfusion and function of the transplanted kidney, except two cases of polar arterial thrombosis. Mean creatinine levels during at least two years of follow-up remained acceptable. Patient and graft survival were excellent. No cases of ATN, hypertension, rejection and urologic complications were found. In conclusion, this technique can be safely and successfully utilized for renal transplantation with kidneys having MRAs, and may be associated with a lower complication rate and better graft function compared with the existing techniques. PMID:23538346

  14. Bacterial adherence to vascular grafts after in vitro bacteremia

    SciTech Connect

    Rosenman, J.E.; Pearce, W.H.; Kempczinski, R.F.

    1985-06-01

    All currently used arterial prosthetics have a greater susceptibility to infection following bacteremia than does autogenous tissue. This experiment compares quantitative bacterial adherence to various prosthetic materials after bacteremia carried out in a tightly controlled and quantitative fashion. Ten centimeters long, 4 mm i.d. Dacron, umbilical vein (HUV), and polytetrafluoroethylene (PTFE) grafts, as well as PTFE grafts with a running suture line at the midportion were tested. Each graft was interposed into a pulsatile perfusion system modified from a Waters MOX 100 TM renal transplant pump. Indium-111-labeled Staphylococcus aureus were added to heparinized canine blood to give a mean concentration of 4.7 X 10(6) bacteria/cc. This infected blood was recirculated through each graft for 30 min at a rate of 125 cc/m, 100 Torr (sys), 60 beats/min. The gamma counts/graft were used to calculate the number of bacteria/cm2 of graft surface. After nine experiments, a mean of 9.63 X 10(5) bacteria/cm2 were adherent to the Dacron, 1.04 X 10(5) bacteria/cm2 to the HUV, and 2.15 X 10(4) bacteria/cm2 to the PTFE. These differences were all significant at the 0.05 level. The addition of a suture line increased bacterial adherence to the PTFE graft by 50%. These results suggest that PTFE is the vascular graft material of choice when a prosthetic graft must be implanted despite a high risk of subsequent clinical bacteremia. An in vitro, pulsatile perfusion model gave accurate and reproducible results, and appears well suited for further studies of bacterial, or platelet adherence to grafts, as well as the biomechanics of vascular conduits.

  15. Mammary gland involution is associated with rapid down regulation of major mammary Ca**2+-ATPases

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sixty percent of calcium in milk is transported across the mammary cells apical membrane by the plasma membrane Ca**2+-ATPase 2 (PMCA2). The effect of abrupt cessation of milk production on the Ca**2+-ATPases and mammary calcium transport is unknown. We found that 24 hours after stopping milk prod...

  16. Morphological and histological characteristics of mammary dysplasias occurring in cell dissociation-derived murine mammary outgrowths

    SciTech Connect

    Ethier, S.P.; Adams, L.M.; Ullrich, R.L.

    1984-10-01

    The morphological and histological characteristics of ductal dysplasias that were observed in mammary outgrowths derived from monodispersed mammary cells of carcinogen-treated mice are described. Mammary outgrowths were derived by injecting either 10(4) or 10(5) enzymatically dissociated mammary cells, obtained from control or carcinogen-treated BALB/c mice, into gland-free mammary fat pads of syngeneic hosts. The mammary dysplasias observed varied considerably in morphological and histological characteristics. The majority of the lesions were ductal in origin and were associated with epithelial hyperplasia which ranged from mild hyperplasia, in which only a few extra layers of epithelium were present, to severe hyperplasia, in which the ducts and end buds were occluded and distended with epithelial cells. In addition, papillary and lobular lesions were observed which were also associated with varying degrees of hyperplasia. The range of mammary dysplasias observed in these outgrowths closely resembles that of lesions associated with the pathogenesis of mammary carcinoma in mice, rats, and humans.

  17. An Epigenetic Memory of Pregnancy in the Mouse Mammary Gland

    E-print Network

    dos Santos, Camila O.; Dolzhenko, Egor; Hodges, Emily; Smith, Andrew D.; Hannon, Gregory J.

    2015-05-07

    Pregnancy is the major modulator of mammary gland activity. It induces a tremendous expansion of the mammary epithelium and the generation of alveolar structures for milk production. Anecdotal evidence from multiparous humans indicates...

  18. Technique of Coronary Transfer for TGA with Single Coronary Artery

    PubMed Central

    Kim, Tae Ho; Jung, Jae Jun; Kim, Yong Han; Yang, Ji-Hyuk; Jun, Tae-Gook

    2014-01-01

    An eight-day-old neonate was diagnosed with dextro-transposition of the great arteries, atrial septal defect, patent ductus arteriosus, and a single sinus origin of the coronary arteries. The single coronary artery originated from the left sinus (sinus 2), had a proximal left circumflex arterial branch, and passed anteriorly to the right side of the aorta, further branching into the right coronary and left anterior descending arteries. We successfully performed an arterial switch operation and coronary transfer by tube graft reconstruction with autologous aortic tissue to treat the dextro-transposition of the great arteries and atrial septal defect with a single-sinus origin of the coronary arteries. PMID:25551074

  19. Management of early hepatic artery occlusion after liver transplantation with failed rescue

    PubMed Central

    Hsiao, Chih-Yang; Ho, Cheng-Maw; Wu, Yao-Ming; Ho, Ming-Chih; Hu, Rey-Heng; Lee, Po-Huang

    2015-01-01

    Hepatic artery thrombosis is a serious complication after liver transplantation which often results in biliary complications, early graft loss, and patient death. It is generally thought that early hepatic artery thrombosis without urgent re-vascularization or re-transplantation almost always leads to mortality, especially if the hepatic artery thrombosis occurs within a few days after transplantation. This series presents 3 cases of early hepatic artery thrombosis after living donor liver transplantation, in which surgical or endovascular attempts at arterial re-vascularization failed. Unexpectedly, these 3 patients survived with acceptable graft function after 32 mo, 11 mo, and 4 mo follow-up, respectively. The literatures on factors affecting this devastating complication were reviewed from an anatomical perspective. The collective evidence from survivors indicated that modified nonsurgical management after liver transplantation with failed revascularization may be sufficient to prevent mortality from early hepatic artery occlusion. Re-transplantation may be reserved for selected patients with unrecovered graft function. PMID:26640351

  20. Laser radiation in the treatment of prosthetic graft stenosis. A preliminary study of prosthesis damage by laser energy

    SciTech Connect

    Seeger, J.M.; Abela, G.S.; Klingman, N.

    1987-09-01

    Transluminal laser recanalization is potentially an important new treatment of anastomotic intimal hyperplasia. However, currently used grafts or sutures may be damaged by laser radiation at power and energy levels required for plaque removal. To investigate this problem, two commonly used grafts (Dacron and polytetrafluoroethylene (PTFE)) and two types of vascular suture (polypropylene and PTFE) were exposed to argon laser radiation in vitro. Dacron and PTFE grafts recovered from amputations were also studied to determine whether graft healing affected graft resistance to laser damage. Power and energy levels required to perforate atherosclerotic superficial femoral arteries were determined for comparison. PTFE grafts were significantly (1.5 to 7 times) more resistant to perforation by laser energy than atherosclerotic arteries under all conditions. In contrast, Dacron grafts perforated at power and energy levels one half to one third of that required for vaporization of atherosclerotic plaque. PTFE sutures remained intact at power and energy levels above the levels that perforated atherosclerotic arteries, whereas polypropylene sutures were destroyed by very low levels of power and energy (0.5 joules at 0.5 watts). Because of the variable levels of power and energy that damage different types of prosthetic grafts and sutures, laser angioplasty should only be investigated clinically as a therapy for anastomotic intimal hyperplasia when PTFE grafts and sutures are present.

  1. Quantitative Ultrasound Assessment of Ultrasound Therapy in Rodent Mammary

    E-print Network

    Illinois at Urbana-Champaign, University of

    Quantitative Ultrasound Assessment of Ultrasound Therapy in Rodent Mammary Tumors: In Vivo and Ex as temperature monitoring in a rat model mammary tumor both in vivo and ex vivo. In the in vivo study, 40 rodent. These studies demonstrated increases in the BSC in rodent mammary tumors with therapy in both ex vivo, water

  2. Edinburgh Research Explorer Gene expression profiling of mammary gland development

    E-print Network

    MacDonald, Andrew

    Edinburgh Research Explorer Gene expression profiling of mammary gland development reveals putative of mammary gland development reveals putative roles for death receptors and immune mediators in post. 2015 #12;R92 Introduction Mammary gland development during the pregnancy cycle is characterized

  3. INTRODUCTION Mammary gland development (Fig. 1), like that of many

    E-print Network

    Scott, Matthew

    INTRODUCTION Mammary gland development (Fig. 1), like that of many organs, requires interactions control growth, govern overall patterning of the ductal tree, and influence the function of the gland interactions critical to mammary gland development and those in other organs make the mammary gland

  4. Comparative aspects of mammary gland development and homeostasis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Mammary glands are crucial to the reproductive strategy of mammals and the milk of domesticated ruminants serves as an important source of nutrients for the human population. The majority of mammary gland development occurs postnatally and the mammary gland undergoes cyclical periods of growth, dif...

  5. Spontaneous Coronary Artery Dissection: A Case Report

    PubMed Central

    Mokhberi, Vahid; Bagheri, Babak; Navidi, Seyfollah; Amini, Seyed Mohammad

    2015-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare and important cause of acute coronary syndrome and sudden cardiac death. Various etiologies are thought to be responsible for this condition, among which underlying atherosclerosis seems to be the most common. SCAD is predominant in women and is usually diagnosed via coronary artery angiography. Therapeutic interventions include medical therapy, percutaneous coronary artery intervention, and surgery based on lesion characteristics. We describe a 36-year-old woman with SCAD presenting with acute chest pain to Fatemeh-Zahra Hospital, Sari, Iran. The patient had no current atherosclerosis risk factors and had given birth 6 months previously. Coronary angiography was performed due to the persistence of the chest pain after initial management, and a spontaneous dissection of the left anterior descending artery was observed. She underwent coronary artery bypass graft and was discharged in good condition. PMID:26697091

  6. The Cleared Mammary Fat Pad Transplantation Assay for Mammary Epithelial Organogenesis.

    PubMed

    Lawson, Devon A; Werb, Zena; Zong, Yang; Goldstein, Andrew S

    2015-01-01

    Cleared mammary fat pad (MFP) transplantation has been a standard technique for studies of mammary development and cancer for several decades. The mammary gland is comprised of several fundamental components: The epithelial compartment contains basal/myoepithelial cells and luminal cells, and the stromal compartment (called the MFP) contains adipocytes, smooth muscle cells, fibroblasts, and immune cells. In 3- to 4-wk-old female mice, the mammary epithelium is concentrated very close to the nipple and has not yet grown beyond the mammary lymph node to penetrate the bulk of the MFP. This developmental feature provides an anatomical fixed point, and enables one to cut away the portion of the MFP from the nipple to the lymph node, leaving behind the majority of the MFP free of epithelium. The "cleared" MFP can serve as a supportive native microenvironment fully sufficient for the organogenesis of injected donor epithelium. Normal mammary epithelial donor cells will produce histologically and functionally normal mammary ductal epithelium several weeks posttransplant, with the exception that the ducts will not be connected to the nipple. The assay described here provides a powerful platform for assessing the developmental and tumorigenic potential of engineered cells of interest. PMID:26631119

  7. Vascular replacement using a layered elastin-collagen vascular graft in a porcine model: one week patency versus one month occlusion.

    PubMed

    Koens, M J W; Krasznai, A G; Hanssen, A E J; Hendriks, T; Praster, R; Daamen, W F; van der Vliet, J A; van Kuppevelt, T H

    2015-07-01

    A persistent clinical demand exists for a suitable arterial prosthesis. In this study, a vascular conduit mimicking the native 3-layered artery, and constructed from the extracellular matrix proteins type I collagen and elastin, was evaluated for its performance as a blood vessel equivalent. A tubular 3-layered graft (elastin-collagen-collagen) was prepared using highly purified type I collagen fibrils and elastin fibers, resembling the 3-layered native blood vessel architecture. The vascular graft was crosslinked and heparinised (37 ± 4 ?g heparin/mg graft), and evaluated as a vascular graft using a porcine bilateral iliac artery model. An intra-animal comparison with clinically-used heparinised ePTFE (Propaten®) was made. Analyses included biochemical characterization, duplex scanning, (immuno)histochemistry and scanning electron microscopy. The tubular graft was easy to handle with adequate suturability. Implantation resulted in pulsating grafts without leakage. One week after implantation, both ePTFE and the natural acellular graft had 100% patencies on duplex scanning. Grafts were partially endothelialised (Von Willebrand-positive endothelium with a laminin-positive basal membrane layer). After one month, layered thrombi were found in the natural (4/4) and ePTFE graft (1/4), resulting in occlusion which in case of the natural graft is likely due to the porosity of the inner elastin layer. In vivo application of a molecularly-defined tubular graft, based on nature's matrix proteins, for vascular surgery is feasible. PMID:26060888

  8. Effects of nutrient restriction on mammary cell turnover and mammary gland remodeling in lactating dairy cows.

    PubMed

    Dessauge, F; Lollivier, V; Ponchon, B; Bruckmaier, R; Finot, L; Wiart, S; Cutullic, E; Disenhaus, C; Barbey, S; Boutinaud, M

    2011-09-01

    The aim of this study was to investigate the effects of a severe nutrient restriction on mammary tissue morphology and remodeling, mammary epithelial cell (MEC) turnover and activity, and hormonal status in lactating dairy cows. We used 16 Holstein × Normande crossbred dairy cows, divided into 2 groups submitted to different feeding levels (basal and restricted) from 2 wk before calving to wk 11 postpartum. Restricted-diet cows had lower 11-wk average daily milk yield from calving to slaughter than did basal-diet cows (20.5 vs. 33.5 kg/d). Feed restriction decreased milk fat, protein, and lactose yields. Restriction also led to lower plasma insulin-like growth factor 1 and higher growth hormone concentrations. Restricted-diet cows had lighter mammary glands than did basal-diet cows. The total amount of DNA in the mammary gland and the size of the mammary acini were smaller in the restricted-diet group. Feed restriction had no significant effect on MEC proliferation at the time of slaughter but led to a higher level of apoptosis in the mammary gland. Gelatin zymography highlighted remodeling of the mammary extracellular matrix in restricted-diet cows. Udders from restricted-diet cows showed lower transcript expression of ?-lactalbumin and kappa-casein. In conclusion, nutrient restriction resulted in lower milk yield in lactating dairy cows, partly due to modulation of MEC activity and a lower number of mammary cells. An association was found between feed restriction-induced changes in the growth hormone-insulin-like growth factor-1 axis and mammary epithelial cell dynamics. PMID:21854935

  9. Mammary serum amyloid A3 activates involution of the mammary gland in dairy cows.

    PubMed

    Domènech, A; Parés, S; Bach, A; Arís, A

    2014-12-01

    The dry period is a nonlactating phase in which senescent mammary cells are regenerated, which is thought to optimize milk production in the subsequent lactation. In bovines, the dry period normally coexists with pregnancy and the lactogenic hormones delay mammary gland involution and impair the activation of immune system to fight the risk of intramammary infections. Conventionally, long dry periods of up to 60 d are required to allow sufficient mammary regeneration for full milk yield in the next lactation. The aim of this study was to evaluate the potential of mammary serum amyloid A3 (M-SAA3) as an activator of the involution of the mammary gland. One milligram of recombinant M-SAA3 and the corresponding negative controls (saline solution and lipopolysaccharide) were infused into the mammary gland via the teat canal, and mammary secretion samples were taken during the first 3 d after drying off to analyze metalloproteinase activity, somatic cell count, protein, and fat contents. Primary mammary gland epithelial cell cultures and bovine dendritic cells, obtained from necropsy tissue and blood, respectively, were incubated with and without M-SAA3 and cytokine expression was quantified. Last, the protective role of the M-SAA3 against infections was evaluated after a Staphylococcus aureus challenge. Matrix metalloproteinase 9 activity, a key protein that directly participates in the onset of the involution process, was greater in quarters treated with the M-SAA3. Protein content was increased in mammary secretions compared with control quarters. M-SAA3 increased cytokines directly related to innate immunity in both epithelial and dendritic cells and reduced the infection by Staphylococcus aureus. PMID:25306281

  10. Radiogenic neoplasia in thyroid and mammary clonogens. Progress report, January 1, 1991--December 31, 1991

    SciTech Connect

    Clifton, K.H.

    1991-05-31

    We have developed rat thyroid and mammary clonogen transplantation systems for the study of radiogenic cancer induction at the target cell level in vivo. The epithelial cell populations of both glands contain small subpopulations of cells which are capable of giving rise to monoclonal glandular structures when transplanted and stimulated with appropriate hormones. During the end of the last grant year and the first half of the current grant year, we have completed analyses and summarized for publication: investigations on the relationship between grafted thyroid cell number and the rapidity and degree of reestablishment of the thyroid-hypothalamicpituitary axis in thyroidectomized rats maintained on a normal diet or an iodine deficient diet; studies of the persistence of, and the differentiation potential and functional characteristics of, the TSH- (thyrotropin-) responsive sub-population of clonogens during goitrogenesis, the plateau-phase of goiter growth, and goiter involution; studies of changes in the size of the clonogen sub-population during goitrogenesis, goiter involution and the response to goitrogen rechallenge; and the results of the large carcinogenesis experiment on the nature of the grafted thyroid cell number-dependent suppression of promotion/progression to neoplasia in grafts of radiation-initiated thyroid cells. We are testing new techniques for the culture, cytofluorescent analysis and characterization mammary epithelial cells and of clonogens in a parallel project, and plan to apply similar technology to the thyroid epithelial cells and clonogen population. Data from these studies will be used in the design of future carcinogenesis experiments on neoplastic initiation by high and low LET radiations and on cells interactions during the neoplastic process.

  11. Involvement of mouse mammary tumor virus in spontaneous and hormone-induced mammary tumors in low-mammary-tumor mouse strains.

    PubMed Central

    Michalides, R; van Deemter, L; Nusse, R; Röpcke, G; Boot, L

    1978-01-01

    The involvement of the mouse mammary tumor virus (MTV) in spontaneous and hormone-induced mammary tumors in low-mammary-tumor mouse strains was studied by comparing the amounts of MTV RNA and MTV DNA sequences in mammary tumors and other tissues of mice with an without hormonal treatments. The following results were obtained. (i) Mammary tumors which appeared in C3H mice as a result of an infection with MTV contained more MTV DNA compared with noninfected organs; these mammary tumors also contained more MTV RNA than was present in lactating mammary gland cells. (ii) Hormonal stimulation by administration of excessive amounts of prolactin via hypophyseal isografts in C3Hf and O20 mice resulted in an increased expression of MTV RNA in the mammary glands. This elevated level of MTV RNA expression was, however, not maintained in the hormone-induced mammary tumors. (iii) Spontaneous mammary tumors in BALB/c mice contained similar levels of MTV DNA and MTV RNA sequences as were found in other cells of these animals. PMID:212580

  12. Of Microenvironments and Mammary Stem Cells

    SciTech Connect

    LaBarge, Mark A; Petersen, Ole W; Bissell, Mina J

    2007-06-01

    In most adult tissues there reside pools of stem and progenitor cells inside specialized microenvironments referred to as niches. The niche protects the stem cells from inappropriate expansion and directs their critical functions. Thus guided, stem cells are able to maintain tissue homeostasis throughout the ebb and flow of metabolic and physical demands encountered over a lifetime. Indeed, a pool of stem cells maintains mammary gland structure throughout development, and responds to the physiological demands associated with pregnancy. This review discusses how stem cells were identified in both human and mouse mammary glands; each requiring different techniques that were determined by differing biological needs and ethical constraints. These studies together create a robust portrait of mammary gland biology and identify the location of the stem cell niche, elucidate a developmental hierarchy, and suggest how the niche might be manipulated for therapeutic benefit.

  13. Mammary stem cells have myoepithelial cell properties

    PubMed Central

    Prater, Michael D.; Petit, Valérie; Russell, I. Alasdair; Giraddi, Rajshekhar; Shehata, Mona; Menon, Suraj; Schulte, Reiner; Kalajzic, Ivo; Rath, Nicola; Olson, Michael F.; Metzger, Daniel; Faraldo, Marisa M.; Deugnier, Marie-Ange; Glukhova, Marina A.; Stingl, John

    2014-01-01

    Contractile myoepithelial cells dominate the basal layer of the mammary epithelium and are considered to be differentiated cells. However, we observe that up to 54% of single basal cells can form colonies when seeded into adherent culture in the presence of agents that disrupt acin-myosin interactions, and on average, 65% of the single-cell-derived basal colonies can repopulate a mammary gland when transplanted in vivo. This indicates that a high proportion of basal myoepithelial cells can give rise to a mammary repopulating unit (MRU). We demonstrate that myoepithelial cells, flow-sorted using 2 independent myoepithelial-specific reporter strategies, have MRU capacity. Using an inducible lineage tracing approach we follow the progeny of ?-smooth muscle actin-expressing myoepithelial cells and show that they function as long-lived lineage-restricted stem cells in the virgin state and during pregnancy. PMID:25173976

  14. [A case of ischemic dilated cardiomyopathy, mitral regurgitation and congestive heart failure successfully treated by Batista operation, coronary artery bypass grafting and mitral valve replacement; usefulness of myocardial scintigraphy].

    PubMed

    Okoshi, T; Ueda, K; Neya, K; Suzuki, Y; Nakajima, H; Akasaka, T; Kaminaga, T

    2002-01-01

    A 75-year-old man diagnosed as having ischemic dilated cardiomyopathy, congestive heart failure and mitral regurgitation underwent left ventricle volume reduction operation (Batista), coronary bypass grafting and mitral valve replacement because myocardial infarction had developed at lateral, inferior and small area of apex wall, not at interventricular septum. Left ventricular endodiastolic volume index and left ventricular endosystolic volume index decreased from pre-operative values of 155, and 128 ml/m2 to post-operative values of 113, and 82 ml/m2, respectively. Left ventricular ejection fraction increased from a pre-operative value of 17% to a post-operative value of 27%. This evaluation was performed by myocardial scintigraphy (quantitative gated spect: QGS). This method was bloodless and useful for determination of indication of left ventricle volume reduction surgery including Batista operation and pre- and post-operative evaluation of this type of surgery. Today, Batista operation is, generally speaking, performed for non-ischemic dilated cardiomyopathy. In this case, however, Batista operation was applied to ischemic dilated cardiomyopathy and was very effective. PMID:11797415

  15. Stromal Effects on Mammary Gland Development and Breast Cancer

    NASA Astrophysics Data System (ADS)

    Wiseman, Bryony S.; Werb, Zena

    2002-05-01

    Breast cancer manifests itself in the mammary epithelium, yet there is a growing recognition that mammary stromal cells also play an important role in tumorigenesis. During its developmental cycle, the mammary gland displays many of the properties associated with breast cancer, and many of the stromal factors necessary for mammary development also promote or protect against breast cancer. Here we review our present knowledge of the specific factors and cell types that contribute to epithelial-stromal crosstalk during mammary development. To find cures for diseases like breast cancer that rely on epithelial-stromal crosstalk, we must understand how these different cell types communicate with each other.

  16. Secondary prevention following coronary artery bypass surgery: a pilot study for improved patient education

    E-print Network

    Kramer, Jeffrey B.; Howard, Patricia A.; Barnes, Brian Joseph; Ababneh, Bashar; Mukhopadhyay, Purna; Biria, Mazda; Muehlebach, Gregory F.; Daon, Emmanuel; Zorn, George L.; Reed, William A.; Vacek, James

    2012-07-01

    of statin induced rhabdomyolysis ? Severe co-morbid illness /end of life status Box 1. Indications and contraindications to secondary pre- vention medications after coronary artery bypass graft sur- gery (CABG). 100 to obtain a survey score for both...

  17. Repair of abdominal aortic aneurysm by transfemoral endovascular graft placement.

    PubMed Central

    Moore, W S; Vescera, C L

    1994-01-01

    PURPOSE: The authors describe the initial clinical experience with a new device, approved by the FDA for investigation, for repair of abdominal aortic aneurysm by transfemoral endovascular insertion of an aortic graft. METHODS: Sixty-nine patients with abdominal aortic aneurysms were screened, and ten were found to be suitable for endovascular grafting. Repair was done in the operating room using general anesthesia. One femoral artery was surgically exposed, and the device, containing a premeasured graft with proximal and distal self-expanding fixation devices, was inserted with fluoroscopic control through an open arteriotomy. FINDINGS: Eight of ten patients underwent successful graft placement, and two patients required conversion to an open repair. On follow-up, six of eight patients who underwent graft placement functioned normally, with documented aneurysm thrombosis. Two patients who underwent graft placement functioned normally, with contrast computed tomography evidence of incomplete aneurysm thrombosis, but without further expansion. CONCLUSION: Transfemoral repair is safe and appears to be effective. Phase II study currently is appropriate, with need for long-term follow-up. Images Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. PMID:8092899

  18. ?-casein gene expression by in vitro cultured bovine mammary epithelial cells derived from developing mammary glands.

    PubMed

    Monzani, P S; Bressan, F F; Mesquita, L G; Sangalli, J R; Meirelles, F V

    2011-01-01

    Epithelial cells from mammary gland tissue that are cultured in vitro are able to maintain specific functions of this gland, such as cellular differentiation and milk protein synthesis. These characteristics make these cells a useful model to study mammary gland physiology, development and differentiation; they can also be used for production of exogenous proteins of pharmaceutical interest. Bovine mammary epithelial cells were cultured in vitro after isolation from mammary gland tissue of animals at different stages of development. The cells were plated on Petri dishes and isolated from fibroblasts using saline/EDTA treatment, followed by trypsinization. Cells isolated on plastic were capable of differentiating into alveolus-like structures; however, only cells derived from non-pregnant and non-lactating animals expressed ?-casein. Real-time qPCR and epifluorescence microscopy analyses revealed that alveolus-like structures were competent at expressing Emerald green fluorescent protein (EmGFP) driven by the ?-casein promoter, independent of ?-casein expression. PMID:21491370

  19. Perioperative myocardial infarction associated with coronary artery bypass graft surgery: improved sensitivity in the diagnosis within 6 hours after operation with 99mTc-glucoheptonate myocardial imaging and myocardial-specific isoenzymes.

    PubMed

    Roberts, A J; Combes, J R; Jacobstein, J G; Alonso, D R; Post, M R; Subramanian, V A; Abel, R M; Brachfeld, N; Kline, S A; Gay, W A

    1979-01-01

    The present study was performed to evaluate scintigraphic imaging with technetium 99m-labeled glucoheptonate and serum enzyme levels of creatine phosphokinase isoenzyme (MB-CPK) in the early diagnosis of perioperative acute myocardial infarction associated with saphenous vein bypass graft operations. Myocardial imaging was done in 27 patients (50% of whom were considered high-risk) before operation and again 5 hours after operation. Four of these patients (15%) had both electrocardiographic and serum MB-CPK evidence of acute myocardial infarction, and all 4 had developed positive postoperative scintigrams. Four other patients had only elevated serum MB-CPK, and scintigrams became positive after operation in 3 of them. In addition, serum MB-CPK 6 hours after operation was 83 +/- 21 mIU/ml (mean +/- standard error of the mean) in patients with positive postoperative scans compared with 24 +/- 5 mIU/ml in those patients with negative postoperative scintigrams (p less than 0.001). Myocardial imaging with 99mTc-glucoheptonate in the perioperative period is rapid, safe, and atraumatic. Furthermore, our results suggest that it is a sensitive method for the early diagnosis of perioperative acute myocardial infarction, and, when imaging is combined with serum MB-CPK isoenzyme analysis, the reliability of the diagnosis of acute myocardial infarction is enhanced even further. Only 1 of the patients who showed perioperative myocardial damage had acute hemodynamic compromise or obvious impairment of recovery in the immediate postoperative period, and the 30-day mortality of the total group was 4% (1 of 27). PMID:313189

  20. Inferior mesenteric artery aneurysm: case report and literature review.

    PubMed

    Edogawa, Seiji; Shibuya, Takashi; Kurose, Kimihiro; Sasaki, Kazuki; Tomita, Hirohiko

    2013-01-01

    An inferior mesenteric artery (IMA) aneurysm is the rarest among visceral artery aneurysms. A 69-year-old man was referred to our hospital with an asymptomatic IMA aneurysm associated with occlusion of the superior mesenteric artery (SMA) and celiac artery (CA). After revascularization of the SMA with an 8-mm expanded polytetrafluoroethylene (ePTFE) graft, the aneurysm was resected, and the IMA was reconstructed. The "jet disorder" phenomenon has been thought to cause an IMA aneurysm in the case of CA and SMA obstruction. We consider it better to revascularize not only an IMA but also an SMA or CA for preventing that phenomenon. PMID:23641294

  1. Inferior Mesenteric Artery Aneurysm: Case Report and Literature Review

    PubMed Central

    Shibuya, Takashi; Kurose, Kimihiro; Sasaki, Kazuki; Tomita, Hirohiko

    2013-01-01

    An inferior mesenteric artery (IMA) aneurysm is the rarest among visceral artery aneurysms. A 69-year-old man was referred to our hospital with an asymptomatic IMA aneurysm associated with occlusion of the superior mesenteric artery (SMA) and celiac artery (CA). After revascularization of the SMA with an 8-mm expanded polytetrafluoroethylene (ePTFE) graft, the aneurysm was resected, and the IMA was reconstructed. The “jet disorder” phenomenon has been thought to cause an IMA aneurysm in the case of CA and SMA obstruction. We consider it better to revascularize not only an IMA but also an SMA or CA for preventing that phenomenon. PMID:23641294

  2. Mouse Mammary Tumor Virus-Like Nucleotide Sequences in Canine and Feline Mammary Tumors?

    PubMed Central

    Hsu, Wei-Li; Lin, Hsing-Yi; Chiou, Shyan-Song; Chang, Chao-Chin; Wang, Szu-Pong; Lin, Kuan-Hsun; Chulakasian, Songkhla; Wong, Min-Liang; Chang, Shih-Chieh

    2010-01-01

    Mouse mammary tumor virus (MMTV) has been speculated to be involved in human breast cancer. Companion animals, dogs, and cats with intimate human contacts may contribute to the transmission of MMTV between mouse and human. The aim of this study was to detect MMTV-like nucleotide sequences in canine and feline mammary tumors by nested PCR. Results showed that the presence of MMTV-like env and LTR sequences in canine malignant mammary tumors was 3.49% (3/86) and 18.60% (16/86), respectively. For feline malignant mammary tumors, the presence of both env and LTR sequences was found to be 22.22% (2/9). Nevertheless, the MMTV-like LTR and env sequences also were detected in normal mammary glands of dogs and cats. In comparisons of the MMTV-like DNA sequences of our findings to those of NIH 3T3 (MMTV-positive murine cell line) and human breast cancer cells, the sequence similarities ranged from 94 to 98%. Phylogenetic analysis revealed that intermixing among sequences identified from tissues of different hosts, i.e., mouse, dog, cat, and human, indicated the MMTV-like DNA existing in these hosts. Moreover, the env transcript was detected in 1 of the 19 MMTV-positive samples by reverse transcription-PCR. Taken together, our study provides evidence for the existence and expression of MMTV-like sequences in neoplastic and normal mammary glands of dogs and cats. PMID:20881168

  3. Peripheral Artery Disease

    MedlinePLUS

    ... Physician Resources Professions Site Index A-Z Peripheral Artery Disease (PAD) Peripheral artery disease (PAD) refers to ... is peripheral artery disease treated? What is peripheral artery disease (PAD)? Peripheral artery disease, or PAD, refers ...

  4. Dietary genistein stimulates mammary development in gilts

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The possible role of the phytoestrogen, genistein, on prepubertal development of mammary glands, hormonal status and bone resorption was investigated in gilts. Forty-five gilts were fed a control diet containing soya (CTLS, n = 15), a control diet without soya (CTL0, n = 15) or the CTLS diet supplem...

  5. Grafting Technique to Eliminate Rootstock Suckering of Grafted Tomatoes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Vegetable grafting has been proposed as a technique for avoiding disease problems in tomatoes in open field production. In this study we investigated the current use of grafting in an open field scenario and found a serious problem with the grafting techniques. In the Fall of 2007, commercially pr...

  6. Robot-Assisted Antegrade In-Situ Fenestrated Stent Grafting

    SciTech Connect

    Riga, Celia V. Bicknell, Colin D.; Wallace, Daniel; Hamady, Mohamad; Cheshire, Nicholas

    2009-05-15

    To determine the technical feasibility of a novel approach of in-situ fenestration of aortic stent grafts by using a remotely controlled robotic steerable catheter system in the porcine model. A 65-kg pig underwent robot-assisted bilateral antegrade in-situ renal fenestration of an abdominal aortic stent graft with subsequent successful deployment of a bare metal stent into the right renal artery. A 16-mm iliac extension covered stent served as the porcine aortic endograft. Under fluoroscopic guidance, the graft was punctured with a 20-G customized diathermy needle that was introduced and kept in place by the robotic arm. The needle was exchanged for a 4 x 20 mm cutting balloon before successful deployment of the renal stent. Robot-assisted antegrade in-situ fenestration is technically feasible in a large mammalian model. The robotic system enables precise manipulation, stable positioning, and minimum instrumentation of the aorta and its branches while minimizing radiation exposure.

  7. Grafts for Ridge Preservation

    PubMed Central

    Jamjoom, Amal; Cohen, Robert E.

    2015-01-01

    Alveolar ridge bone resorption is a biologic phenomenon that occurs following tooth extraction and cannot be prevented. This paper reviews the vertical and horizontal ridge dimensional changes that are associated with tooth extraction. It also provides an overview of the advantages of ridge preservation as well as grafting materials. A Medline search among English language papers was performed in March 2015 using alveolar ridge preservation, ridge augmentation, and various graft types as search terms. Additional papers were considered following the preliminary review of the initial search that were relevant to alveolar ridge preservation. The literature suggests that ridge preservation methods and augmentation techniques are available to minimize and restore available bone. Numerous grafting materials, such as autografts, allografts, xenografts, and alloplasts, currently are used for ridge preservation. Other materials, such as growth factors, also can be used to enhance biologic outcome. PMID:26262646

  8. Hyaluronic acid enhancement of expanded polytetrafluoroethylene for small diameter vascular grafts

    NASA Astrophysics Data System (ADS)

    Lewis, Nicole R.

    Cardiovascular disease is the leading cause of mortality and morbidity in the United States and other developed countries. In the United States alone, 8 million people are diagnosed with peripheral arterial disease per year and over 250,000 patients have coronary bypass surgery each year. Autologous blood vessels are the standard graft used in small diameter (<6mm) arterial bypass procedures. Synthetic small diameter grafts have had limited success. While polyethylene (Dacron) and expanded polytetrafluoroethylene (ePTFE) are the most commonly used small diameter synthetic vascular graft materials, there are significant limitations that make these materials unfavorable for use in the low blood flow conditions of the small diameter arteries. Specifically, Dacron and ePTFE grafts display failure due to early thrombosis or late intimal hyperplasia. With the shortage of tissue donors and the limited supply of autologous blood vessels available, there is a need for a small diameter synthetic vascular graft alternative. The aim of this research is to create and characterize ePTFE grafts prepared with hyaluronic acid (HA), evaluate thrombogenic potential of ePTFE-HA grafts, and evaluate graft mechanical properties and coating durability. The results in this work indicate the successful production of ePTFE-HA materials using a solvent infiltration technique. Surface interactions with blood show increased platelet adhesion on HA-modified surfaces, though evidence may suggest less platelet activation and erythrocyte lysis. Significant changes in mechanical properties of HA-modified ePTFE materials were observed. Further investigation into solvent selection, uniformity of HA, endothelialization, and dynamic flow testing would be beneficial in the evaluation of these materials for use in small diameter vascular graft bypass procedures.

  9. Microvascular assembly and cell invasion in chick mesonephros grafted onto chorioallantoic membrane

    PubMed Central

    Navarro, Marc; DeRuiter, Marco C; Carretero, Ana; Ruberte, Jesús

    2003-01-01

    Embryonic tissues, in common with other tissues, including tumours, tend to develop a substantial vasculature when transplanted onto the chorioallantoic membrane (CAM). Studies conducted to date have not examined in any detail the identity of vessels that supply these grafts, although it is known that the survival of transplanted tissues depends on their ability to connect with CAM vessels supplying oxygen and nutrients. We grafted the mesonephros, a challenging model for studies in vascular development, when it was fully developed (HH35). We used reciprocal chick-quail transplantations in order to study the arterial and venous connections and to analyse the cell invasion from the CAM to the organ, whose degeneration in normal conditions is rapid. The revascularization of the grafted mesonephros was produced by the formation of peripheral anastomoses between the graft and previous host vasculatures. The assembly of graft and CAM blood vessels occurred between relatively large arteries or veins, resulting in chimeric vessels of varying morphology depending on their arterial or venous status. Grafts showed an increased angiogenesis from their original vasculature, suggesting that the normal vascular degeneration of the mesonephros was partially inhibited. Three types of isolated host haemangioblast were identified in the mesonephros: migrating angioblast-like cells, indicating vasculogenesis, undifferentiated haematopoietic cells and macrophages, which might have been involved in the angiogenesis. Tomato lectin was found to bind activated macrophages in avian embryos. PMID:12647871

  10. Interposition vein graft for giant coronary aneurysm repair

    NASA Technical Reports Server (NTRS)

    Firstenberg, M. S.; Azoury, F.; Lytle, B. W.; Thomas, J. D.

    2000-01-01

    Coronary aneurysms in adults are rare. Surgical treatment is often concomitant to treating obstructing coronary lesions. However, the ideal treatment strategy is poorly defined. We present a case of successful treatment of a large coronary artery aneurysm with a reverse saphenous interposition vein graft. This modality offers important benefits over other current surgical and percutaneous techniques and should be considered as an option for patients requiring treatment for coronary aneurysms.

  11. Extracorporeal membrane oxygenation in pulmonary crisis and primary graft dysfunction.

    PubMed

    Hsu, Hsao-Hsun; Ko, Wen-Je; Chen, Jin-Shing; Lin, Cheng-Hsin; Kuo, Shuenn-Wen; Huang, Shu-Chien; Lee, Yung-Chie

    2008-02-01

    This report describes the clinical use of an extracorporeal membrane oxygenation system in a 23-year-old woman with severe pulmonary arterial hypertension due to end-stage systemic lupus erythematosus. The system was also used to provide a direct bridge from resuscitation to transplantation after acute onset of pulmonary crisis and maintenance of stable hemodynamics during the bilateral lung transplant, and also to provide optimal oxygenation until the transplanted lung recovered from severe primary graft dysfunction. PMID:18267233

  12. Aspirin and dipyridamole reduce platelet deposition on prosthetic femoro-popliteal grafts in man.

    PubMed Central

    Goldman, M D; Simpson, D; Hawker, R J; Norcott, H C; McCollum, C N

    1983-01-01

    Platelet inhibitory drugs may be used in an attempt to reduce high failure rates in small artery bypass using prosthetic grafts. We evaluated in patients the effects of aspirin and dipyridamole (ASA/DPM) on radiolabelled platelet accumulation on femoro-popliteal grafts of Dacron, polytetrafluorethylene and saphenous vein. Forty-seven patients awaiting femoro-popliteal bypass received, at random and double blind, either ASA/DPM or placebo capsules. On the seventh postoperative day, the 42 remaining patients with patent grafts were injected with autologous 111-Indium labelled platelets. Graft platelet accumulation was expressed as the Thrombogenicity Index (TI), which was defined as the mean daily rise in the ratio of radioactivity over the graft to that over the contralateral thigh. ASA/DPM reduced mean (+/- s.e. mean) TI in Dacron grafts from 0.25 +/- 0.09 on placebo to 0.16 +/- 0.05 (p less than 0.05). Mean TI in polytetrafluorethylene grafts was also significantly lower at 0.06 +/- 0.01 on ASA/DPM compared to 0.16 +/- 0.03 on placebo. Vein grafts, however, accumulated few, if any, labelled platelets and ASA/DPM had no further influence. ASA/DPM reduces platelet accumulation in prosthetic femoro-popliteal grafts in man. Images Fig. 1. PMID:6227296

  13. Endovascular stent-graft treatment for a traumatic vertebrovertebral arteriovenous fistula with pseudoaneurysm.

    PubMed

    Li, Fangda; Song, Xiaojun; Liu, Changwei; Liu, Bao; Zheng, Yuehong

    2014-02-01

    The rarely occurring vertebrovertebral arteriovenous fistula (VVAVF) is characterized by abnormal direct communications between the vertebral artery or its branches and the neighboring venous system. We present our experience using a stent graft to occlude a chronic, traumatic VVAVF. A 40-year-old woman with dizziness and loud bruits from the occiput underwent digital subtraction angiography (DSA), which revealed a VVAVF with pseudoaneurysm at the C5-C6 level, with retrograde flow from the right vertebral artery. A stent graft was placed across the fistula after balloon dilation. The fistula and pseudoaneurysm disappeared immediately. After 9 months, the patient remained asymptomatic with a patent stent. PMID:24200138

  14. Bone Grafts in Craniofacial Surgery

    PubMed Central

    Elsalanty, Mohammed E.; Genecov, David G.

    2009-01-01

    Reconstruction of cranial and maxillofacial defects is a challenging task. The standard reconstruction method has been bone grafting. In this review, we shall describe the biological principles of bone graft healing, as pertinent to craniofacial reconstruction. Different types and sources of bone grafts will be discussed, as well as new methods of bone defect reconstruction. PMID:22110806

  15. Aortic Stent-Graft Infection Following Septic Complications of a Kidney Stone

    SciTech Connect

    Berg, H. Rogier van den Leijdekkers, Vanessa J.; Vahl, Anco

    2006-06-15

    A 73-year-old man was treated because of a renal pelvis blowout of the left kidney for which he received a nephrostomy catheter without antibiotic prophylaxis. Almost a year previously this patient had undergone endovascular repair of a symptomatic infrarenal abdominal aorta aneurysm. Four weeks after the diagnosis and treatment of the ruptured renal pelvis, a new computed tomography scan and ultrasound-guided fine needle aspiration confirmed the diagnosis of infected aortic stent-graft. An extra-anatomic axillo-uniiliac bypass and graft excision was performed. Two weeks after discharge the patient returned to the hospital with an occlusion of his left renal artery and died of renal failure. This is the first time an infected aortic stent-graft after a renal pelvis blowout has been reported. Although infections of aortic stent-grafts occur rarely, one should be aware of the possibility in aortic stent-graft patients undergoing abdominal procedures without antibiotic prophylaxis.

  16. Leaking false aneurysm of right coronary saphenous vein graft: successful treatment by percutaneous coil embolisation

    PubMed Central

    Dimitri, W R; Reid, A W; Dunn, F G

    1992-01-01

    An unusual complication after aortocoronary bypass grafting (CABG) is described in which a false aneurysm of the saphenous vein graft to the right coronary artery (RCA) developed and caused profuse intermittent bleeding through the sternotomy wound. The aetiology of this condition is uncertain but it could occur whenever a suture line is present especially in the presence of infection. The diagnosis was made non-invasively by a contrast enhanced computed tomogram and was subsequently confirmed by selective coronary bypass angiography. The pseudoaneurysm was successfully obliterated by coil embolisation of the right coronary graft, which stopped the bleeding immediately and was followed by rapid wound healing. PMID:1467059

  17. Aspirin and dipyridamole decrease intimal hyperplasia in experimental vein grafts.

    PubMed Central

    McCann, R L; Hagen, P O; Fuchs, J C

    1980-01-01

    Release from platelets of a factor mitogenic for smooth muscle cells is a postulated mechanism for the pathogenesis of vascular intimal hyperplasia. In this study the effect of antiplatelet therapy was evaluated. Aspirin (165 mg twice daily) and dipyridamole (25 mg twice daily) were administered to six rhesus monkeys and six were given placebo only. Bilateral vein bypass grafts were placed in the iliac arteries. In addition, to evaluate the relative contribution of adventitial dissection and intimal injury, on one side the carotid artery and femoral vein were stripped of adventitia and on the other side the intima of these vessels were injured by the single passage of an inflated balloon tipped catheter. Animals were killed after 16 weeks. In grafts relative luminal area was determined by a photographic gravimetric method at three standard locations. Femoral veins and carotid arteries were classified as histologically normal or as exhibiting hyperplasia. All vessels with adventitial stripping were normal. All vessels with intimal injury in the placebo group except one exhibited intimal hyperplasia compared to the drug treated group in which over half were normal. Relative intimal area was significantly less in grafts from drug treated animals at all three locations and luminal area greater in two. These data suggest that vascular intimal hyperplasia can be reduced by treatment with antiplatelet agents. Images Fig. 1. Fig. 2a. Fig. 2b. Fig. 3. PMID:6767450

  18. Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions.

    PubMed Central

    Marin, M L; Veith, F J; Cynamon, J; Sanchez, L A; Lyon, R T; Levine, B A; Bakal, C W; Suggs, W D; Wengerter, K R; Rivers, S P

    1995-01-01

    OBJECTIVES: Complex arterial occlusive, traumatic, and aneurysmal lesions may be difficult or impossible to treat successfully by standard surgical techniques when severe medical or surgical comorbidities exist. The authors describe a single center's experience over a 2 1/2-year period with 96 endovascular graft procedures performed to treat 100 arterial lesions in 92 patients. PATIENTS AND METHODS: Thirty-three patients had 36 large aortic and/or peripheral artery aneurysms, 48 had 53 multilevel limb-threatening aortoiliac and/or femoropopliteal occlusive lesions, and 11 had traumatic arterial injuries (false aneurysms and arteriovenous fistulas). Endovascular grafts were placed through remote arteriotomies under local (16[17%]), epidural (42[43%]), or general (38[40%]) anesthesia. RESULTS: Technical and clinical successes were achieved in 91% of the patients with aneurysms, 91% with occlusive lesions, and 100% with traumatic arterial lesions. These patients and grafts have been followed from 1 to 30 months (mean, 13 months). The primary and secondary patency rates at 18 months for aortoiliac occlusions were 77% and 95%, respectively. The 18-month limb salvage rate was 98%. Immediately after aortic aneurysm exclusion, a total of 6 (33%) perigraft channels were detected; 3 of these closed within 8 weeks. Endovascular stented graft procedures were associated with a 10% major and a 14% minor complication rate. The overall 30-day mortality rate for this entire series was 6%. CONCLUSIONS: This initial experience with endovascular graft repair of complex arterial lesions justifies further use and careful evaluation of this technique for major arterial reconstruction. Images Figure 1. Figure 4. Figure 5. Figure 5. Figure 6. Figure 7. Figure 8. Figure 9. Figure 11. PMID:7574926

  19. Inadvertent subclavian artery cannulation treated by percutaneous closure.

    PubMed

    Cohen, José E; Moshe Gomori, J; Anner, Haim; Itshayek, Eyal

    2014-11-01

    Accidental arterial puncture occurs in around 1% and 2.7% of jugular and subclavian approaches, respectively. When a line has been inadvertently inserted into an artery at a noncompressible site, there is an increased risk for serious complications. This complication can be treated by either surgical or endovascular intervention or a combination; however, in critically ill patients or in those with impaired coagulation, therapeutic options are more limited. We describe successful endovascular management of inadvertent subclavian artery cannulation during insertion of a triple lumen central line catheter in a 35-year-old man suffering from leukemia, with sepsis and multi-organ failure. He was hypotensive and hemodynamically unstable, with severe coagulopathy. The catheter had entered the artery at the level of the origin of the internal mammary artery, just above the origin of the vertebral artery. The tip was lying in the aortic arch. The artery was successfully closed by endovascular deployment of an 8 French Angio-Seal device (St. Jude Medical, St. Paul, MN, USA). The device is licensed for use in femoral arterial puncture sites but provided safe and effective closure of the subclavian artery puncture in our patient. PMID:24913929

  20. TGF-? signaling mediates endothelial to mesenchymal transition (EndMT) during vein graft remodeling

    PubMed Central

    Yang, Dan; Hilaire, Cynthia St.; Negro, Alejandra; Fang, Fang; Chen, Guibin; San, Hong; Walts, Avram D.; Schwartzbeck, Robin L.; Taylor, Brandi; Lanzer, Jan D.; Wragg, Andrew; Elagha, Abdalla; Beltran, Leilani E.; Berry, Colin; Feil, Robert; Virmani, Renu; Ladich, Elena; Kovacic, Jason C.; Boehm, Manfred

    2014-01-01

    Veins grafted into an arterial environment undergo a complex vascular remodeling process. Pathologic vascular remodeling often results in stenosed or occluded conduit grafts. Understanding this complex process is important for improving the outcome of patients with coronary and peripheral artery disease undergoing surgical revascularization. Using in vivo murine cell lineage-tracing models, we show that endothelial-derived cells contribute to neointimal formation through endothelial to mesenchymal transition (EndMT), which is dependent upon early activation of the Smad2/3-Slug signaling pathway. Antagonism of TGF-? signaling by TGF-? neutralizing antibody, shRNA-mediated Smad3 or Smad2 knockdown, Smad3 haploinsufficiency, or endothelial cell-specific Smad2 deletion resulted in decreased EndMT and less neointimal formation compared to controls. Histological examination of postmortem human vein graft tissue corroborated the changes observed in our mouse vein graft model, suggesting that EndMT is operative during human vein graft remodeling. These data establish that EndMT is an important mechanism underlying neointimal formation in interpositional vein grafts, and identifies the TGF-?/Smad2/3-Slug signaling pathway as a potential therapeutic target to prevent clinical vein graft restenosis. PMID:24622514

  1. Arterial embolism

    MedlinePLUS

    ... There may be signs of tissue death or gangrene. Tests to diagnose arterial embolism or reveal the ... or permanent kidney failure Tissue death ( necrosis ) and gangrene Transient ischemic attack (TIA)

  2. Arterial Catheterization

    MedlinePLUS

    ... mechanical ventilator (respirator; breathing machine) settings. The blood oxygen pres- sure measures from an arterial line give more de- tailed information than that from a pulse oximeter (a sensor that is clipped on to a patient’s finger, ...

  3. Grafting for disease resistance

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The primary purpose of grafting vegetables worldwide has been to provide resistance to soilborne diseases. The potential loss of methyl bromide as a soil fumigant combined with pathogen resistance to commonly used pesticides will make resistance to soil born pathogens even more important in the futu...

  4. Acrylonitrile grafted to PVDF

    DOEpatents

    Yang, Jin; Eitouni, Hany Basam

    2015-03-31

    PVDF-g-PAN has been synthesized by grafting polyacrylonitrile onto polyvinylidene fluoride using an ATRP/AGET method. The novel polymer is ionically conducive and has much more flexibility than PVDF alone, making it especially useful either as a binder in battery cell electrodes or as a polymer electrolyte in a battery cell.

  5. Coronary Artery Disease and Diabetes Mellitus.

    PubMed

    Aronson, Doron; Edelman, Elazer R

    2016-01-01

    Diabetes mellitus (DM) is a major risk factor for cardiovascular disease. Near-normal glycemic control does not reduce cardiovascular events. For many patients with 1- or 2-vessel coronary artery disease, there is little benefit from any revascularization procedure over optimal medical therapy. For multivessel coronary disease, randomized trials demonstrated the superiority of coronary artery bypass grafting over multivessel percutaneous coronary intervention in patients with treated DM. However, selection of the optimal myocardial revascularization strategy requires a multidisciplinary team approach ('heart team'). This review summarizes the current evidence regarding the effectiveness of various medical therapies and revascularization strategies in patients with DM. PMID:26567979

  6. Arterial Stiffness

    PubMed Central

    Avolio, Alberto

    2013-01-01

    Stiffness of large arteries has been long recognized as a significant determinant of pulse pressure. However, it is only in recent decades, with the accumulation of longitudinal data from large and varied epidemiological studies of morbidity and mortality associated with cardiovascular disease, that it has emerged as an independent predictor of cardiovascular risk. This has generated substantial interest in investigations related to intrinsic causative and associated factors responsible for the alteration of mechanical properties of the arterial wall, with the aim to uncover specific pathways that could be interrogated to prevent or reverse arterial stiffening. Much has been written on the haemodynamic relevance of arterial stiffness in terms of the quantification of pulsatile relationships of blood pressure and flow in conduit arteries. Indeed, much of this early work regarded blood vessels as passive elastic conduits, with the endothelial layer considered as an inactive lining of the lumen and as an interface to flowing blood. However, recent advances in molecular biology and increased technological sophistication for the detection of low concentrations of biochemical compounds have elucidated the highly important regulatory role of the endothelial cell affecting vascular function. These techniques have enabled research into the interaction of the underlying passive mechanical properties of the arterial wall with the active cellular and molecular processes that regulate the local environment of the load-bearing components. This review addresses these emerging concepts. PMID:26587425

  7. Improved endothelial cell seeding with cultured cells and fibronectin-coated grafts

    SciTech Connect

    Seeger, J.M.; Klingman, N.

    1985-06-01

    A possible approach to the low seeding efficiency of endothelial cells into prosthetic grafts is to increase the number of cells to be seeded in cell culture and improve seeding efficiency by graft precoating with fibronectin. The effect of cell culture on cell adhesion is unknown, however, and fibronectin also binds fibrin, which may increase the thrombogenicity of the graft luminal surface. To investigate these questions, freshly harvested canine jugular vein endothelial cells from six animals and similar cells harvested from six primary and eight secondary cell cultures were labeled with /sup 111/Indium and seeded into 5 cm, 4 mm PTFE grafts coated with fibronectin, using similar uncoated PTFE grafts as controls. Platelet accumulation and distribution on six similar coated and uncoated grafts placed in canine carotid, external jugular arterial venous shunts for 2 hr were also determined using autogenous /sup 111/Indium-labeled platelets. Significant differences between group means were determined using the paired Student's t test. Results reveal that seeding efficiency is significantly better in all groups of coated grafts compared to uncoated grafts (P less than 0.01). Cells derived from cell culture also had significantly higher seeding efficiencies than freshly harvested cells when seeded into coated grafts (P less than 0.05) and tended to have higher seeding efficiencies than harvested cells when seeded into uncoated grafts (P = 0.53). Fibronectin coating increased mean platelet accumulation on the entire graft luminal surface, but not to a statistically significant degree (P greater than 0.1). Whether this increased seeding efficiency will improve graft endothelialization remains to be investigated.

  8. The role of neutralizing antibodies for mouse mammary tumor virus transmission and mammary cancer development

    NASA Astrophysics Data System (ADS)

    Finke, Daniela; Luther, Sanjiv A.; Acha-Orbea, Hans

    2003-01-01

    Mouse mammary tumor virus (MMTV) infection establishes chronic germinal centers and a lifelong neutralizing Ab response. We show that removal of the draining lymph node after establishment of the germinal center reaction led to complete loss of neutralizing Abs despite comparable infection levels in peripheral lymphocytes. Importantly, in the absence of neutralization, only the exocrine organs mammary gland, salivary gland, pancreas, and skin showed strikingly increased infection, resulting in accelerated mammary tumor development. Induction of stronger neutralization did not influence chronic infection levels of peripheral lymphoid organs but strongly inhibited mammary gland infection and virus transmission to the next generation. Taken together, we provide evidence that a tight equilibrium in virus neutralization allows limited infection of exocrine organs and controls cancer development in susceptible mouse strains. These experiments show that a strong neutralizing Ab response induced after infection is not able to control lymphoid MMTV infection. Strong neutralization, however, is capable of blocking amplification of mammary gland infection, tumor development, and virus transmission to the next generation. The results also indicate a role of neutralization in natural resistance to MMTV infection.

  9. Embolized ductus device extraction and associated iliofemoral artery repair.

    PubMed

    Ahmad, Tanveer; Pasarad, Ashwini Kumar; Kishore, Kolkebaile Sadanand; Maheshwarappa, Nandakumar Neralakere

    2016-01-01

    Less-invasive methods for nonsurgical closure of a patent ductus arteriosus have gained popularity as first-line therapy. An 11-year-old girl underwent percutaneous patent ductus arteriosus closure with a device. The device embolized into the descending aorta. An attempt at catheter retrieval was complicated by iliofemoral arterial injury. Subsequent device extraction was performed with repair of the arterial injury using a tube graft. PMID:25114323

  10. Double level arterial injury with neuropraxia following anterior shoulder dislocation.

    PubMed

    Zaraa, Mourad; Sehli, Heithem; Mahjoub, Sabri; Dridi, Moez; Mbarek, Mondher

    2015-12-01

    Vascular and nervous complications are rare after shoulder dislocation. We report the case of a double level arterial injury with neuropraxia following anterior shoulder dislocation that was diagnosed by MultiDetector-row Computed Tomographic (MDCT) angiography and treated by surgical bypass graft and embolectomy. Our case is original, not only because of the rarity of these complications, but also because of the thromboembolism of brachial artery which could be undiagnosed and could compromise prognosis. PMID:26566344

  11. Carotid artery surgery

    MedlinePLUS

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  12. Bone Graft Substitution and Augmentation.

    PubMed

    Nauth, Aaron; Lane, Joseph; Watson, J Tracy; Giannoudis, Peter

    2015-12-01

    Selection of appropriate bone graft or bone graft substitute requires careful recognition of the bone healing needs of the patient's specific clinical problem and a thorough understanding of the different properties possessed by the available bone grafts and substitutes. Although autogenous iliac crest bone graft remains the gold standard of treatment for delayed unions, nonunions, and bone defects, there are a number of promising alternatives available, and emerging evidence suggests that they can be very effective when used in the proper setting. Among these, reamer-irrigator-aspirator bone graft, bone marrow concentrate, bone morphogenetic proteins, and calcium phosphate cements have received a great deal of attention in the literature. This review describes these grafts in detail along with the evidence for their use. In addition, a framework is provided for selecting the appropriate graft or substitute based on their provided properties. PMID:26584264

  13. Establishment of Mammary Gland Model In Vitro: Culture and Evaluation of a Yak Mammary Epithelial Cell Line

    PubMed Central

    Xiong, Xianrong; Lan, Daoliang; Li, Jian

    2014-01-01

    This study aimed to establish yak mammary epithelial cells (YMECs) for an in vitro model of yak mammary gland biology. The primary culture of YMECs was obtained from mammary gland tissues of lactating yak and then characterized using immunocytochemistry, RT-PCR, and western blot analysis. Whether foreign genes could be transfected into the YMECs were examined by transfecting the EGFP gene into the cells. Finally, the effect of Staphylococcus aureus infection on YMECs was determined. The established YMECs retained the mammary epithelial cell characteristics. A spontaneously immortalized yak mammary epithelial cell line was established and could be continuously subcultured for more than 60 passages without senescence. The EGFP gene was successfully transferred into the YMECs, and the transfected cells could be maintained for a long duration in the culture by continuous subculturing. The cells expressed more antimicrobial peptides upon S.aureus invasion. Therefore, the established cell line could be considered a model system to understand yak mammary gland biology. PMID:25479378

  14. Acute Popliteal Artery Occlusion after Revision Total Knee Arthroplasty

    PubMed Central

    Tsujimoto, Ryu; Matsumoto, Tomoyuki; Takayama, Koji; Kawakami, Yohei; Kamimura, Masato; Matsushita, Takehiko; Kuroda, Ryosuke; Kurosaka, Masahiro

    2015-01-01

    Acute arterial occlusions are a rare complication of total knee arthroplasty (TKA). However, in revision TKA, the risk of such complications is higher and these complications can lead to amputation if not adequately treated. We describe a case of acute popliteal artery occlusion 4 hours after second revision TKA in a patient with a history of several surgical procedures because of periprosthetic infection at a previous hospital. Revascularization was achieved via bypass grafting and amputation was narrowly avoided despite time lag after symptom onset to revascularization. In this case, it was possible that the arterial disease that accompanied the vascular endothelium injury such as pseudoaneurysm had existed since the previous surgery at another hospital and was destroyed by the surgical procedure, which led to the formation of thrombosis and arterial occlusion. Preoperative evaluation of the arterial condition should be considered to avoid acute arterial occlusive disease, especially in patients who had several previous surgical procedures. PMID:26357582

  15. PKA signaling drives mammary tumorigenesis through Src.

    PubMed

    Beristain, A G; Molyneux, S D; Joshi, P A; Pomroy, N C; Di Grappa, M A; Chang, M C; Kirschner, L S; Privé, G G; Pujana, M A; Khokha, R

    2015-02-26

    Protein kinase A (PKA) hyperactivation causes hereditary endocrine neoplasias; however, its role in sporadic epithelial cancers is unknown. Here, we show that heightened PKA activity in the mammary epithelium generates tumors. Mammary-restricted biallelic ablation of Prkar1a, which encodes for the critical type-I PKA regulatory subunit, induced spontaneous breast tumors characterized by enhanced type-II PKA activity. Downstream of this, Src phosphorylation occurs at residues serine-17 and tyrosine-416 and mammary cell transformation is driven through a mechanism involving Src signaling. The phenotypic consequences of these alterations consisted of increased cell proliferation and, accordingly, expansion of both luminal and basal epithelial cell populations. In human breast cancer, low PRKAR1A/high SRC expression defines basal-like and HER2 breast tumors associated with poor clinical outcome. Together, the results of this study define a novel molecular mechanism altered in breast carcinogenesis and highlight the potential strategy of inhibiting SRC signaling in treating this cancer subtype in humans. PMID:24662820

  16. Overexpression of Human Cripto-1 in Transgenic Mice Delays Mammary Gland Development and Differentiation and Induces Mammary Tumorigenesis

    PubMed Central

    Sun, Youping; Strizzi, Luigi; Raafat, Ahmed; Hirota, Morihisa; Bianco, Caterina; Feigenbaum, Lionel; Kenney, Nicholas; Wechselberger, Christian; Callahan, Robert; Salomon, David S.

    2005-01-01

    Overexpression of Cripto-1 has been reported in several types of human cancers including breast cancer. To investigate the role of human Cripto-1 (CR-1) in mammary gland development and tumorigenesis, we developed transgenic mice that express the human CR-1 transgene under the regulation of the whey acidic protein (WAP) promoter in the FVB/N mouse background. The CR-1 transgene was detected in the mammary gland of 15-week-old virgin WAP-CR-1 female mice that eventually developed hyperplastic lesions. From mid-pregnancy to early lactation, mammary lobulo-alveolar structures in WAP-CR-1 mice were less differentiated and delayed in their development due to decreased cell proliferation as compared to FVB/N mice. Early involution, due to increased apoptosis, was observed in the mammary glands of WAP-CR-1 mice. Higher levels of phosphorylated AKT and MAPK were detected in mammary glands of multiparous WAP-CR-1 mice as compared to multiparous FVB/N mice suggesting increased cell proliferation and survival of the transgenic mammary gland. In addition, more than half (15 of 29) of the WAP-CR-1 multiparous female mice developed multifocal mammary tumors of mixed histological subtypes. These results demonstrate that overexpression of CR-1 during pregnancy and lactation can lead to alterations in mammary gland development and to production of mammary tumors in multiparous mice. PMID:16049342

  17. New insights into lineage restriction of mammary gland epithelium using parity-identified mammary epithelial cells

    PubMed Central

    2014-01-01

    Introduction Parity-identified mammary epithelial cells (PI-MECs) are an interesting cellular subset because they survive involution and are a presumptive target for transformation by human epidermal growth factor receptor 2 (HER2)/neu in mammary tumors. Depending on the type of assay, PI-MECs have been designated lobule-restricted progenitors or multipotent stem/progenitor cells. PI-MECs were reported to be part of the basal population of mammary epithelium based on flow cytometry. We investigated the cellular identity and lineage potential of PI-MECs in intact mammary glands. Methods We performed a quantitative and qualitative analysis of the contribution of PI-MECs to mammary epithelial cell lineages in pregnant and involuted mammary glands by immunohistochemistry, fluorescence-activated cells sorting (FACS), and quantitative polymerase chain reaction. PI-MECs were labeled by the activation of Whey Acidic Protein (WAP)-Cre during pregnancy that results in permanent expression of yellow fluorescent protein. Results After involution, PI-MECs are present exclusively in the luminal layer of mammary ducts. During pregnancy, PI-MECs contribute to the luminal layer but not the basal layer of alveolar lobules. Strikingly, whereas all luminal estrogen receptor (ER)-negative cells in an alveolus can be derived from PI-MECs, the alveolar ER-positive cells are unlabeled and reminiscent of Notch2-traced L cells. Notably, we observed a significant population of unlabeled alveolar progenitors that resemble PI-MECs based on transcriptional and histological analysis. Conclusions Our demonstration that PI-MECs are luminal cells underscores that not only basal cells display multi-lineage potential in transplantation assays. However, the lineage potential of PI-MECs in unperturbed mammary glands is remarkably restricted to luminal ER-negative cells of the secretory alveolar lineage. The identification of an unlabeled but functionally similar population of luminal alveolar progenitor cells raises the question of whether PI-MECs are a unique population or the result of stochastic labeling. Interestingly, even when all luminal ER-negative cells of an alveolus are PI-MEC-derived, the basal cells and hormone-sensing cells are derived from a different source, indicating that cooperative outgrowth of cells from different lineages is common in alveologenesis. PMID:24398145

  18. Acute arterial occlusion - kidney

    MedlinePLUS

    Acute arterial occlusion of the kidney is a sudden, severe blockage of the artery that supplies blood to the kidney. ... The kidneys need a good blood supply. The main artery to the kidney is called the renal artery. Reduced ...

  19. Helical CT Angiography of Abdominal Aortic Aneurysms Treated with Suprarenal Stent Grafting: A Pictorial Essay

    SciTech Connect

    Sun Zhonghua

    2003-06-15

    The endovascular repair of abdominal aorticaneurysm (AAA) with stent grafts is rapidly becoming an important alternative to open repair. Suprarenal stent grafting, recently modified from conventional infrarenal stent grafting, is a technique for the purpose of treating patients with inappropriate aneurysm necks.Unlike open repair, the success of endoluminal repair cannot be ascertained by means of direct examination and thus relies on imaging results. The use of conventional angiography for arterial imaging has become less dominant, while helical computed tomography angiography(CTA) has become the imaging modality of choice for both preoperative assessment and postoperative followup after treatment with stent graft implants. There is an increasing likelihood that radiologists will become more and more involved in the procedure of aortic stent grafting and in giving the radiological report on these patients treated with stent grafts. It is necessary for radiologists to be familiar with the imaging findings, including common and uncommon appearances following aortic stent grafting. The purpose of this pictorial essay is to describe and present normal and abnormal imaging appearances following aortic stent grafting based on helical CTA.

  20. Insights into the pathogenesis of vein graft disease: lessons from intravascular ultrasound

    PubMed Central

    Murphy, Gavin J; Angelini, Gianni D

    2004-01-01

    The success of coronary artery bypass grafting (CABG) is limited by poor long-term graft patency. Saphenous vein is used in the vast majority of CABG operations, although 15% are occluded at one year with as many as 50% occluded at 10 years due to progressive graft atherosclerosis. Intravascular ultrasound (IVUS) has greatly increased our understanding of this process. IVUS studies have shown that early wall thickening and adaptive remodeling of vein grafts occurs within the first few weeks post implantation, with these changes stabilising in angiographically normal vein grafts after six months. Early changes predispose to later atherosclerosis with occlusive plaque detectable in vein grafts within the first year. Both expansive and constrictive remodelling is present in diseased vein grafts, where the latter contributes significantly to occlusive disease. These findings correlate closely with experimental and clinicopathological studies and help define the windows for prevention, intervention or plaque stabilisation strategies. IVUS is also the natural tool for evaluating the effectiveness of pharmacological and other treatments that may prevent or slow the progression of vein graft disease in clinical trials. PMID:15268762

  1. Isolated huge aneurysm of the left main coronary artery in a 22-year-old patient with type 1 neurofibromatosis.

    PubMed

    Pontailler, Margaux; Vilarem, Didier; Paul, Jean-François; Deleuze, Philippe H

    2015-03-01

    A 22-year-old patient with neurofibromatosis type 1 presented with acute chest pain. A computed tomography scan and coronary angiography revealed a partially thrombosed huge aneurysm of the left main coronary artery. Despite medical treatment, the patient's angina recurred. The patient underwent a coronary bypass grafting operation and surgical exclusion of the aneurysm. Postoperative imaging disclosed good permeability of the 3 coronary artery bypass grafts and complete thrombosis of the excluded aneurysm. PMID:25742828

  2. Siloxane-grafted membranes

    DOEpatents

    Friesen, D.T.; Obligin, A.S.

    1989-10-31

    Composite cellulosic semipermeable membranes are disclosed which are the covalently bonded reaction product of an asymmetric cellulosic semipermeable membrane and a polysiloxane containing reactive functional group. The two reactants chemically bond by ether, ester, amide or acrylate linkages to form a siloxane-grafted cellulosic membrane having superior selectivity and flux stability. Selectivity may be enhanced by wetting the surface with a swelling agent such as water.

  3. Interventional Management of Massive Hemothorax Due to Inadvertent Puncture of an Aberrant Right Subclavian Artery

    SciTech Connect

    Jahnke, Thomas Schaefer, Phillip Jost; Heller, Martin; Mueller-Huelsbeck, Stefan

    2008-07-15

    We report a case of massive hemothorax due to inadvertent puncture of an aberrant right subclavian artery during central venous access. Iatrogenic laceration at the origin of the right internal thoracic artery was successfully treated with coil embolization of the internal thoracic artery followed by stent-graft placement into the subclavian artery. Due to its elongated and abnormal course, an aberrant right subclavian artery may predispose to inadvertent puncture during vein catheterization and should be recognized as a potential threat for such procedures. Our case emphasizes that ultrasound guidance should be used routinely for central venous lines wherever possible.

  4. The performance of a small-calibre graft for vascular reconstructions in a senescent sheep model.

    PubMed

    Ahmed, Maqsood; Hamilton, George; Seifalian, Alexander M

    2014-11-01

    There is an acute clinical need for small-calibre (<6 mm) vascular grafts for surgery. The aim of this study was to evaluate the long-term performance of a small-calibre graft produced from a nanocomposite biomaterial, polyhedral oligomeric silsesquioxane poly(carbonate-urea)urethane (POSS-PCU), in a large animal model following Good Manufacturing Practice (GMP) and Good Laboratory Practice (GLP) protocols. Grafts were characterised and implanted into the left carotid artery (LCA) of senescent sheep (n = 11) for a period of 9 months. In vivo compliance and blood flow rates were measured using ultrasound wall tracking software and a Transonic flow meter. Graft patency and degree of intimal hyperplasia (IH) were examined at the study end point. Seven of the POSS-PCU grafts were free from thrombosis, IH, calcification and aneurysmal dilation, with 4 occluding within 14 days. All of the ePTFE controls (n = 4) were found to be occluded by day 32. The lumen of the patent POSS-PCU grafts was free from any cellular deposits, whilst perigraft tissue could be seen to be infiltrating into the body of the graft from the adventitia. No significant differences were detected between the blood flow rates (p = 0.3693) and compliance (p = 0.9706) of the POSS-PCU grafts and the native artery, either post-operatively or after 9 months implantation. Small-calibre vascular grafts produced from POSS-PCU offer a viable option for the clinical use in revascularisation procedures with a patency rate of 64%. PMID:25106769

  5. Embolization of experimental aneurysms using a heparin-loaded stent graft with micropores

    SciTech Connect

    Nishi, Shogo; Nakayama, Yasuhide; Ueda-Ishibashi, Hatsue; Matsuda, Takehisa

    2003-03-01

    Purpose: For percutaneous transluminal angioplasty (PTA), a heparin-loaded stent graft, composed of a commercially available metallic stent with a microporous and surface-modified thin film, has been developed. Early controlled endothelialization is promoted by a regular array of micropores produced by an excimer laser ablation technique. Early thrombus is prevented by a drug delivery system established by impregnation of photoreactive gelatin with heparin. Our stent grafts were used for embolization of experimental carotid aneurysms with an autologous external jugular vein patch in dogs. Materials and methods: At 1 month after formation, the aneurysms were occluded with stent grafts. Affected arteries were removed with the aneurysms, immediately (two aneurysms in one dog), 1 week (four aneurysms in two dogs), 1 month (three aneurysms in two dogs) and 3 months (four aneurysms in two dogs) after embolization, and were studied histologically to evaluate patency and endothelialization over the intraluminal surface of the thin film. Results: Treated carotid arteries were all patent with occluded aneurysms completely at any periods. Even at 1 week after embolization, endothelialization was confirmed on the surface of the stent graft on the lumen side. At 1 and 3 months, all treated aneurysms with enough patent parent arteries were filled with organized tissues and completely occluded. Conclusion: Our developed stent graft appears to be promising for the treatment of aneurysms, especially with respect to immediate termination of blood inflow and early endothelialization in the neck of the aneurysm.

  6. Perfusion of veins at arterial pressure increases the expression of KLF5 and cell cycle genes in smooth muscle cells

    SciTech Connect

    Amirak, Emre; Zakkar, Mustafa; Evans, Paul C.; Kemp, Paul R.

    2010-01-01

    Vascular smooth muscle cell (VSMC) proliferation remains a major cause of veno-arterial graft failure. We hypothesised that exposure of venous SMCs to arterial pressure would increase KLF5 expression and that of cell cycle genes. Porcine jugular veins were perfused at arterial or venous pressure in the absence of growth factors. The KLF5, c-myc, cyclin-D and cyclin-E expression were elevated within 24 h of perfusion at arterial pressure but not at venous pressure. Arterial pressure also reduced the decline in SM-myosin heavy chain expression. These data suggest a role for KLF5 in initiating venous SMCs proliferation in response to arterial pressure.

  7. Evolution of the mammary gland from the innate immune system?

    E-print Network

    Capecchi, Mario R.

    Evolution of the mammary gland from the innate immune system? Claudia Vorbach,1 * Mario R. Capecchi, we postulate that the mammary gland evolved from the innate immune system. In addition, we suggest as in lactation. BioEssays 28:606­616, 2006. ß 2006 Wiley Periodicals, Inc. Introduction The innate immune system

  8. A MAMMARY GLAND BIOLOGIST'S PERSEPECTIVE ON FUNCTIONAL GENOMICS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Use of molecular and genomic methodologies to study mammary gland biology has led to an increasingly reductionist approach and outlook. The mammary gland is regulated at the systemic level by the coordinated activity of a number of hormones. Thus study of systemic regulation is refractory to a fun...

  9. Bovine Mammary Epithelial Cell Lineages and Parenchymal Development

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Mammary development proceeds from an aggregation of cells in the ventral ectoderm to the establishment of an elaborate tree of alveoli, ducts, and cisternae. However, despite abundant data on endocrine regulation of ruminant mammary growth, we know comparatively little about cell lineages, express...

  10. Pim-1 kinase expression during murine mammary development

    SciTech Connect

    Gapter, Leslie A.; Magnuson, Nancy S.; Ng, Ka-yun; Hosick, Howard L. . E-mail: hosick@wsu.edu

    2006-07-07

    Pim-1 kinase phosphorylates substrates whose activities are linked to proliferation, survival, differentiation, and apoptosis. Although pim-1 is induced by hormones and cytokines, the hormonal control and contribution of Pim-1 to mammary gland development have not been evaluated. We examined Pim-1 expression in mammary cell lines, investigated whether Pim-1 levels could be altered in breast epithelia by mammogenic hormones, and evaluated Pim-1 expression during mammary development. We found that Pim-1 was elevated in most mammary carcinoma cell lines and progesterone increased Pim-1 protein to some extent in non-tumorigenic mammary epithelia. Pim-1 expression in situ was consistent with the documented profile of progesterone activity in mouse mammary glands. Pim-1 nuclear localization correlated with cytoplasmic distribution for its substrate, p21{sup CIP/Waf1}, and we found that Pim-1 and p21 associate in vitro. Our results suggest that Pim-1 expression may be regulated by progesterone during mammary development and Pim-1 associates with p21 in mammary epithelial cells.

  11. Regulation of Mammary Lactogenic Differentiation by Singleminded-2s 

    E-print Network

    Wellberg, Elizabeth

    2010-07-14

    models were used to test this hypothesis: (1) a transgenic mouse, expressing Sim2s under control of the MMTV-LTR, and (2) the mouse mammary epithelial cell line HC11. Together, these models allow analysis of the effect of Sim2s on global mammary gland...

  12. Bovine mammary stem cells: Cell biology meets production agriculture

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Mammary stem cells (MaSC) provide for net growth, renewal and turnover of mammary epithelial cells, and are therefore potential targets for strategies to increase production efficiency. Appropriate regulation of MaSC can potentially benefit milk yield, persistency, dry period management and tissue ...

  13. The Diagnosis and Treatment of Arterial Injuries

    PubMed Central

    MacLean, Lloyd D.

    1963-01-01

    Repair of arterial injuries has decreased the amputation rate to 15% from 50%, which was prevalent when ligation was practised. Methods of treatment include lateral repair, resection of damaged area with end-to-end anastomosis, and resection and graft, with or without the assistance of partial or complete cardiopulmonary bypass. Lacerations of large arteries (aorta, iliac) may be treated by lateral repair. Lacerations of smaller arteries are best treated by resection and anastomosis, or by resection and graft. True and false aneurysms and arteriovenous fistulas are best treated by resection and restoration of blood flow. “Spasm” in an artery is frequently due to intimal rupture or subintimal hemorrhage, and likewise requires resection and anastomosis in many instances. Clinical examples of each type of injury are presented. Angiography is of great value in establishing the precise abnormality present, its location, the degree of collateral circulation, and the result achieved by surgery. ImagesFig. 2aFig. 2bFig. 3Fig. 4aFig. 4bFig. 4cFig. 5Fig. 6Fig. 7Fig. 8aFig. 8bFig. 9aFig. 9bFig. 9cFig. 10Fig. 11Fig. 12aFig. 12bFig. 14aFig. 14b PMID:20327556

  14. Huntingtin regulates mammary stem cell division and differentiation.

    PubMed

    Elias, Salah; Thion, Morgane S; Yu, Hua; Sousa, Cristovao Marques; Lasgi, Charlène; Morin, Xavier; Humbert, Sandrine

    2014-04-01

    Little is known about the mechanisms of mitotic spindle orientation during mammary gland morphogenesis. Here, we report the presence of huntingtin, the protein mutated in Huntington's disease, in mouse mammary basal and luminal cells throughout mammogenesis. Keratin 5-driven depletion of huntingtin results in a decreased pool and specification of basal and luminal progenitors, and altered mammary morphogenesis. Analysis of mitosis in huntingtin-depleted basal progenitors reveals mitotic spindle misorientation. In mammary cell culture, huntingtin regulates spindle orientation in a dynein-dependent manner. Huntingtin is targeted to spindle poles through its interaction with dynein and promotes the accumulation of NUMA and LGN. Huntingtin is also essential for the cortical localization of dynein, dynactin, NUMA, and LGN by regulating their kinesin 1-dependent trafficking along astral microtubules. We thus suggest that huntingtin is a component of the pathway regulating the orientation of mammary stem cell division, with potential implications for their self-renewal and differentiation properties. PMID:24749073

  15. Mechanical Interactions of Mouse Mammary Gland Cells with Collagen in a Three-Dimensional Construct

    E-print Network

    Beebe, David J.

    Mechanical Interactions of Mouse Mammary Gland Cells with Collagen in a Three-Dimensional Construct to understand the development of breast cancer motivates the study of mammary gland cells and their interactions with the extracellular matrix. A mixture of mammary gland epithelial cells (normal murine mammary gland), collagen

  16. Localization of plasma membrane and secretory calcium pumps in the mammary gland

    E-print Network

    Rao, Rajini

    Localization of plasma membrane and secretory calcium pumps in the mammary gland Helen M. Faddy PMCA2 SPCA2 Mouse Mammary gland 3D mammary culture Milk a b s t r a c t Until recently the mechanism of the recently identified secretory calcium ATPase, SPCA2, and SPCA1, in the mouse mammary gland during

  17. CHARACTERIZATION OF MAMMARY GLAND TISSUE USING JOINT ESTIMATORS OF MINKOWSKI FUNCTIONALS

    E-print Network

    Schmidt, Volker

    CHARACTERIZATION OF MAMMARY GLAND TISSUE USING JOINT ESTIMATORS OF MINKOWSKI FUNCTIONALS TORSTEN-dimensional images show mammary gland tissue and should be classified automatically as tumor-free or mammary cancer Carcinoma, Mammary Gland Tissue, Minkowski Functionals, Random Closed Set, Specific Intrinsic Volumes. 1 #12

  18. Localization of plasma membrane and secretory calcium pumps in the mammary gland

    E-print Network

    Kenny, Paraic

    Localization of plasma membrane and secretory calcium pumps in the mammary gland Helen M. Faddy PMCA1 SPCA1 PMCA2 SPCA2 Mouse Mammary gland 3D mammary culture Milk a b s t r a c t Until recently mammary gland during development. SPCA2 levels increased over 35-fold during lactation with expression

  19. Genistein-mediated inhibition of mammary stromal adipocyte differentiation limits expansion of mammary stem/progenitor cells by paracrine signaling

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Mammary adiposity may contribute to breast cancer development and progression by releasing cytokines and other inflammatory mediators that promote mammary epithelial proliferation. We evaluated the effects of soy isoflavone genistein (GEN) on the adipogenic differentiation of a SV40-immortalized mou...

  20. Mammary epithelial cells isolated from milk are a valuable, non-invasive source of mammary transcripts

    PubMed Central

    Boutinaud, Marion; Herve, Lucile; Lollivier, Vanessa

    2015-01-01

    Milk is produced in the udder by mammary epithelial cells (MEC). Milk contains MEC, which are gradually exfoliated from the epithelium during lactation. Isolation of MEC from milk using immunomagnetic separation may be a useful non-invasive method to investigate transcriptional regulations in ruminants’ udder. This review aims to describe the process of isolating MEC from milk, to provide an overview on the studies that use this method to analyze gene expression by qRT PCR and to evaluate the validity of this method by analyzing and comparing the results between studies. In several goat and cow studies, consistent reductions in alpha-lactalbumin mRNA levels during once-daily milking (ODM) and in SLC2A1 mRNA level during feed restriction are observed. The effect of ODM on alpha-lactalbumin mRNA level was similarly observed in milk isolated MEC and mammary biopsy. Moreover, we and others showed decreasing alpha-lactalbumin and increasing BAX mRNA levels with advanced stages of lactation in dairy cows and buffalo. The relevance of using the milk-isolated MEC method to analyze mammary gene expression is proven, as the transcript variations were also consistent with milk yield and composition variations under the effect of different factors such as prolactin inhibition or photoperiod. However, the RNA from milk-isolated MEC is particularly sensitive to degradation. This could explain the differences obtained between milk-isolated MEC and mammary biopsy in two studies where gene expression was compared using qRT-PCR or RNA Sequencing analyses. As a conclusion, when the RNA quality is conserved, MEC isolated from milk are a valuable, non-invasive source of mammary mRNA to study various factors that impact milk yield and composition (ODM, feeding level, endocrine status, photoperiod modulation, and stage of lactation). PMID:26579195

  1. Foot ischemia after a free fibula flap harvest: immediate salvage with an interpositional sapheneous vein graft.

    PubMed

    Saydam, Funda Akoz; Basaran, Karaca; Ceran, Fatih; Mert, Bulent

    2014-09-01

    The most dreaded major donor-site complication of free fibula flap is a foot ischemia, which is fortunately rare. Various authors have discussed the efficacy of the use of preoperative imaging methods including color Doppler, magnetic resonance angiography, and conventional angiography. A 25-year-old man presented with a 10-cm mandibular defect after a facial gunshot injury. Lower extremity color Doppler revealed triphasic peroneal, tibialis anterior, and posterior artery flows. A fibula osteocutaneous flap was harvested, and the mandible was reconstructed. However, the suture sites at the donor site began to demonstrate signs of necrosis, abscess formation, and widespread cellulitis beginning from postoperative day 9. Angiogram of the lower extremity on the 13th day demonstrated no flow in the right posterior tibial artery distal to the popliteal artery, whereas the anterior tibial artery had weak flow with collateral filling distally. An emergency bypass with a saphenous vein graft between the popliteal artery and the distal posterior tibial artery was performed. Repeated debridements, local wound care, and vacuum-assisted closure were applied. A skin graft was placed eventually. The extremity healed without severe functional disability. In conclusion, although the arterial anatomy is completely normal in preoperative evaluation, vascular complications may still ocur at the donor fibula free flap site. In addition, emergency cardiovascular bypass surgery, as we experienced, may be necessary for limb perfusion. PMID:25119400

  2. The Renal Impact of Aortic Stent-Grafting in Patients with a Horseshoe Kidney

    SciTech Connect

    Jackson, Ralph W. Fay, Dominic M.; Wyatt, Mike G.; Rose, John D.

    2004-11-15

    Aortic stent grafting may be an alternative to surgery for patients with an abdominal aortic aneurysm and coexistent horseshoe kidney but is not without difficulties. This study examines the renal consequences of aortic stent grafting in such patients. This is a retrospective review of patients with horseshoe kidney in whom aortic stent grafting was performed between December 1995 and August 2000. Follow-up occurred within the EUROSTAR protocol and included measurement of serum creatinine. Of 130 patients in whom aortic stent grafting was performed, 4 had coexistent horseshoe kidney. In all patients the aneurysm was successfully excluded with the occlusion of between one and four anomalous renal arteries. At follow-up, no clinically significant renal impairment was detected. Endovascular aneurysm repair is an attractive option for patients with a horseshoe kidney and normal preoperative creatinine levels.

  3. Grafting effects on vegetable quality

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Vegetable grafting began in the 1920s to control soil-borne disease. It is now a common practice in Asia, parts of Europe, and the Middle East. In Japan and Korea most of the cucurbits and tomatoes (Lycopersicon esculentum Mill.) grown are grafted. This practice is rare in the U.S. and there have...

  4. Polyether/Polyester Graft Copolymers

    NASA Technical Reports Server (NTRS)

    Bell, Vernon L., Jr.; Wakelyn, N.; Stoakley, D. M.; Proctor, K. M.

    1986-01-01

    Higher solvent resistance achieved along with lower melting temperature. New technique provides method of preparing copolymers with polypivalolactone segments grafted onto poly (2,6-dimethyl-phenylene oxide) backbone. Process makes strong materials with improved solvent resistance and crystalline, thermally-reversible crosslinks. Resulting graft copolymers easier to fabricate into useful articles, including thin films, sheets, fibers, foams, laminates, and moldings.

  5. Radiogenic neoplasia in thyroid and mammary clonogens. Progress report, January 1, 1990--December 31, 1992

    SciTech Connect

    Clifton, K.H.

    1992-05-20

    We have developed rat thyroid and mammary clonogen transplantation systems for the study of radiogenic cancer induction at the target cell level in vivo. The epithelial cell populations of both glands contain small subpopulations of cells which are capable of giving rise to monoclonal glandular structures when transplanted and stimulated with appropriate hormones. Previous results indicated that these clonogens are the precursor cells of radiogenic cancer, and that initiation, is common event at the clonegenic cell level. Detailed information on the physiologic control of clonogen proliferation, differentiation, and total numbers is thus essential to an understanding of the carcinogenic process. We report here studies on investigations on the relationships between grafted thyroid cell number and the rapidity and degree of reestablishment of the thyroid-hypothalamus-pituitary feedback axis in thyroidectomized rats maintained on a normal diet or an iodine deficient diet; studies of the persistence of, and the differentiation potential and functional characteristics of, the TSH-(thyrotropin-) responsive sub- population of clonogens during goitrogenesis, the plateau-phase of goiter growth, and goiter involution; studies of changes in the size of the clonogen sub-population during goitrogenesis, goiter involution and the response to goitrogen rechallenge; and a large carcinogenesis experiment on the nature of the grafted thyroid cell number-dependent suppression of promotion/progression to neoplasia in grafts of radiation-initiated thyroid cells. Data from these studies will be used in the design of future carcinogenesis experiments on neoplastic initiation by high and low LET radiations and on cell interactions during the neoplastic process.

  6. Well-organized neointima of large-pore poly(l-lactic acid) vascular graft coated with poly(l-lactic-co-?-caprolactone) prevents calcific deposition compared to small-pore electrospun poly(l-lactic acid) graft in a mouse aortic implantation model

    PubMed Central

    Tara, Shuhei; Kurobe, Hirotsugu; Rocco, Kevin A.; Maxfield, Mark W.; Best, Cameron A.; Yi, Tai; Naito, Yuji; Breuer, Christopher K.; Shinoka, Toshiharu

    2014-01-01

    Objective Tissue engineering techniques have emerged that allow bioresorbable grafts to be implanted that restore function and transform into biologically active arteries. However, these implants are susceptible to calcification during the remodeling process. The objective of this study was to evaluate the role of pore size of bioabsorbable grafts in the development of calcification. Methods Two types of grafts were prepared: a large-pore graft constructed of poly(l-lactic acid) (PLA) fibers coated with poly(l-lactide-co-?-caprolactone) (PLCL) (PLA-PLCL), and a small-pore graft made of electrospun PLA nanofibers (PLA-nano). Twenty-eight PLA-PLCL grafts and twenty-five PLA-nano grafts were implanted as infra-renal aortic interposition conduits in 8-week-old female SCID/Bg mice, and followed for 12 months after implantation. Results Large-pore PLA-PLCL grafts induced a well-organized neointima after 12 months, and Alizarin Red S staining showed neointimal calcification only in the thin neointima of small-pore PLA-nano grafts. At 12 months, macrophage infiltration, evaluated by F4/80 staining, was observed in the thin neointima of the PLA-nano graft, and there were few vascular smooth muscle cells (VSMCs) in this layer. On the other hand, the neointima of the PLA-PLCL graft was composed of abundant VSMCs, and a lower density of macrophages (F4/80 positive cells, PLA-PLCL; 68.1±41.4/mm2 vs PLA-nano; 188.3±41.9/mm2, p = 0.007). The VSMCs of PLA-PLCL graft expressed transcription factors of both osteoblasts and osteoclasts. Conclusion These findings demonstrate that in mouse arterial circulation, large-pore PLA-PLCL grafts created a well-organized neointima and prevented calcific deposition compared to small-pore, electrospun PLA-nano grafts. PMID:25463106

  7. The mammary gland and its origin during synapsid evolution.

    PubMed

    Oftedal, Olav T

    2002-07-01

    Lactation appears to be an ancient reproductive trait that predates the origin of mammals. The synapsid branch of the amniote tree that separated from other taxa in the Pennsylvanian (>310 million years ago) evolved a glandular rather than scaled integument. Repeated radiations of synapsids produced a gradual accrual of mammalian features. The mammary gland apparently derives from an ancestral apocrine-like gland that was associated with hair follicles. This association is retained by monotreme mammary glands and is evident as vestigial mammary hair during early ontogenetic development of marsupials. The dense cluster of mammo-pilo-sebaceous units that open onto a nipple-less mammary patch in monotremes may reflect a structure that evolved to provide moisture and other constituents to permeable eggs. Mammary patch secretions were coopted to provide nutrients to hatchlings, but some constituents including lactose may have been secreted by ancestral apocrine-like glands in early synapsids. Advanced Triassic therapsids, such as cynodonts, almost certainly secreted complex, nutrient-rich milk, allowing a progressive decline in egg size and an increasingly altricial state of the young at hatching. This is indicated by the very small body size, presence of epipubic bones, and limited tooth replacement in advanced cynodonts and early mammaliaforms. Nipples that arose from the mammary patch rendered mammary hairs obsolete, while placental structures have allowed lactation to be truncated in living eutherians. PMID:12751889

  8. EMT tumorigenesis in the mouse mammary gland

    PubMed Central

    Damonte, Patrizia; Gregg, Jeffrey P; Borowsky, Alexander D; Keister, Blaine A; Cardiff, Robert D

    2009-01-01

    The term EMT (epithelial–mesenchymal transition) is used in many settings. This term is used to describe the mechanisms facilitating cellular repositioning and redeployment during embryonic development and tissue reconstruction after injury. Recently, EMT has also been applied to potential mechanisms for malignant progression and has appeared as a specific diagnostic category of tumors. In mice, most ‘EMT’ tumors have a spindle cell phenotype. The definition of EMT is controversial because spindle cell tumors are not common in humans, especially in human breast cancers. Spindle cell tumors of the mouse mammary gland have been observed for many years where they are usually classified as sarcomas or carcinosarcomas. Genetically engineered mice develop mammary spindle cell tumors that appear to arise in the epithelium and undergo EMT. To better understand the origin and evolution of these spindle cell tumors in progression and metastases, seven cohorts of spindle cell tumors from the archives of the University of California, Davis Mutant Mouse Pathology Laboratory were studied. This study provides experimental and immunohistochemical evidence of EMT showing that dual epithelial and mesenchymal staining of tumor spindle cells identifies some, but not all, EMT-type tumors in the mouse. This suggests that potential EMT tumors are best designated EMT-phenotype tumors. PMID:17922020

  9. Coronary Artery Bypass Graft Surgery (Beyond the Basics)

    MedlinePLUS

    ... UpToDate, Inc. ("UpToDate"), in consideration of the subscription fee and acceptance of this Agreement, grants you a ... or your Institution have agreed to pay subscription fees. At the end of this period, your license ...

  10. What to Expect After Coronary Artery Bypass Grafting

    MedlinePLUS

    ... first. Ongoing Care Care after surgery may include periodic checkups with doctors. During these visits, tests may ... someone else’s. The NHLBI has created a new series of informative, easy-to-read heart attack materials ...

  11. What to Expect during Coronary Artery Bypass Grafting

    MedlinePLUS

    ... support from an anesthesiologist, perfusionist (heart-lung bypass machine specialist), other surgeons, and nurses. There are several ... The tube will connect to a ventilator (a machine that supports breathing). The surgeon will make an ...

  12. Recovery After Coronary Artery Bypass Graft Surgery (Beyond the Basics)

    MedlinePLUS

    ... brand name: Diovan), and irbesartan (brand name: Avapro). ? Lipid lowering therapy – Almost all patients are given a medication to lower lipids after CABG. Cholesterol lowering can be beneficial both ...

  13. Radiation grafting on natural films

    NASA Astrophysics Data System (ADS)

    Lacroix, M.; Khan, R.; Senna, M.; Sharmin, N.; Salmieri, S.; Safrany, A.

    2014-01-01

    Different methods of polymer grafting using gamma irradiation are reported in the present study for the preparation of newly functionalized biodegradable films, and some important properties related to their mechanical and barrier properties are described. Biodegradable films composed of zein and poly(vinyl alcohol) (PVA) were gamma-irradiated in presence of different ratios of acrylic acid (AAc) monomer for compatibilization purpose. Resulting grafted films (zein/PVA-g-AAc) had their puncture strength (PS=37-40 N mm-1) and puncture deformation (PD=6.5-9.8 mm) improved for 30% and 50% PVA in blend, with 5% AAc under 20 kGy. Methylcellulose (MC)-based films were irradiated in the presence of 2-hydroxyethyl methacrylate (HEMA) or silane, in order to determine the effect of monomer grafting on the mechanical properties of films. It was found that grafted films (MC-g-HEMA and MC-g-silane) using 35% monomer performed higher mechanical properties with PS values of 282-296 N mm-1 and PD of 5.0-5.5 mm under 10 kGy. Compatibilized polycaprolactone (PCL)/chitosan composites were developed via grafting silane in chitosan films. Resulting trilayer grafted composite film (PCL/chitosan-g-silane/PCL) presented superior tensile strength (TS=22 MPa) via possible improvement of interfacial adhesion (PCL/chitosan) when using 25% silane under 10 kGy. Finally, MC-based films containing crystalline nanocellulose (CNC) as a filling agent were prepared and irradiated in presence of trimethylolpropane trimethacrylate (TMPTMA) as a grafted plasticizer. Grafted films (MC-g-TMPTMA) presented superior mechanical properties with a TS of 47.9 MPa and a tensile modulus (TM) of 1792 MPa, possibly due to high yield formation of radicals to promote TMPTMA grafting during irradiation. The addition of CNC led to an additional improvement of the barrier properties, with a significant 25% reduction of water vapor permeability (WVP) of grafted films.

  14. Results of bypasses to the anterior tibial artery through the interosseous membrane.

    PubMed

    Illuminati, G; Calio, F G; Bertagni, A; Martinelli, V

    1998-08-01

    The purpose of the present study was to retrospectively evaluate the results of anatomically tunneled grafts to the anterior tibial artery for distal revascularization in terms of patency and limb salvage rates as well as local morbidity, which can lengthen the postoperative hospital stay. Twenty-three patients received 24 bypasses to the anterior tibial artery, with grafts tunneled through the interosseous membrane. The mean age was 67 years; 10 patients were diabetic, 12 were smokers, 9 presented with significant coronary artery disease, and 2 with chronic renal insufficiency. The donor vessel was the common femoral artery in 17 cases, the superficial femoral artery in 4, and the infra-articular popliteal artery in 3. The graft material consisted in the reversed saphenous vein in 4 cases, the non-reversed devalvulated ex situ saphenous vein in 11, composite polytetrafluoroethylene (PTFE) + inversed saphenous vein in 6, and PTFE alone in 3 cases. No postoperative mortality was observed, nor was there postoperative graft occlusion or need for major amputation. The average postoperative length of stay in the hospital was 9.7 days. Two local surgical wound complications were observed, which did not necessitate a postoperative hospital stay exceeding 15 days. Cumulative primary patency and limb salvage rates at 3 years were 50% and 70%, respectively. Anatomic tunneling of grafts to the anterior tibial artery yields patency and limb salvage rates comparable to those reported in the literature for distal bypasses and, considered overall, an acceptably low local morbidity and short hospital stay. Definitive superiority over externally tunneled grafts, however, is not definitely demonstrated by this study and should be prospectively tested. PMID:9776453

  15. Sequencing the transcriptome of milk production: milk trumps mammary tissue

    PubMed Central

    2013-01-01

    Background Studies of normal human mammary gland development and function have mostly relied on cell culture, limited surgical specimens, and rodent models. Although RNA extracted from human milk has been used to assay the mammary transcriptome non-invasively, this assay has not been adequately validated in primates. Thus, the objectives of the current study were to assess the suitability of lactating rhesus macaques as a model for lactating humans and to determine whether RNA extracted from milk fractions is representative of RNA extracted from mammary tissue for the purpose of studying the transcriptome of milk-producing cells. Results We confirmed that macaque milk contains cytoplasmic crescents and that ample high-quality RNA can be obtained for sequencing. Using RNA sequencing, RNA extracted from macaque milk fat and milk cell fractions more accurately represented RNA from mammary epithelial cells (cells that produce milk) than did RNA from whole mammary tissue. Mammary epithelium-specific transcripts were more abundant in macaque milk fat, whereas adipose or stroma-specific transcripts were more abundant in mammary tissue. Functional analyses confirmed the validity of milk as a source of RNA from milk-producing mammary epithelial cells. Conclusions RNA extracted from the milk fat during lactation accurately portrayed the RNA profile of milk-producing mammary epithelial cells in a non-human primate. However, this sample type clearly requires protocols that minimize RNA degradation. Overall, we validated the use of RNA extracted from human and macaque milk and provided evidence to support the use of lactating macaques as a model for human lactation. PMID:24330573

  16. The Endovascular Management of Iliac Artery Aneurysms

    SciTech Connect

    Stroumpouli, Evangelia; Nassef, Ahmed; Loosemore, Tom; Thompson, Matt; Morgan, Robert; Belli, Anna-Maria

    2007-11-15

    Background: Isolated aneurysms of the iliac arteries are uncommon. Previously treated by conventional surgery, there is increasing use of endografts to treat these lesions. Purpose: The purpose of this study was to assess the efficacy, safety, and durability of the stent-grafts for treatment of iliac artery aneurysms (IAAs). The results of endografting for isolated IAAs over a 10-year period were analyzed retrospectively. The treatment methods differed depending on the anatomic location of the aneurysms. Twenty-one patients (1 woman, 20 men) underwent endovascular stent-graft repair, with one procedure carried out under emergency conditions after acute rupture. The mean aneurysm diameter was 4.6 cm.Results:The procedural technical success was 100%. There was zero 30-day mortality. Follow-up was by interval CT scans. At a mean follow-up of 51.2 months, the stent-graft patency rate was 100%. Reintervention was performed in four patients (19%): one patient (4.7%) with a type I endoleak and three patients (14.3%) with type II endoleaks.Conclusion:We conclude that endovascular repair of isolated IAAs is a safe, minimally invasive technique with low morbidity rates. Follow-up results up to 10 years suggest that this approach is durable and should be regarded as a first treatment option for appropriate candidates.

  17. INHIBITION OF SMOOTH MUSCLE CELL MIGRATION AND NEOINTIMA FORMATION IN VEIN GRAFTS BY OVEREXPRESSION OF MATRIX METALLOPROTEINASE-3

    PubMed Central

    Kallenbach, Klaus; Salcher, Rolf; Heim, Albert; Karck, Matthias; Mignatti, Paolo; Haverich, Axel

    2013-01-01

    Objective Saphenous vein grafts suffer from neointima formation following bypass surgery. Matrix metalloproteinases (MMPs) play important roles in this process. We examined MMP-3 for its therapeutic potential to prevent smooth muscle cell migration and neointima formation in venous bypass grafts using adenovirus-mediated gene transfer. Methods Human aortic smooth muscle cells (hAoSMC) were transduced with adenoviral vectors encoding ?-galactosidase (Ad.?gal) or human MMP-3 (Ad.hMMP-3), and characterized for migration in the amniotic membrane stroma as an in vitro model of the vascular wall. Cholesterol-fed New Zealand White rabbits underwent jugular vein bypass grafting into carotid arteries. Before insertion, grafts were incubated ex vivo with either Ad.?gal or Ad.hMMP-3. Transgene expression was characterized by immunohistochemistry and in situ zymography. Grafts (n=6) were explanted after 28 days and intimal hyperplasia was quantified. Results Migration of hAoSMC was significantly reduced when transduced with Ad.hMMP-3 compared to controls (p<0.001). Immunocytochemistry of Ad.hMMP-3 transduced venous grafts localized this protein to the intima. In situ-zymography showed increased MMP activity in the intima of Ad.hMMP-3 transfected grafts. Stenosis degree (p=0,001), intima/media-ratio (p=0,023) and lesion thickness (p=0,003) were significantly reduced in grafts transduced with Ad.MMP-3 in comparison to controls. There was no difference inside control groups. Conclusions MMP-3 overexpression inhibits formation of intimal hyperplasia in arterialized vein grafts. Adenovirus mediated gene transfer of MMP-3 may be of clinical use to prevent vein graft stenosis following bypass surgery. PMID:19268777

  18. Bone grafts and their substitutes.

    PubMed

    Fillingham, Y; Jacobs, J

    2016-01-01

    The continual cycle of bone formation and resorption is carried out by osteoblasts, osteocytes, and osteoclasts under the direction of the bone-signaling pathway. In certain situations the host cycle of bone repair is insufficient and requires the assistance of bone grafts and their substitutes. The fundamental properties of a bone graft are osteoconduction, osteoinduction, osteogenesis, and structural support. Options for bone grafting include autogenous and allograft bone and the various isolated or combined substitutes of calcium sulphate, calcium phosphate, tricalcium phosphate, and coralline hydroxyapatite. Not all bone grafts will have the same properties. As a result, understanding the requirements of the clinical situation and specific properties of the various types of bone grafts is necessary to identify the ideal graft. We present a review of the bone repair process and properties of bone grafts and their substitutes to help guide the clinician in the decision making process. Cite this article: Bone Joint J 2016;98-B(1 Suppl A):6-9. PMID:26733632

  19. Are Aortic Stent Grafts Safe in Pregnancy?

    PubMed Central

    Khandanpour, Nader; Mehta, Tapan A.; Adiseshiah, M.; Meyer, Felicity J.

    2015-01-01

    Aortic stent grafts are increasingly used to treat aortic aneurysms and also other aortic pathologies. The safety of aortic stent grafts in pregnancy has never been studied or reported. We report on two cases of aortic stent grafts in pregnant women and discuss the effect of pregnancy on these aortic stent grafts. PMID:26229702

  20. Carotid Artery Disease

    MedlinePLUS

    ... from the NHLBI on Twitter. What Is Carotid Artery Disease? Carotid artery disease is a disease in ... blood to your face, scalp, and neck. Carotid Arteries Figure A shows the location of the right ...

  1. Carotid Artery Disease

    MedlinePLUS

    ... brain with blood. If you have carotid artery disease, the arteries become narrow, usually because of atherosclerosis. ... one of the causes of stroke. Carotid artery disease often does not cause symptoms, but there are ...

  2. Detection of aortoarterial graft infections by leukocyte scintigraphy

    SciTech Connect

    Wilson, D.G.; Seabold, J.E.; Lieberman, L.M.

    1983-09-01

    Infections of aortoarterial prostheses are serious, difficult to detect, and difficult to treat. Scintigraphy with indium-111 labeled autologous leukocytes is an accurate noninvasive method of assessing the presence and extent of such an infection. In three cases of aorto-arterial bypass graft infections, the leukocyte study was successful in establishing the diagnosis and in assessing the extent of infection. Other noninvasive diagnostic techniques are useful, but all have serious limitations. The leukocyte study alone appears to be free of likely sources of error.

  3. Journal of Mammary Gland Biology and Neoplasia, Vol. 8, No. 2, April 2003 ( C 2003) The Nuclear Factor I (NFI) Gene Family in Mammary

    E-print Network

    Gronostajski, Richard M.

    Journal of Mammary Gland Biology and Neoplasia, Vol. 8, No. 2, April 2003 ( C 2003) The Nuclear Factor I (NFI) Gene Family in Mammary Gland Development and Function Janice Murtagh,1 Finian Martin,1,3 and Richard M. Gronostajski2,3 Mammary gland development and function require the coordinated spatial

  4. Laminin Mediates Tissue-specific Gene Expression in Mammary Epithelia

    E-print Network

    Streuli, Charles H

    2011-01-01

    tissue culture plastic, synthesized no ?-caseins (Fig. 1 c).plastic, mammary cells respond to soluble basement membrane or purified laminin, but not other extracellular matrix components, by synthesizing ?-casein.

  5. Developmental biology: cell fate in the mammary gland

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Most breast cancers have their origin in the luminal epithelial cells of the mammary gland. Defining how a master regulator controls the development of this cell lineage could provide important hints about why this should be. ...

  6. Successful hybrid treatment for huge visceral artery aneurysms with contained rupture complicating segmental arterial mediolysis.

    PubMed

    Kimura, Yasutoshi; Ito, Toshiro; Imamura, Masafumi; Hirata, Koichi

    2015-12-01

    Segmental arterial mediolysis (SAM) is a rare arteriopathy that can cause acute abdomen. This report describes the case of a 31-year old male suffering from huge visceral aneurysms with contained rupture. We established a treatment strategy using a hybrid procedure that consisted of endovascular and surgical techniques for these splenic, common hepatic artery and coeliac axis aneurysms related to SAM. The patient was successfully treated with aorto-superior mesenteric artery bypass followed by endovascular aortic stent grafting to interrupt inflow to coeliac aneurysms, and distal splenopancreatectomy with en bloc resection of those aneurysms. We conclude that this hybrid procedure consisting of endovascular and surgical techniques is useful and is a safe treatment option for SAM-related visceral aneurysms. PMID:26362627

  7. Management of Failing Prosthetic Bypass Grafts with Metallic Stent Placement

    SciTech Connect

    Siskin, Gary P.; Stainken, Brian F.; Mandell, Valerie S.; Darling, R. Clement; Dowling, Kyran; Herr, Allen

    1999-09-15

    Purpose: To evaluate the role of metallic stents in treating stenoses involving prosthetic arterial bypass grafts. Methods: Patients undergoing stent placement within a failing prosthetic bypass graft, during a 41-month period, were reviewed for treatment outcome and complications. The indications for stent placement in 15 patients included severe claudication (n= 3), rest pain (n= 9), and minor or major tissue loss (n= 3). Lesions were at the proximal anastomosis (n= 6), the distal anastomosis (n= 3), or within the graft (n= 6). Results: Treatment with metallic stents was successful in all patients. There was one acute stent thrombosis, successfully treated with thrombolytic therapy. Follow-up data are available for a mean duration of 12.3 months. The mean duration of primary patency was 9.4 months with 6- and 12-month primary patency rates of 51.9% and 37.0%, respectively. The mean duration of secondary patency was 12.1 months with 6- and 12-month secondary patency rates of 80.0% and 72.7%, respectively. Two patients with discontinuous runoff and preexisting gangrene required a below-knee amputation. Six patients were revised surgically after stent placement (at a mean of 10.8 months). Three late deaths occurred during follow-up. Conclusion: Given the mortality risks of surgical revision and the reduced life expectancy of this patient population, metallic stent placement represents a viable, short-term treatment option for stenoses within or at the anastomoses of prosthetic grafts. Further evaluation is warranted to compare intragraft stent placement with surgical graft revision.

  8. Abstract The lactating mammary gland of the African el-ephant (Loxodonta africana) has been studied with a panel

    E-print Network

    Pretoria, University of

    Abstract The lactating mammary gland of the African el- ephant (Loxodonta africana) has been Mammary gland · Lactation · Secretion · Proliferation · Apoptosis · Milk · African elephant, Loxodonta · Stuart Patton Histo- and cytophysiology of the lactating mammary gland of the African elephant (Loxodonta

  9. Staged Hybrid Repair of an Intrathoracic Subclavian Artery Aneurysm Associated with a Long Segment Dissection.

    PubMed

    Kochupura, Paul V; Greelish, James P

    2016-01-01

    Intrathoracic subclavian artery aneurysms (ISAAs) are infrequently seen in clinical practice. We report the repair of a left ISAA associated with a long segment dissection from the ostia extending to the axillary artery. A hybrid approach was used. Carotid-to-axillary bypass using a reversed greater saphenous vein was first performed, followed by coverage of the origin of the subclavian artery using a thoracic stent graft. Finally, percutaneous access of the radial artery with coil embolization was performed to successfully thrombose the ISAA. PMID:26362621

  10. Proliferative response of mammary glandular tissue to formononetin.

    PubMed

    Wang, W; Tanaka, Y; Han, Z; Higuchi, C M

    1995-01-01

    Dietary phytoestrogens have been implicated in infertility among ruminants and may relate to human breast cancer risk. Formononetin is an isoflavonoid phytoestrogen found in animal fodder and in certain human foodstuffs. To investigate a possible mechanism by which phytoestrogens might influence mammary carcinogenesis, this study examined the capacity of formononetin to stimulate mammary gland proliferation. Formononetin was administered to castrated female BALB/c mice by daily subcutaneous injection; then mammary gland proliferation and estrogen receptor expression were quantified, and plasma prolactin levels were measured. A preliminary dose-finding study demonstrated an estrogenic effect on vaginal cytology when formononetin was injected at 40 mg/kg sc. Peak plasma concentrations of 2.5 +/- 0.8 (SD) micrograms/ml at two hours and peak mammary tissue concentrations of 2.0 +/- 0.2 ng/mg tissue at four hours were noted after a single injection at this minimally bioactive dose. Among animals treated with formononetin at 40 mg/kg/day for five days, mammary gland proliferation was enhanced 3.3-fold over saline-treated controls and was comparable to that of animals treated with estradiol-17 beta at 1 microgram/kg/day for five days. Mammary tissue estrogen receptor expression was 2-fold higher among the formononetin-treated animals (P < 0.01 vs. saline-treated controls), and plasma prolactin concentrations were increased 1.7-fold (P < 0.001 vs. saline-treated controls). In subsequent in vitro binding studies, formononetin competitively bound murine mammary estrogen receptors, but with a relative binding affinity 15,000 times less potent than that of estradiol-17 beta. The results demonstrate an ability of formononetin to support mammary gland proliferation. However, the estrogenic potency of formononetin appears extremely weak compared with that of estradiol-17 beta and is roughly proportional to estrogen receptor-binding capacity. PMID:7644382

  11. Genomic and Phenomic Study of Mammary Pathogenic Escherichia coli.

    PubMed

    Blum, Shlomo E; Heller, Elimelech D; Sela, Shlomo; Elad, Daniel; Edery, Nir; Leitner, Gabriel

    2015-01-01

    Escherichia coli is a major etiological agent of intra-mammary infections (IMI) in cows, leading to acute mastitis and causing great economic losses in dairy production worldwide. Particular strains cause persistent IMI, leading to recurrent mastitis. Virulence factors of mammary pathogenic E. coli (MPEC) involved pathogenesis of mastitis as well as those differentiating strains causing acute or persistent mastitis are largely unknown. This study aimed to identify virulence markers in MPEC through whole genome and phenome comparative analysis. MPEC strains causing acute (VL2874 and P4) or persistent (VL2732) mastitis were compared to an environmental strain (K71) and to the genomes of strains representing different E. coli pathotypes. Intra-mammary challenge in mice confirmed experimentally that the strains studied here have different pathogenic potential, and that the environmental strain K71 is non-pathogenic in the mammary gland. Analysis of whole genome sequences and predicted proteomes revealed high similarity among MPEC, whereas MPEC significantly differed from the non-mammary pathogenic strain K71, and from E. coli genomes from other pathotypes. Functional features identified in MPEC genomes and lacking in the non-mammary pathogenic strain were associated with synthesis of lipopolysaccharide and other membrane antigens, ferric-dicitrate iron acquisition and sugars metabolism. Features associated with cytotoxicity or intra-cellular survival were found specifically in the genomes of strains from severe and acute (VL2874) or persistent (VL2732) mastitis, respectively. MPEC genomes were relatively similar to strain K-12, which was subsequently shown here to be possibly pathogenic in the mammary gland. Phenome analysis showed that the persistent MPEC was the most versatile in terms of nutrients metabolized and acute MPEC the least. Among phenotypes unique to MPEC compared to the non-mammary pathogenic strain were uric acid and D-serine metabolism. This study reveals virulence factors and phenotypic characteristics of MPEC that may play a role in pathogenesis of E. coli mastitis. PMID:26327312

  12. Genomic and Phenomic Study of Mammary Pathogenic Escherichia coli

    PubMed Central

    Blum, Shlomo E.; Heller, Elimelech D.; Sela, Shlomo; Elad, Daniel; Edery, Nir; Leitner, Gabriel

    2015-01-01

    Escherichia coli is a major etiological agent of intra-mammary infections (IMI) in cows, leading to acute mastitis and causing great economic losses in dairy production worldwide. Particular strains cause persistent IMI, leading to recurrent mastitis. Virulence factors of mammary pathogenic E. coli (MPEC) involved pathogenesis of mastitis as well as those differentiating strains causing acute or persistent mastitis are largely unknown. This study aimed to identify virulence markers in MPEC through whole genome and phenome comparative analysis. MPEC strains causing acute (VL2874 and P4) or persistent (VL2732) mastitis were compared to an environmental strain (K71) and to the genomes of strains representing different E. coli pathotypes. Intra-mammary challenge in mice confirmed experimentally that the strains studied here have different pathogenic potential, and that the environmental strain K71 is non-pathogenic in the mammary gland. Analysis of whole genome sequences and predicted proteomes revealed high similarity among MPEC, whereas MPEC significantly differed from the non-mammary pathogenic strain K71, and from E. coli genomes from other pathotypes. Functional features identified in MPEC genomes and lacking in the non-mammary pathogenic strain were associated with synthesis of lipopolysaccharide and other membrane antigens, ferric-dicitrate iron acquisition and sugars metabolism. Features associated with cytotoxicity or intra-cellular survival were found specifically in the genomes of strains from severe and acute (VL2874) or persistent (VL2732) mastitis, respectively. MPEC genomes were relatively similar to strain K-12, which was subsequently shown here to be possibly pathogenic in the mammary gland. Phenome analysis showed that the persistent MPEC was the most versatile in terms of nutrients metabolized and acute MPEC the least. Among phenotypes unique to MPEC compared to the non-mammary pathogenic strain were uric acid and D-serine metabolism. This study reveals virulence factors and phenotypic characteristics of MPEC that may play a role in pathogenesis of E. coli mastitis. PMID:26327312

  13. Gene Therapy Techniques for Peripheral Arterial Disease

    SciTech Connect

    Manninen, Hannu I.; Maekinen, Kimmo

    2002-03-15

    Somatic gene therapy is the introduction of new genetic material into selective somatic cells with resulting therapeutic benefits. Vascular wall and, subsequently, cardiovascular diseases have become an interesting target for gene therapy studies.Arteries are an attractive target for gene therapy since vascular interventions, both open surgical and endovascular, are well suited for minimally invasive, easily monitored gene delivery. Promising therapeutic effects have been obtained in animal models in preventing post-angioplasty restenosis and vein graft thickening, as well as increasing blood flow and collateral development in ischemic limbs.First clinical trials suggest a beneficial effect of vascular endothelial growth factor in achieving therapeutic angiogenesis in chronic limb ischemia and the efficacy of decoy oligonucleotides to prevent infrainguinal vein graft stenosis. However, further studies are mandatory to clarify the safety issues, to develop better gene delivery vectors and delivery catheters, to improve transgene expression, as well as to find the most effective and safe treatment genes.

  14. Chemoprevention of Radiation Induced Rat Mammary Neoplasms

    NASA Technical Reports Server (NTRS)

    Huso, David L.

    1999-01-01

    Radiations encountered in space include protons and heavy ions such as iron as well as their secondaries. The relative biological effect (RBE) of these ions is not known, particularly at the doses and dose-rates expected for planetary missions. Neutrons, are not particularly relevant to space travel, but have been found experimentally to have an increase in their RBE with decreasing dose. If a similar trend of increasing RBE with decreasing dose is present for heavy ions and protons during irradiation in space, the small doses received during space travel could potentially have substantial carcinogenic risk. Clearly more investigation of the effects of heavy ions and protons is needed before accurate risk assessment for prolonged travel in space can be done. One means to mitigate the increased risk of cancer due to radiation exposure in space is by developing effective countermeasures that can reduce the incidence of tumor development. Tamoxifen has recently been shown to be an effective chemopreventive agent in both animal models and humans for the prevention of mammary tumors. Tamoxifen is a unique drug, with a highly specific mechanism of action affecting a specific radiation-sensitive population of epithelial cells in the mammary gland. In human studies, the annual incidence of a primary tumor in the contralateral breast of women with previous breast cancer is about 8 per 1000, making them an exceedingly high-risk group for the development of breast cancer. In this high risk group, treated with tamoxifen, daily, for 2 years, the incidence of a new primary tumor in the contralateral breast was approximately one third of that noted in the non-tamoxifen treatment group. Tamoxifen antagonizes the action of estrogen by competing for the nuclear receptor complex thereby altering the association of the receptor complex and nuclear binding sites. Its effects in reducing the development of breast cancer could be accomplished by controlling clinically undetectable microcancers, arresting preneoplastic lesions, or correcting abnormal environments which predispose to high risk of malignant transformation.

  15. Bone Grafting: Sourcing, Timing, Strategies, and Alternatives.

    PubMed

    Egol, Kenneth A; Nauth, Aaron; Lee, Mark; Pape, Hans-Christoph; Watson, J Tracy; Borrelli, Joseph

    2015-12-01

    Acute fractures, nonunions, and nonunions with bone defects or osteomyelitis often need bone graft to facilitate union. There are several factors to consider when it is determined that a bone graft is needed. These factors include the source of the bone graft (autograft vs. allograft), proper timing for placement of the bone graft, strategies to avoid further complications (particularly in the setting of osteomyelitis), and with the development of a variety of bone graft substitutes, whether alternatives to autograft are available and appropriate for the task at hand. Autograft bone has commonly been referred to as the "gold standard" of bone grafts, against which the efficacy of other grafts has been measured. The best timing for when to place a bone graft or substitute is also somewhat controversial, particularly after an open fracture or a potentially contaminated bed. The treatment of infected nonunions, particularly those that require a graft to facilitate healing, can be quite challenging. Typically, the infection is completely eradicated before placement of a bone graft, but achieving a sterile bed and the timing of a bone graft require strategic thinking and planning. This review outlines the benefits of autografts, the most suitable sites for harvesting bone grafts, the timing of bone graft procedures, the potential risks and benefits of grafting in the face of infection, and the currently available bone graft extenders. PMID:26584259

  16. Glial grafting for demyelinating disease

    PubMed Central

    Tepav?evi?, V; Blakemore, W.F

    2005-01-01

    Remyelination of demyelinated central nervous system (CNS) axons is considered as a potential treatment for multiple sclerosis, and it has been achieved in experimental models of demyelination by transplantation of pro-myelinating cells. However, the experiments undertaken have not addressed the need for tissue-type matching in order to achieve graft-mediated remyelination since they were performed in conditions in which the chance for graft rejection was minimized. This article focuses on the factors determining survival of allogeneic oligodendrocyte lineage cells and their contribution to the remyelination of demyelinating CNS lesions. The immune status of the CNS as well as the suitability of different models of demyelination for graft rejection studies are discussed, and ways of enhancing allogeneic oligodendrocyte-mediated remyelination are presented. Finally, the effects of glial graft rejection on host remyelination are described, highlighting the potential benefits of the acute CNS inflammatory response for myelin repair. PMID:16147541

  17. Reduction of intimal hyperplasia and enhanced reactivity of experimental vein bypass grafts with verapamil treatment.

    PubMed Central

    el-Sanadiki, M N; Cross, K S; Murray, J J; Schuman, R W; Mikat, E; McCann, R L; Hagen, P O

    1990-01-01

    Recent studies have shown that calcium antagonists exert an antiatherogenic effect in animals fed cholesterol. Vein graft intimal hyperplasia is believed to be an early event in atherosclerotic lesion formation, which is a significant cause of graft failure. Altered vasoreactivity has also been postulated in the etiology of vein graft failure. Therefore this study examined the effect of verapamil treatment on the development of intimal hyperplasia and the vasoreactivity of experimental vein bypass grafts. The right external jugular vein was grafted into the right carotid artery of 30 male New Zealand white rabbits fed normal rabbit chow. The left external jugular vein was used as the control vein. Fifteen animals received verapamil (1.25 mg/day for 28 days) via the femoral vein by means of an osmotic pump. In 15 control animals the pump contained saline. Plasma verapamil concentration was 50.9 +/- 13.2 ng/mL (x +/- SEM), a dose that showed no effect on either blood pressure, total serum cholesterol, or in vitro platelet aggregation to ADP. Fourteen of fifteen grafts were patent in each group, for a patency rate of 93%. Histologic examination using computer morphometry showed significant reduction of intimal hyperplasia at the proximal, middle, and distal graft segments (p less than 0.05). In addition in vitro isometric tension studies of the vein grafts and control veins showed that verapamil causes enhanced reactivity of both vein grafts and control veins in response to norepinephrine and histamine (p less than 0.05). Reactivity of vein grafts to serotonin was unaltered. While none of the normal veins in the control group responded to serotonin, normal veins treated with verapamil contracted readily in response to serotonin. Endothelial-dependent relaxation to acetylcholine was absent in both control and verapamil-treated vein grafts, while normal veins from both groups responded to the same extent to acetylcholine. Because we could not demonstrate any difference in platelet or endothelium function between untreated and verapamil-treated animals, we examined the direct effect of verapamil on smooth muscle. Verapamil significantly inhibited [3H]-thymidine incorporation into DNA in vascular smooth muscle cells in culture in a dose-dependent manner. Verapamil treatment significantly reduces intimal hyperplasia in experimental vein grafts and inhibits smooth muscle cell proliferation in culture. Furthermore the enhanced reactivity to norepinephrine and histamine in the verapamil-treated vessels has no detrimental effect on the patency rate at 4 weeks. Thus by inhibiting intimal hyperplasia, calcium antagonists may improve the long-term patency of vein bypass grafts. Images Figs. 1A-C. PMID:2363608

  18. A new technique for intra-abdominal arteries revascularization via extra-anatomic bypass from the brachiocephalic artery with a videoscopic retrosternal tunnel.

    PubMed

    Javerliat, Isabelle; Pichon, Audrey; Glorion, Matthieu; Coscas, Raphaël; Goëau-Brissonnière, Olivier; Coggia, Marc

    2015-07-01

    Extra-anatomic revascularizations of intra-abdominal or lower limbs arteries, or both, are indicated (1) when the aorta is unsuitable for anatomic bypasses, (2) in patients unfit for aortic surgery, (3) for graft infections, and (4) for visceral debranching during hybrid treatment of a thoracoabdominal aneurysm. We describe a new extra-anatomic bypass from the brachiocephalic artery with video-guided retrosternal tunneling. We discuss the advantages and drawbacks of this technique. PMID:25936654

  19. Interventions in Infrainguinal Bypass Grafts

    SciTech Connect

    Mueller-Huelsbeck, S. Order, B.-M.; Jahnke, T.

    2006-02-15

    The interventional radiologist plays an important role in the detection and prevention of infrainguinal bypass failure. Early detection and evaluation of flow-limiting lesions effectively preserve graft (venous bypass and polyester or expanded polytetrafluoroethylene bypass) patency by identifying stenoses before occlusion occurs. Delay in treatment of the at-risk graft may result in graft failure and a reduced chance of successful revascularization. For this reason, surveillance protocols form an important part of follow-up after infrainguinal bypass surgery. As well as having an understanding of the application of imaging techniques including ultrasound, MR angiography, CT angiography and digital subtraction angiography, the interventional radiologist should have detailed knowledge of the minimally invasive therapeutic options. Percutaneous transluminal angioplasty (PTA), or alternatively cutting balloon angioplasty, is the interventional treatment of choice in prevention of graft failure and occlusion. Further alternatives include metallic stent placement, fibrinolysis, and mechanical thrombectomy. Primary assisted patency rates following PTA can be up to 65% at 5 years. When the endovascular approach is unsuccessful, these therapeutic options are complemented by surgical procedures including vein patch revision, jump grafting, or placement of a new graft.

  20. Assessment of Novel Anti-thrombotic Fusion Proteins for Inhibition of Stenosis in a Porcine Model of Arteriovenous Graft

    PubMed Central

    Terry, Christi M.; Zhuplatov, Ilya; He, Yuxia; Wun, Tze-Chein; Kim, Seong-Eun; Cheung, Alfred K.

    2015-01-01

    Background Hemodialysis arteriovenous synthetic grafts (AVG) provide high volumetric blood flow rates shortly after surgical placement. However, stenosis often develops at the vein-graft anastomosis contributing to thrombosis and early graft failure. Two novel fusion proteins, ANV-6L15 and TAP-ANV, inhibit the tissue factor/factor VIIa coagulation complex and the factor Xa/factor Va complex, respectively. Each inhibitor domain is fused to an annexin V domain that targets the inhibitor activity to sites of vascular injury to locally inhibit thrombosis. This study’s objective was to determine if these antithrombotic proteins are safe and effective in inhibiting AVG stenosis. Methods A bolus of either TAP-ANV or ANV-6L15 fusion protein was administered intravenously immediately prior to surgical placement of a synthetic graft between the external jugular vein and common carotid artery in a porcine model. At surgery, the vein and artery were irrigated with the anti-thrombotic fusion protein. Control animals received intravenous heparin. At 4 weeks, MRI was performed to evaluate graft patency, the pigs were then euthanized and grafts and attached vessels were explanted for histomorphometric assessment of neointimal hyperplasia at the vein-graft anastomosis. Blood was collected at surgery, immediately after surgery and at euthanasia for serum metabolic panels and coagulation chemistries. Results No acute thrombosis occurred in the control group or in either experimental group. No abnormal serum chemistries, activated clotting times or PT, PTT values were observed after treatment in experimental or control animals. However, at the vein-graft anastomosis, there was no difference between the control and experimental groups in cross-sectional lumen areas, as measured on MRI, and no difference in hyperplasia areas as determined by histomorphometry. These results suggest that local irrigation of TAP-ANV or ANV-6L15 intra-operatively was as effective in inhibiting acute graft thrombosis as intravenous administration of heparin, but failed to inhibit hyperplasia development and stenosis in AVG. PMID:26360605

  1. Open Surgical Bypass for Superficial Femoral Artery Occlusion Caused by Blunt Trauma

    PubMed Central

    Kudo, Yohei; Maeda, Michihiro; Tochiki, Aito; Ichimura, Haruto; Uesugi, Masafumi; Jikuya, Tomoaki

    2015-01-01

    Blunt vascular trauma of the lower extremities brings about a high amputation rate, because other organ injuries disturb revascularization. We experienced a case of a superficial femoral artery occlusion caused by blunt trauma. The patient also had a femoral bone fracture and a large skin defect with deep muscular injuries of the thigh. We performed a femoropopliteal (FP) bypass using a saphenous vein which was routed through the contaminated wound. Postoperative vacuum-assisted closure therapy was used to prevent graft infection. Surgical bypasses using saphenous veins are approved treatments for arterial occlusions from blunt trauma if the grafts go through contaminated wounds. PMID:26421079

  2. Open Surgical Bypass for Superficial Femoral Artery Occlusion Caused by Blunt Trauma.

    PubMed

    Ikeda, Akihiko; Kudo, Yohei; Maeda, Michihiro; Tochiki, Aito; Ichimura, Haruto; Uesugi, Masafumi; Jikuya, Tomoaki

    2015-01-01

    Blunt vascular trauma of the lower extremities brings about a high amputation rate, because other organ injuries disturb revascularization. We experienced a case of a superficial femoral artery occlusion caused by blunt trauma. The patient also had a femoral bone fracture and a large skin defect with deep muscular injuries of the thigh. We performed a femoropopliteal (FP) bypass using a saphenous vein which was routed through the contaminated wound. Postoperative vacuum-assisted closure therapy was used to prevent graft infection. Surgical bypasses using saphenous veins are approved treatments for arterial occlusions from blunt trauma if the grafts go through contaminated wounds. PMID:26421079

  3. Innominate artery injury from disseminated tuberculosis.

    PubMed

    Chow, Oliver S; Huang, Joe T; Sambol, Justin T; Bolanowski, Paul J; Lovoulos, Constantinos J

    2015-07-01

    A 49-year-old man presented with chest pain and was found to have hemorrhage and drainage from a chest wound secondary to disseminated tuberculosis involving the sternum and ankle. He then developed acute hemorrhage from an innominate artery pseudoaneurysm originating just below a severely diseased sternoclavicular junction. A staged approach was used to manage his pathology given the life-threatening bleeding and his debilitated condition. He underwent endovascular stent grafting to exclude the pseudoaneurysm, followed by aggressive debridement of the affected sternal area. PMID:24585307

  4. Late Onset of Cholesterol Embolism Leading to Graft Failure After Renal Transplantation: Report of Two Cases.

    PubMed

    González, A P; Juega, J; Vazquez, C; Hernández-Gallego, A; López, D; Cañas, L; Bancu, I; Bonet, J; Lauzurica, R

    2015-10-01

    Cholesterol-crystal embolization (CE) usually presents as an acute or subacute multisystemic disease. When affecting native kidneys prognosis is poor, often leading to chronic kidney disease. Presentation in renal allografts is a rare condition although probably underdiagnosed. If renal CE originates from the recipient, allograft survival is usually good, whereas if the donor is the origin, graft dysfunction and subsequent graft loss are common. Associated risk factors are common to native and transplanted kidneys. We report 2 renal graft recipients of different cadaveric donors, both male and 68 years old, diagnosed with CE in renal grafts at 19 and 72 months after transplantation, respectively. They presented previous risk factors for CE, including severe atherosclerosis. They presented insidious and asymptomatic impairment of renal function initially. Renal graft biopsy specimens showed CE in the interlobular arteries. Potential triggers for CE were suspended and high doses of steroids were started. However, progressive decline in renal function and requirement of chronic dialysis occurred within the first year after diagnosis in both cases. Herein we discuss the causal or incidental role of CE in the graft failure of these cases, highlighting the serious outcome despite the recipient origin of the CE and the initiation of treatment. PMID:26518927

  5. Endovascular Treatment of Descending Thoracic Aortic Aneurysms with the EndoFit Stent-Graft

    SciTech Connect

    Saratzis, N.; Saratzis, Athanasios Melas, N.; Ginis, G.; Lioupis, A.; Lykopoulos, D.; Lazaridis, J.; Kiskinis, Dimitrios

    2007-04-15

    Objective. To evaluate the mid-term feasibility, efficacy, and durability of descending thoracic aortic aneurysm (DTAA) exclusion using the EndoFit device (LeMaitre Vascular). Methods. Twenty-three (23) men (mean age 66 years) with a DTAA were admitted to our department for endovascular repair (21 were ASA III+ and 2 refused open repair) from January 2003 to July 2005. Results. Complete aneurysm exclusion was feasible in all subjects (100% technical success). The median follow-up was 18 months (range 8-40 months). A single stent-graft was used in 6 cases. The deployment of a second stent-graft was required in the remaining 17 patients. All endografts were attached proximally, beyond the left subclavian artery, leaving the aortic arch branches intact. No procedure-related deaths have occurred. A distal type I endoleak was detected in 2 cases on the 1 month follow-up CT scan, and was repaired with reintervention and deployment of an extension graft. A nonfatal acute myocardial infarction occurred in 1 patient in the sixth postoperative month. Graft migration, graft infection, paraplegia, cerebral or distal embolization, renal impairment or any other major complications were not observed. Conclusion. The treatment of DTAAs using the EndoFit stent-graft is technically feasible. Mid-term results in this series are promising.

  6. Vapor resistant arteries

    NASA Technical Reports Server (NTRS)

    Shaubach, Robert M. (Inventor); Dussinger, Peter M. (Inventor); Buchko, Matthew T. (Inventor)

    1989-01-01

    A vapor block resistant liquid artery structure for heat pipes. A solid tube artery with openings is encased in the sintered material of a heat pipe wick. The openings are limited to that side of the artery which is most remote from the heat source. The liquid in the artery can thus exit the artery through the openings and wet the sintered sheath, but vapor generated at the heat source is unlikely to move around the solid wall of the artery and reverse its direction in order to penetrate the artery through the openings. An alternate embodiment uses finer pore size wick material to resist vapor entry.

  7. History and current status of robotic totally endoscopic coronary artery bypass.

    PubMed

    Lee, Jeffrey D; Srivastava, Mukta; Bonatti, Johannes

    2012-01-01

    Robotic totally endoscopic coronary artery bypass (TECAB) is a minimally invasive endoscopic surgical approach using the daVinci robotic telemanipulation system to perform coronary artery bypass grafting on the arrested or beating heart. It is a procedure that can be a useful alternative to the classic open procedure performed through sternotomy. After extensive modeling in cadavers, the first clinical case was performed in June 1998 placing a left internal thoracic artery graft (LITA) to the left anterior descending artery completely robotically on the arrested heart. During the early and late 2000s, international groups have adopted this evolving technology, which has included iterations such as beating-heart TECAB, use of bilateral ITA grafting and radial artery grafting, as well as 3- and 4-vessel TECAB. TECAB is combined with percutaneous coronary intervention in hybrid procedures. Despite increasing complexity of endoscopic coronary bypass surgery, conversion rates to open bypass surgery have dropped significantly and operative times have decreased. Published major morbidities and mortality rates in arrested-and beating-heart TECAB have been cumulatively in the 0-2% range and are considered well within the expected range for these highly complex surgical procedures. Long-term survival and freedom from major adverse events also meet the standards of open bypass surgery. PMID:22893280

  8. Specific posttranslational modification regulates early events in mammary carcinoma formation

    PubMed Central

    Guo, Hua-Bei; Johnson, Heather; Randolph, Matthew; Nagy, Tamas; Blalock, Ryan; Pierce, Michael

    2010-01-01

    The expression of an enzyme, GnT-V, that catalyzes a specific posttranslational modification of a family of glycoproteins, namely a branched N-glycan, is transcriptionally up-regulated during breast carcinoma oncogenesis. To determine the molecular basis of how early events in breast carcinoma formation are regulated by GnT-V, we studied both the early stages of mammary tumor formation by using 3D cell culture and a her-2 transgenic mouse mammary tumor model. Overexpression of GnT-V in MCF-10A mammary epithelial cells in 3D culture disrupted acinar morphogenesis with impaired hollow lumen formation, an early characteristic of mammary neoplastic transformation. The disrupted acinar morphogenesis of mammary tumor cells in 3D culture caused by her-2 expression was reversed in tumors that lacked GnT-V expression. Moreover, her-2-induced mammary tumor onset was significantly delayed in the GnT-V null tumors, evidence that the lack of the posttranslational modification catalyzed by GnT-V attenuated tumor formation. Inhibited activation of both PKB and ERK signaling pathways was observed in GnT-V null tumor cells. The proportion of tumor-initiating cells (TICs) in the mammary tumors from GnT-V null mice was significantly reduced compared with controls, and GnT-V null TICs displayed a reduced ability to form secondary tumors in NOD/SCID mice. These results demonstrate that GnT-V expression and its branched glycan products effectively modulate her-2-mediated signaling pathways that, in turn, regulate the relative proportion of tumor initiating cells and the latency of her-2-driven tumor onset. PMID:21078982

  9. Brachial Artery Injury Accompanying Closed Elbow Dislocations

    PubMed Central

    Harnarayan, Patrick; Cawich, Shamir O.; Harnanan, Dave; Budhooram, Steve

    2014-01-01

    Introduction Brachial artery injuries from elbow dislocations are uncommon, but they may lead to disastrous consequences if the diagnosis is delayed. Presentation of case We report a case of a patient who sustained a fall onto the elbow, with dislocation and brachial artery injury, despite an ipsilateral radial pulse being palpable. Discussion Clinicians should maintain a high index of suspicion for brachial injury when patients present with a fall onto the elbow coupled with signs suggestive of fracture-dislocation, nerve injury and/or signs of limb ischemia. Frank ischamia, however, is uncommon as there is a rich collateral anastomosis in the upper limb. Conclusion A high index of suspicion should be maintained in order to make the diagnosis early. Exploration with excision of the injured segment and reverse vein interposition grafting is the treatment of choice in these cases. PMID:25644552

  10. INDUCTION OF MAMMARY GLAND DEVELOPMENT IN ESTROGEN RECEPTOR-ALPHA KNOCKOUT MICE

    EPA Science Inventory

    Mammary glands from the estrogen receptor knockout ( ERKO) mouse do not undergo ductal morphogenesis or alveolar development. Disrupted Er signaling may result in reduced estrogen-responsive gene products in the mammary gland or reduced mammotropic hormones that contribute t...

  11. Role of C/EBP? in two luminal progenitor populations in the mouse mammary gland 

    E-print Network

    Zay, Agnes

    2013-06-29

    The mammary gland is a branched epithelial organ comprised of myoepithelial, ductal and alveolar cells that are derived from resident stem and progenitor cells. The progression from mammary gland stem cell(s) to the ...

  12. Characterisation of microRNA expression in post-natal mouse mammary gland development

    E-print Network

    Avril-Sassen, Stefanie; Goldstein, Leonard D.; Stingl, John; Blenkiron, Cherie; Le Quesne, John; Spiteri, Inmaculada; Karagavriilidou, Konstantina; Watson, Christine J.; Tavare, Simon; Miska, Eric A.; Caldas, Carlos

    2009-11-20

    Abstract Background The differential expression pattern of microRNAs (miRNAs) during mammary gland development might provide insights into their role in regulating the homeostasis of the mammary epithelium. Our aim was to analyse these regulatory...

  13. A novel cell culture model for studying differentiation and apoptosis in the mouse mammary gland

    E-print Network

    Gordon, Katrina E.; Binas, Bert; Chapman, Rachel S.; Kurian, Kathreena M.; Clarkson, Richard W. E.; Clark, A. John; Lane, E. Birgitte; Watson, Christine J.

    2000-03-07

    Abstract Background This paper describes the derivation and characterization of a novel, conditionally immortal mammary epithelial cell line named KIM-2. These cells were derived from mid-pregnant mammary glands of a mouse harbouring one to two...

  14. Rupture of the Renal Artery After Cutting Balloon Angioplasty in a Young Woman With Fibromuscular Dysplasia

    SciTech Connect

    Oguzkurt, Levent Tercan, Fahri; Gulcan, Oner; Turkoz, Riza

    2005-04-15

    A 24-year-old woman with uncontrollable high blood pressure for 3 months had significant stenosis of the left renal artery caused by fibromuscular dysplasia (FMD). The lesion was resistant to percutaneous transluminal angioplasty at 18 atm with a semicompliant balloon. Angioplasy with a 6 x 10 mm cutting balloon (CB) caused rupture of the artery. Low-pressure balloon inflation decreased but did not stop the leak. An attempt to place a stent-graft (Jostent; Jomed, Rangendingen, Germany) failed, and a bare, 6-mm balloon-expandable stent (Express SD; Boston Scientific, MN) was deployed to seal the leak, which had decreased considerably after long-duration balloon inflation. The bleeding continued, and the patient underwent emergent surgical revascularization of the renal artery with successful placement of a 6-mm polytetrafluoroethylene bypass graft. CBs should be used very carefully in the treatment of renal artery stenosis, particularly in patients with FMD.

  15. Revascularization Options: Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention.

    PubMed

    Kappetein, A Pieter; van Mieghem, Nicolas M; Head, Stuart J

    2016-01-01

    Coronary artery bypass grafting (CAGB) is superior to percutaneous coronary intervention (PCI) in reducing mortality in certain patients and improving the composite end points of angina, recurrent myocardial infarction, and repeat revascularization procedures. However, CABG is associated with a higher perioperative stroke risk. For patients with less complex disease or left main coronary disease, PCI is an acceptable alternative to CABG. Lesion complexity is an essential consideration for stenting, whereas patient comorbidity is an essential consideration for CABG. All patients with complex multivessel coronary artery disease should be reviewed by a heart team including a cardiac surgeon and interventional cardiologist. PMID:26567980

  16. Delayed Development of Brain Abscesses Following Stent-Graft Placement in a Head and Neck Cancer Patient Presenting with Carotid Blowout Syndrome

    SciTech Connect

    Oweis, Yaseen; Gemmete, Joseph J. Chaudhary, Neeraj; Pandey, Aditya; Ansari, Sameer

    2011-02-15

    We describe the delayed development of intracranial abscesses following emergent treatment with a covered stent-graft for carotid blowout syndrome (CBS) in a patient with head and neck cancer. The patient presented with hemoptysis and frank arterial bleeding through the tracheostomy site. A self-expandable stent-graft was deployed across a small pseudoaneurysm arising from the right common carotid artery (RCCA) and resulted in immediate hemostasis. Three months later, the patient suffered a recurrent hemorrhage. CT of the neck demonstrated periluminal fluid around the caudal aspect of the stent-graft with intraluminal thrombus and a small pseudoaneurysm. Subsequently, the patient underwent a balloon test occlusion study and endovascular sacrifice of the RCCA and right internal carotid artery. MRI of the brain demonstrated at least four ring-enhancing lesions within the right cerebral hemisphere consistent with intracranial abscesses that resolved with broad-spectrum antibiotic coverage.

  17. Polymeric Materials for Tissue Engineering of Arterial Substitutes

    PubMed Central

    Ravi, Swathi; Qu, Zheng; Chaikof, Elliot L.

    2009-01-01

    Cardiovascular disease is the leading cause of mortality in the United States. The limited availability of healthy autologous vessels for bypass grafting procedures has led to the fabrication of prosthetic vascular conduits. Synthetic polymeric materials, while providing the appropriate mechanical strength, lack the compliance and biocompatibility that bioresorbable and naturally occurring protein polymers offer. Vascular tissue engineering approaches have emerged in order to meet the challenges of designing a vascular graft with long-term patency. In vitro culture techniques that have been explored with vascular cell seeding of polymeric scaffolds and the use of bioactive polymers for in situ arterial regeneration have yielded promising results. This review describes the development of polymeric materials in various tissue engineering strategies for the improvement in the mechanical and biological performance of an arterial substitute. PMID:19426609

  18. Plant grafting: new mechanisms, evolutionary implications.

    PubMed

    Goldschmidt, Eliezer E

    2014-01-01

    Grafting, an old plant propagation practice, is still widely used with fruit trees and in recent decades also with vegetables. Taxonomic proximity is a general prerequisite for successful graft-take and long-term survival of the grafted, composite plant. However, the mechanisms underlying interspecific graft incompatibility are as yet insufficiently understood. Hormonal signals, auxin in particular, are believed to play an important role in the wound healing and vascular regeneration within the graft union zone. Incomplete and convoluted vascular connections impede the vital upward and downward whole plant transfer routes. Long-distance protein, mRNA and small RNA graft-transmissible signals currently emerge as novel mechanisms which regulate nutritional and developmental root/top relations and may play a pivotal role in grafting physiology. Grafting also has significant pathogenic projections. On one hand, stock to scion mechanical contact enables the spread of diseases, even without a complete graft union. But, on the other hand, grafting onto resistant rootstocks serves as a principal tool in the management of fruit tree plagues and vegetable soil-borne diseases. The 'graft hybrid' historic controversy has not yet been resolved. Recent evidence suggests that epigenetic modification of DNA-methylation patterns may account for certain graft-transformation phenomena. Root grafting is a wide spread natural phenomenon; both intraspecific and interspecific root grafts have been recorded. Root grafts have an evolutionary role in the survival of storm-hit forest stands as well as in the spread of devastating diseases. A more fundamental evolutionary role is hinted by recent findings that demonstrate plastid and nuclear genome transfer between distinct Nicotiana species in the graft union zone, within a tissue culture system. This has led to the formation of alloploid cells that, under laboratory conditions, gave rise to a novel, alloploid Nicotiana species, indicating that natural grafts may play a role in plant speciation, under certain circumstances. PMID:25566298

  19. Plant grafting: new mechanisms, evolutionary implications

    PubMed Central

    Goldschmidt, Eliezer E.

    2014-01-01

    Grafting, an old plant propagation practice, is still widely used with fruit trees and in recent decades also with vegetables. Taxonomic proximity is a general prerequisite for successful graft-take and long-term survival of the grafted, composite plant. However, the mechanisms underlying interspecific graft incompatibility are as yet insufficiently understood. Hormonal signals, auxin in particular, are believed to play an important role in the wound healing and vascular regeneration within the graft union zone. Incomplete and convoluted vascular connections impede the vital upward and downward whole plant transfer routes. Long-distance protein, mRNA and small RNA graft-transmissible signals currently emerge as novel mechanisms which regulate nutritional and developmental root/top relations and may play a pivotal role in grafting physiology. Grafting also has significant pathogenic projections. On one hand, stock to scion mechanical contact enables the spread of diseases, even without a complete graft union. But, on the other hand, grafting onto resistant rootstocks serves as a principal tool in the management of fruit tree plagues and vegetable soil-borne diseases. The ‘graft hybrid’ historic controversy has not yet been resolved. Recent evidence suggests that epigenetic modification of DNA-methylation patterns may account for certain graft-transformation phenomena. Root grafting is a wide spread natural phenomenon; both intraspecific and interspecific root grafts have been recorded. Root grafts have an evolutionary role in the survival of storm-hit forest stands as well as in the spread of devastating diseases. A more fundamental evolutionary role is hinted by recent findings that demonstrate plastid and nuclear genome transfer between distinct Nicotiana species in the graft union zone, within a tissue culture system. This has led to the formation of alloploid cells that, under laboratory conditions, gave rise to a novel, alloploid Nicotiana species, indicating that natural grafts may play a role in plant speciation, under certain circumstances. PMID:25566298

  20. Platelet reactivity in human aortic grafts: a prospective, randomized midterm study of platelet adherence and release products in Dacron and polytetrafluoroethylene conduits

    SciTech Connect

    Wakefield, T.W.; Shulkin, B.L.; Fellows, E.P.; Petry, N.A.; Spaulding, S.A.; Stanley, J.C.

    1989-02-01

    Platelet-related phenomena at the blood-surface interface of randomly placed knitted Dacron (n = 6) and polytetrafluoroethylene (ePTFE) (n = 6) interposition aortic grafts were studied in patients undergoing abdominal aortic aneurysmectomy. Luminal accumulation of platelets was assessed by infusing indium-111-oxine (400 microCi) labeled autologous platelets and imaging grafts at 1 week, 3 months, and 6 months after surgery. Image analysis included an indium ratio technique (comparing aortic graft radioactivity to that of an iliac artery) and a red blood cell technetium subtraction technique (excluding blood pool radioactivity from graft radioactivity, with the heart or iliac artery serving as reference regions). Plasma levels of beta-thromboglobulin and platelet factor 4 were correlated with platelet accumulations on the aortic prostheses. Differences in graft radioactivity or platelet-release products were not evident 1 week after surgery. Three months after implantation, Dacron and ePTFE conduits exhibited 87% and 47% (p less than 0.05) more radioactivity with the indium ratio technique than the iliac artery. Similarly, increased Dacron compared with ePTFE graft radioactivity was noted using technetium subtraction techniques: 71% vs 30% with a heart reference and 26% vs 11% with an iliac artery reference, respectively. Increases in graft radioactivity correlated with increases in both plasma beta-thromboglobulin and platelet factor 4 at 3 months (r = 0.6 to 0.9; p less than 0.05 to 0.001 depending on the imaging technique used). At 6 months, differences did not persist. In fact, technetium subtraction techniques suggested less Dacron conduit reactivity. It is speculated that differences in platelet accumulation and activation associated with different graft substrates may prove clinically important.

  1. Five markers useful for the distinction of canine mammary malignancy

    PubMed Central

    2013-01-01

    Background Spontaneous canine mammary tumors constitute a serious clinical problem. There are significant differences in survival between cases with different tumor grades. Unfortunately, the distinction between various grades is not clear. A major problem in evaluating canine mammary cancer is identifying those, that are “truly” malignant. That is why the aim of our study was to find the new markers of canine malignancy, which could help to diagnose the most malignant tumors. Results Analysis of gene expression profiles of canine mammary carcinoma of various grade of malignancy followed by the boosted tree analysis distinguished a `gene set`. The expression of this gene set (sehrl, zfp37, mipep, relaxin, and magi3) differs significantly in the most malignant tumors at mRNA level as well as at protein level. Despite this `gene set` is very interesting as an additional tool to estimate canine mammary malignancy, it should be validated using higher number of samples. Conclusions The proposed gene set can constitute a `malignancy marker` that could help to distinguish the most malignant canine mammary carcinomas. These genes are also interesting as targets for further investigations and therapy. So far, only two of them were linked with the cancer development. PMID:23844591

  2. In vitro expansion of the mammary stem/progenitor cell population by xanthosinetreatment

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Background: Mammary stem cells are critical for growth and maintenance of the mammary gland and therefore of considerable interest for improving productivity and efficiency of dairy animals. Xanthosine (Xs) treatment has been demonstrated to promote expansion of putative mammary stem cells in vivo ...

  3. Expression of novel, putative stem cell markers in prepubertal and lactating mammary glands of bovine

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Mammary stem cells (MaSC) are essential for growth and maintenance of the mammary epithelium. Two main phases of mammary growth include ductal elongation prior to puberty and lobulo-alveolar growth and development during pregnancy. Some studies have utilized morphological characteristics and retenti...

  4. Bovine mammary stem cells: Transcriptome profiling and the stem cell niche

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Identification and transcriptome analysis of mammary stem cells (MaSC) are important steps toward understanding the molecular basis of mammary epithelial growth, homeostasis and tissue repair. Our objective was to evaluate the molecular profiles of four categories of cells within the bovine mammary ...

  5. Mammary Gland Remodeling Depends on gp130 Signaling through Stat3 and MAPK*

    E-print Network

    Ullrich, Axel

    Mammary Gland Remodeling Depends on gp130 Signaling through Stat3 and MAPK* Received death and tissue remodeling in the mouse mammary gland during involution, which is partially induced, cell-cell communication, and cell cycle regulation (8­10). In the mammary gland, the cycle

  6. Wnt-10b directs hypermorphic development and transformation in mammary glands of male and female mice

    E-print Network

    Lane, Timothy F.

    Wnt-10b directs hypermorphic development and transformation in mammary glands of male and female-regulation of the mammary gland. To test this notion, we created lines of transgenic mice that express elevated levels in profound developmental alterations in the mammary gland, including expanded glandular development

  7. ESTROGEN-DEPENDENT RESPONSES TO THE MAMMARY FAT PAD IN PREPUBERTAL DAIRY HEIFERS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The ovary is required for prepubertal mammary development in the bovine. The aim of this study was to compare the effect of estrogen (E) status on the transcript abundance of specific E-responsive genes within the mammary parenchyma (PAR), mammary fat pad (FP) and another fat depot, subcutaneous ad...

  8. RESEARCH ARTICLE Open Access The role of Sox9 in mouse mammary gland

    E-print Network

    Sander, Maike

    RESEARCH ARTICLE Open Access The role of Sox9 in mouse mammary gland development and maintenance homeostasis are critical to our understanding of normal mammary gland development and its pathology. Results: We demonstrate that conditional knockout of Sox9 in the mouse mammary gland results in impaired

  9. Prolactin receptor expression in the epithelia and stroma of the rat mammary gland

    E-print Network

    Kihara, Daisuke

    Prolactin receptor expression in the epithelia and stroma of the rat mammary gland I G Camarillo, G) in regulating growth and differentiation of the mammary gland is well known. However, it is not well established. To determine where PRL could exert its effects within the mammary gland, we investigated the levels

  10. Endovascular Treatment of Complications of Femoral Arterial Access

    SciTech Connect

    Tsetis, Dimitrios

    2010-06-15

    Endovascular repair of femoral arterial access complications is nowadays the treatment of choice in a group of patients who cannot tolerate vascular reconstruction and bleeding due to advanced cardiovascular disease. Endovascular procedures can be performed under local anesthesia, are well tolerated by the patient, and are associated with a short hospitalization time. Ninitinol stent technology allows for safe stent and stent-graft extension at the common femoral artery (CFA) level, due to increased resistance to external compression and bending stress. Active pelvic bleeding can be insidious, and prompt placement of a stent-graft at the site of leakage is a lifesaving procedure. Percutaneous thrombin injection under US guidance is the treatment of choice for femoral pseudoaneurysms (PAs); this can theoretically be safer with simultaneous balloon occlusion across the entry site of a PA without a neck or with a short and wide neck. In a few cases with thrombin failure due to a large arterial defect or accompanying arteriovenous fistula (AVF), a stent-graft can be deployed. The vast majority of catheter-induced AVFs can be treated effectively with stent-graft implantation even if they are located very close to the femoral bifurcation. Obstructive dissection flaps localized in the CFA are usually treated with prolonged balloon inflation; however, in more extensive dissections involving iliac arteries, self-expanding stents should be deployed. Iliofemoral thrombosis can be treated effectively with catheter-directed thrombolysis (CDT) followed by prolonged balloon inflation or stent placement. Balloon angioplasty and CDT can occasionally be used to treat stenoses and occlusions complicating the use of percutaneous closure devices.

  11. Coronary artery disease and diabetes mellitus

    PubMed Central

    Aronson, Doron; Edelman, Elazer R.

    2015-01-01

    SUMMARY Coronary artery disease (CAD) is a major determinant of the long-term prognosis among patients with diabetes mellitus (DM). DM is associated with a 2 to 4-fold increased mortality risk from heart disease. Furthermore, in patients with DM there is an increased mortality after MI, and worse overall prognosis with CAD. Near-normal glycemic control for a median of 3.5 to 5 years does not reduce cardiovascular events. Thus, the general goal of HbA1c <7% appears reasonable for the majority of patients. Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes, and is an independent cause of excess morbidity and mortality. Statins are effective in reducing major coronary events, stroke, and the need for coronary revascularization. Selection of the optimal myocardial revascularization strategy for patients with DM and multivessel coronary artery disease is crucial and requires a multidisciplinary team approach (‘heart team’). Large scale clinical trials have shown that for many patients with 1- or 2-vessel coronary artery disease, there is little prognostic benefit from any intervention over optimal medical therapy (OMT). PCI with drug-eluting or bare metal stents is appropriate for patients who remain symptomatic with OMT. Randomized trials comparing multivessel PCI to coronary artery bypass grafting (CABG) have consistently demonstrated the superiority of CABG in reducing mortality, myocardial infarctions and need for repeat revascularizations. PMID:25091969

  12. Endovascular Stent Graft Repair of Abdominal and Thoracic Aortic Aneurysms

    PubMed Central

    Marin, Michael L.; Hollier, Larry H.; Ellozy, Sharif H.; Spielvogel, David; Mitty, Harold; Griepp, Randall; Lookstein, Robert A.; Carroccio, Alfio; Morrissey, Nicholas J.; Teodorescu, Victoria J.; Jacobs, Tikva S.; Minor, Michael E.; Sheahan, Claudie M.; Chae, Kristina; Oak, Juliana; Cha, Andrew

    2003-01-01

    Objective: On November 23, 1992, the first endovascular stent graft (ESG) repair of an aortic aneurysm was performed in North America. Following the treatment of this patient, we have continued to evaluate ESG over the past 10 years in the treatment of 817 patients. Summary and Background Data: Abdominal (AAA) or thoracic (TAA) aortic aneurysms are a significant health concern traditionally treated by open surgical repair. ESG therapy may offer protection from aneurysm rupture with a reduction in procedure morbidity and mortality. Methods: Over a 10-year period, 817 patients were treated with ESGs for AAA (723) or TAA (94). Patients received 1 of 12 different stent graft devices. Technical and clinical success of ESGs was reviewed, and the incidence of procedure-related complications was analyzed. Results: The mean age was 74.3 years (range, 25–95 years); 678 patients (83%) were men; 86% had 2 or more comorbid medical illnesses, 67% of which included coronary artery disease. Technical success, on an intent-to-treat basis was achieved in 93.8% of patients. Primary clinical success, which included freedom from aneurysm-related death, type I or III endoleak, graft infection or thrombosis, rupture, or conversion to open repair was 65 ± 6% at 8 years. Of great importance, freedom from aneurysm rupture after ESG insertion was 98 ± 1% at 9 years. There was a 2.3% incidence of perioperative mortality. One hundred seventy five patients died of causes not related to their aneurysm during a mean follow-up of 15.4 months. Conclusions: Stent graft therapy for aortic aneurysms is a valuable alternative to open aortic repair, especially in older sicker patients with large aneurysms. Continued device improvements coupled with an enhanced understanding of the important role of aortic pathology in determining therapeutic success will eventually permit ESGs to be a more durable treatment of aortic aneurysms. PMID:14530730

  13. Cystic adventitial disease of the popliteal artery: report of two cases and review of the literature

    PubMed Central

    VERALDI, G.F.; SCUDO, G.; SCORSONE, L.; MEZZETTO, L.; CASTELLANI, R.L.

    2014-01-01

    Cystic adventitial disease (CAD) is a rare vascular disease that causes a localized stenosis or occlusion in absence of alterations of blood vessels in other sites of the body. CAD is predominantly located to the popliteal artery, although cases have been described involving other arteries. Typically it affects young men with minimal cardiovascular risk factors, presenting a short history of progressive claudication. Imaging is based on US, CTA and MRA. Suspected diagnosis is confirmed at the time of the surgery. We report two cases of CAD involving the popliteal artery. In the first case a 59 year-old man was treated by resection of the popliteal artery and a reversed saphenous vein was used to restore circulation. In the second case a 53 year-old man was treated by resection of the popliteal artery and a cryo-preserved arterial graft was used to restore circulation. We also made a review of the literature on this subject. PMID:25419589

  14. Primary Breast Augmentation with Fat Grafting.

    PubMed

    Coleman, Sydney R; Saboeiro, Alesia P

    2015-07-01

    The controversy over fat grafting to the breasts has now been settled. In 2009, the American Society of Plastic Surgeons Fat Graft Task Force stated that "Fat grafting may be considered for breast augmentation and correction of defects associated with medical conditions and previous breast surgeries; however, results are dependent on technique and surgeon expertise." This article discusses the history, indications, planning, complications, and present technique of fat grafting to the breast using the Coleman technique. PMID:26116935

  15. A simplified two-stitch sleeve technique for arterial anastomosis of cervical heterotopic cardiac transplantation in mice

    PubMed Central

    Fang, Jing; He, Long; Wang, Shi-Qiang; Ma, Ming-Jia; Liu, Hong-Yun; Zhu, Xue-Hai; Zhu, Ping; Wei, Xiang; Wang, Cong-Yi

    2013-01-01

    Although cervical cardiac transplantation is a well recognized useful model in diverse experimental settings, its widespread use, however, has been significantly hampered by the technical challenges relevant to small vessel anastomosis. We herein introduced a simplified two-stitch sleeve technique into arterial anastomosis during the course of cervical cardiac transplantation in mice. Cervical transplantation of allogenic and syngeneic cardiac grafts was conducted to assess the feasibility of this two-stitch sleeve technique in arterial anastomosis. Venous anastomosis was completed by the one-suture end-to-end microsuture technique, while arterial anastomosis was conducted by invaginating the recipient right common carotid artery into the graft left common carotid artery along with two guiding stitches. The two-stitch sleeve technique significantly simplified the procedures for arterial anastomosis as compared with that of the traditional microsuture technique (5.5 ± 1.8 min vs. 15.7 ± 3.0 min). However, the survival time for allografts (8.0 ± 0.2 day vs. 8.0 ± 0.4 day) and the long-term patency for syngeneic grafts (> 120 days) were the same as the grafts implanted by the traditional microsuture technique. This simplified sleeve technique is easy to learn, particularly for beginners without microsuture experience, and therefore, it has the great potential for widespread use in transplant immunology. PMID:23977411

  16. Revascularization for coronary artery disease in diabetes mellitus: Angioplasty, stents and coronary artery bypass grafting

    E-print Network

    Aronson, Doron

    Patients with diabetes mellitus (DM) are prone to a diffuse and rapidly progressive form of atherosclerosis, which increases their likelihood of requiring revascularization. However, the unique pathophysiology of atherosclerosis ...

  17. Costal Cartilage Grafts in Rhinoplasty.

    PubMed

    Fedok, Fred G

    2016-01-01

    Cartilage grafts are regularly used in rhinoplasty. Septal and auricular donor sites are commonly used. Many situations compel the surgeon to use other alternative donor sites, including revision rhinoplasty and trauma. Many patients have a small amount of native septal cartilage and are unable to provide adequate septal cartilage to be used for frequently performed rhinoplasty maneuvers. The rib cage provides an enormous reserve of costal cartilage that can be carved into a variety of necessary grafts. A description of the technique of harvesting costal cartilage, a review of complications and management, and illustrative cases examples are included. PMID:26616708

  18. Cooled artery extension

    NASA Technical Reports Server (NTRS)

    Gernert, Nelson J. (Inventor)

    1990-01-01

    An artery vapor trap. A heat pipe artery is constructed with an extension protruding from the evaporator end of the heat pipe beyond the active area of the evaporator. The vapor migrates into the artery extension because of gravity or liquid displacement, and cooling the extension condenses the vapor to liquid, thus preventing vapor lock in the working portion of the artery by removing vapor from within the active artery. The condensed liquid is then transported back to the evaporator by the capillary action of the artery extension itself or by wick located within the extension.

  19. Mammary blood flow regulation in the nursing rabbit

    SciTech Connect

    Katz, M.; Creasy, R.K.

    1984-11-01

    Cardiac output and mammary blood flow distribution prior to and after suckling were studied in 10 nursing rabbits by means of radionuclide-labeled microspheres. Suckling was followed by a 5.8% rise in cardiac output and a 20.4% rise in mammary blood flow. Determinations of intraglandular blood flow distribution have shown that there was a 43% increase in blood flow to the glands suckled from as compared to a 22.7% rise to the contralateral untouched glands and a 4.9% rise in the remainder of untouched glands. The conclusion is that a local mechanism may be involved in the regulation of mammary blood flow in the nursing rabbit.

  20. Organosiloxane-grafted natural polymer coatings

    DOEpatents

    Sugama, Toshifumi (Wading River, NY)

    1998-01-01

    A new family of polysaccharide graft polymers are provided as corrosion resistant coatings having antimicrobial properties which are useful on light metals such as aluminum, magnesium, zinc, steel and their alloys. Methods of making the polysaccharide graft polymers are also included. The methods of making the polysaccharide graft polymers involve reacting a polysaccharide source with an antimicrobial agent under conditions of hydrolysis-condensation.

  1. Colour Doppler ultrasonography for evaluation of anterior chest blood supply: the possible role of arterial blood supply to the costosternal junction in the aetiology of idiopathic scoliosis in female adolescents.

    PubMed

    Korovessis, Panagiotis; Iliopoulos, Panagiotis; Misiris, Alexandros; Koureas, Georgios

    2004-02-01

    This prospective comparative study was carried out to investigate the blood supply to the anterior chest wall by measurement of several anatomical and haemodynamic flow parameters of the internal mammary artery, with the use of colour Doppler ultrasonography, in female scoliotics with idiopathic right convex scoliosis in adolescence. Previous investigations have postulated that asymmetry of the breasts in female adolescents may be linked with the development of right convex thoracic scoliosis. This breast asymmetry is supposed to be linked with anatomical and functional asymmetry of the internal mammary artery that is the main supplier to the mammary gland. However, no measurements of anatomical and haemodynamic parameters of the internal mammary artery have been made to justify or reject the hypothesis of asymmetric blood flow volume to the breasts and costosternal junction in female adolescent scoliotics. Twenty female adolescents with right convex thoracic scoliosis and 16 comparable female individuals without spine deformity were examined with roentgenograms (scoliotics only) to measure scoliosis curve, vertebral rotation and concave and convex rib-vertebra angle at three vertebrae (the apical, one level above and one below the apical vertebra). Doppler ultrasonography was used to measure, at the origin of the internal mammary artery, its lumen diameter, cross-sectional area, time average mean flow and flow volume per minute in scoliotics and controls, which were compared with each other. The roentgenographic parameters were compared with the ultrasonographic parameters in the scoliotics to disclose any relationship. The reliability of colour Doppler ultrasonography was high and the intra-observer variability low (ANOVA, P=0.92-0.94). There was no statistically significant difference in the ultrasonographic parameters of the internal mammary artery between right and left side in each individual as well as between scoliotics and controls. In scoliotics the right mammary artery time average mean velocity increases with the convex ( P<0.05) and concave ( P<0.01) rib-vertebra angle one level above the apical vertebrae and with the apical convex rib-vertebra angle ( P<0.05). The right internal mammary artery flow volume per minute increases with convex ( P<0.01) and concave ( P<0.01) rib-vertebra angle one level above the apical vertebrae and with the apical convex rib-vertebra angle ( P<0.05). Left internal mammary artery cross-sectional area increases with convex apical rib-vertebra angle ( P<0.01) and concave rib-vertebra angle one level above the apical vertebra ( P<0.01). Conclusively, this investigation showed that haemodynamic flow parameters of the right internal mammary artery and anatomical parameters of the left internal mammary artery are significantly correlated with the magnitude of rib-vertebra angles close to the apex of right thoracic scoliosis in female adolescents. This study did not find any evidence for side-difference in vascularity of the anterior thorax wall and, thus, it could not clearly justify previous theories for development of right thoracic scoliosis in female adolescents. PMID:14648305

  2. Development and characterization of acellular allogeneic arterial matrices.

    PubMed

    Wilshaw, Stacy-Paul; Rooney, Paul; Berry, Helen; Kearney, John N; Homer-Vanniasinkam, Shervanthi; Fisher, John; Ingham, Eileen

    2012-03-01

    Surgeons have used cryopreserved vascular allografts successfully for many years to treat arterial occlusive disease and to repair arterial aneurysms. Vascular allografts demonstrate high patency rates but contain viable cells, which may evoke a rejection response following implantation. Removing the cells could prevent such a response and negate the need for cryopreservation and ultra-low temperature storage. The objectives of the study were to characterize human common femoral arteries and develop a decellularization protocol with a view to the generation of biocompatible and biomechanically functional vascular grafts for use in vascular bypass and arteriovenous access. The arteries were decellularized by subjecting the tissue to a single freeze-thaw cycle followed by sequential incubation in hypotonic tris buffer and low concentration sodium dodecyl sulphate. Each artery was disinfected using 0.1% (v/v) peracetic acid. Histological analysis demonstrated a lack of cells following decellularization and confirmed the integrity of the tissue histioarchitecture and retention of major structural proteins. There was a >95% reduction in DNA levels. The acellular tissues and extracts were not cytotoxic to either mouse 3T3 or baby hamster kidney cells. Biomechanical properties were determined by burst pressure, compliance, and tensile tests, which confirmed the retention of biomechanical properties following decellularization. In conclusion the study has developed a suitable protocol for the removal of cells from human common femoral arteries without adversely affecting the biochemical or biomechanical properties. These properties indicate the potential use for acellular human common femoral arteries for vascular bypass or arteriovenous access. PMID:21919791

  3. Malignant mammary tumor in female dogs: environmental contaminants.

    PubMed

    Andrade, Fábio He; Figueiroa, Fernanda C; Bersano, Paulo Ro; Bissacot, Denise Z; Rocha, Noeme S

    2010-01-01

    Mammary tumors of female dogs have greatly increased in recent years, thus demanding rapid diagnosis and effective treatment in order to determine the animal survival. There is considerable scientific interest in the possible role of environmental contaminants in the etiology of mammary tumors, specifically in relation to synthetic chemical substances released into the environment to which living beings are either directly or indirectly exposed. In this study, the presence of pyrethroid insecticide was observed in adjacent adipose tissue of canine mammary tumor. High Precision Liquid Chromatography - HPLC was adapted to detect and identify environmental contaminants in adipose tissue adjacent to malignant mammary tumor in nine female dogs, without predilection for breed or age. After surgery, masses were carefully examined for malignant neoplastic lesions. Five grams of adipose tissue adjacent to the tumor were collected to detect of environmental contaminants. The identified pyrethroids were allethrin, cyhalothrin, cypermethrin, deltamethrin and tetramethrin, with a contamination level of 33.3%. Histopathology demonstrated six female dogs (66.7%) as having complex carcinoma and three (33.3%) with simple carcinoma. From these tumors, seven (77.8%) presented aggressiveness degree III and two (22.2%) degree I. Five tumors were positive for estrogen receptors in immunohistochemical analysis. The contamination level was observed in more aggressive tumors. This was the first report in which the level of environmental contaminants could be detected in adipose tissue of female dogs with malignant mammary tumor, by HPLC. Results suggest the possible involvement of pyrethroid in the canine mammary tumor carcinogenesis. Hence, the dog may be used as a sentinel animal for human breast cancer, since human beings share the same environment and basically have the same eating habits. PMID:20587072

  4. The mammary glands of the Amazonian manatee, Trichechus inunguis (Mammalia: Sirenia): morphological characteristics and microscopic anatomy.

    PubMed

    Rodrigues, Fernanda Rosa; da Silva, Vera Maria Ferreira; Barcellos, José Fernando Marques

    2014-08-01

    The mammaries from carcasses of two female Amazonian manatees were examined. Trichechus inunguis possesses two axillary mammaries beneath the pectoral fins, one on each side of the body. Each papilla mammae has a small hole on its apex--the ostium papillare. The mammaries are covered by a stratified squamous keratinized epithelium. The epithelium of the mammary ducts became thinner more deeply in the tissue and varied from stratified to simple cuboidal. There was no evidence of glandular activity or secretion into the ducts of the mammary glands. PMID:24920139

  5. In vitro measurements of velocity and wall shear stress in a novel sequential anastomotic graft design model under pulsatile flow conditions.

    PubMed

    Kabinejadian, Foad; Ghista, Dhanjoo N; Su, Boyang; Nezhadian, Mercedeh Kaabi; Chua, Leok Poh; Yeo, Joon Hock; Leo, Hwa Liang

    2014-10-01

    This study documents the superior hemodynamics of a novel coupled sequential anastomoses (SQA) graft design in comparison with the routine conventional end-to-side (ETS) anastomoses in coronary artery bypass grafts (CABG). The flow fields inside three polydimethylsiloxane (PDMS) models of coronary artery bypass grafts, including the coupled SQA graft design, a conventional ETS anastomosis, and a parallel side-to-side (STS) anastomosis, are investigated under pulsatile flow conditions using particle image velocimetry (PIV). The velocity field and distributions of wall shear stress (WSS) in the models are studied and compared with each other. The measurement results and WSS distributions, computed from the near wall velocity gradients reveal that the novel coupled SQA design provides: (i) a uniform and smooth flow at its ETS anastomosis, without any stagnation point on the artery bed and vortex formation in the heel region of the ETS anastomosis within the coronary artery; (ii) more favorable WSS distribution; and (iii) a spare route for the blood flow to the coronary artery, to avoid re-operation in case of re-stenosis in either of the anastomoses. This in vitro investigation complements the previous computational studies of blood flow in this coupled SQA design, and is another necessary step taken toward the clinical application of this novel design. At this point and prior to the clinical adoption of this novel design, in vivo animal trials are warranted, in order to investigate the biological effects and overall performance of this anastomotic configuration in vivo. PMID:25103345

  6. Vascularization of the area between free grafts and irradiated graft beds in the neck in rats.

    PubMed

    Schultze-Mosgau, S; Rödel, F; Radespiel-Tröger, M; Wörl, J; Grabenbauer, G G; Neukam, F W

    2002-02-01

    Inflammatory lesions of the vascular endothelium after preoperative radiotherapy often cause healing-delayed healing of free flaps in the irradiated graft bed. We investigated changes in neovascularization in the transition area between grafted tissues and irradiated tissues of the graft bed. We irradiated the neck(30 and 50 Gy total dose) in 102 Wistar rats and then grafted a free myocutaneous gracilis flap to the irradiated region of the neck 4 weeks later. We examined histologically the tissues of the graft, the transition area between the graft and the irradiated graft bed, and the graft bed. In contrast to control rats, the tissues in the irradiated animals showed a qualitatively reduced and a more irregular capillary distribution, with substantial fibrosis in the irradiated graft bed. We also found significant differences in vascularization and mean capillary lumen in the transitional zone between graft and graft bed in the irradiated rats compared with controls (P = 0.004 and P < 0.001, respectively). Both number and diameter of capillaries were reduced in the irradiated graft bed tissue. The graft failed to improve vascularization in the transitional zone between graft and irradiated tissue, so we conclude that it is the vascularization status of the bed tissue rather than that of the transplant tissue that is the limiting factor for graft healing. PMID:11883968

  7. Extrahepatic Blood Supply to Hepatocellular Carcinoma: Angiographic Demonstration and Transcatheter Arterial Chemoembolization

    SciTech Connect

    Miyayama, Shiro Matsui, Osamu; Taki, Keiichi; Minami, Tetsuya; Ryu, Yasuji; Ito, Chiharu; Nakamura, Koichi; Inoue, Dai; Notsumata, Kazuo; Toya, Daisyu; Tanaka, Nobuyoshi; Mitsui, Takeshi

    2006-02-15

    Purpose. To evaluate the incidence of each extrahepatic collateral pathway to hepatocellular carcinoma (HCC) and to assess technical success rates and complications of transcatheter arterial chemoembolization (TACE) through each collateral. Methods. We retrospective evaluated extrahepatic collateral pathways to HCC on angiography in 386 procedures on 181 consecutive patients. One hundred and seventy patients had previously undergone TACE. TACE through extrahepatic collaterals using iodized oil and gelatin sponge particles was performed when a catheter was advanced into the tumor-feeding branch to avoid nontarget embolization. Results. A single collateral was revealed in 275 TACE procedures, two were revealed in 74, and three or more were revealed in 34. Incidences of collateral source to HCC were 83% from the right inferior phrenic artery (IPA), 24% from the cystic artery, 13% from the omental artery, 12% from the right renal capsular artery (RCA) and left IPA, 8% from the right internal mammary artery (IMA) and right intercostal artery (ICA), and 7% from the right inferior adrenal artery (IAA). Technical success rates of TACE were 53% in the right ICA, 70% in the cystic artery, 74% in the omental artery, 93% in the left IPA, 96% in the right IPA, and 100% in the right RCA, right IMA, and right IAA. Complications included skin necrosis after TACE through the right IMA (n = 1), cholecystitis after TACE through the cystic artery (n = 1), and ulcer formation after TACE through the right gastric artery (n = 1), in addition to pleural effusion and basal atelectasis after TACE through the IPA and IMA. Conclusion. Our study suggests that TACE through extrahepatic collaterals is possible with high success rates, and is also relatively safe.

  8. The contribution of growth hormone to mammary neoplasia.

    PubMed

    Perry, Jo K; Mohankumar, Kumarasamypet M; Emerald, B Starling; Mertani, Hichem C; Lobie, Peter E

    2008-03-01

    While the effects of growth hormone (GH) on longitudinal growth are well established, the observation that GH contributes to neoplastic progression is more recent. Accumulating literature implicates GH-mediated signal transduction in the development and progression of a wide range malignancies including breast cancer. Recently autocrine human GH been demonstrated to be an orthotopically expressed oncogene for the human mammary gland. This review will highlight recent evidence linking GH and mammary carcinoma and discuss GH-antagonism as a potential therapeutic approach for treatment of breast cancer. PMID:18253708

  9. Fenestrated Endovascular Grafts for the Repair of Juxtarenal Aortic Aneurysms

    PubMed Central

    2009-01-01

    Executive Summary Endovascular repair of abdominal aortic aneurysm (AAA) allows the exclusion of the dilated aneurismal segment of the aorta from the systematic circulation. The procedure requires, however, that the endograft extends to the healthy parts of the aorta above and below the aneurysm, yet the neck of a juxtarenal aortic aneurysm (JRA) is too short for a standard endovascular repair. Fenestrated endovascular aortic repair (f—EVAR) provides a solution to overcome this problem by enabling the continuation of blood flow to the renal and visceral arteries through holes or ‘fenestrations’ in the graft. These fenestrations are designed to match the ostial diameter of the renal and visceral arteries. There are three varieties fenestration, small, large, and scallop, and their location needs to be customized to fit the anatomy of the patient. If the device is not properly designed, if the alignment is inaccurate, or if the catheterization of the visceral arteries is not possible, the procedure may fail. In such cases, conversion to open surgery may become the only option as fenestrated endografts are not retrievable. It is recommended that a stent be placed within each small fenestration to the target artery to prevent shuttering of the artery or occlusion. Many authors have noted an increased risk of vessel occlusion in unstented fenestrations and scallops. Once placed in a patient, life-long follow-up at regular intervals is necessary to ensure the graft remains in its intended location, and that the components have adequate overlap. Should the need arise, routine follow-up allows the performance of timely and appropriate intervention through detection of events that could impact the long-term outcomes. Alternative Technology The technique of fenestrated endovascular grafting is still in evolution and few studies have been with published mid-term outcome data. As the technique become more common in vascular surgery practices, it will be important to determine if it can provide better outcomes than open surgical repair (OSR). In an OSR approach, aortic clamping above one or both renal arteries, or above the visceral arteries, is required. The higher the level of aortic clamping, the greater the risk of cardiac stress and renal or visceral ischemia. During suprarenal or supraceliac aortic clamping, strain-induced myocardial ischemia may also occur due to concomitant rise in cardiac afterload and a decrease in cardiac output. Reports indicate that 6% of patients undergoing surgical repair develop myocardial infarction. The ideal level of clamp location remains controversial with conflicting views having been reported. Method A search of electronic databases (OVID MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library, and the International Agency for Health Technology Assessment [INAHTA] database was undertaken to identify evidence published from January 1, 2004 to December 19, 2008. The search was limited to English-language articles and human studies. The automatic search alerts were received and reviewed up to March 23, 2009. The literature search and automatic search update identified 320 citations, of which 13 met inclusion/exclusion criteria. One comparative study presented at an international seminar, five single-arm studies on f—EVAR, and 7 studies on OSR (one prospective and six retrospective) were considered for this analysis. To grade the strength of the body of evidence, the grading system formulated by the GRADE working group and adopted by MAS, was applied. The GRADE system classifies evidence quality as high (Grade A), moderate (Grade B), or low (Grade C) according to four key elements: study design, study quality, consistency across studies, and directness. A summary of the characteristics of the f—EVAR and OSR studies found through the literature search is shown in Table ES-1. ES-1. Patient Characteristics: f–EVAR Studies versus OSR Studies Technique Number ofPatients Mean Age(Range), Years Aneurysm Diameter(Range),mm Mean Durat

  10. NMR characteristics of rat mammary tumors

    SciTech Connect

    Osbakken, M.; Kreider, J.; Taczanowsky, P.

    1984-01-01

    12 rats were injected intradermally with 13762A rat mammary adenocarcinoma (1 x 10/sup 6/ cells). 3 rats died before completion of the study and 2 rat had tumor regression; the first 3 were excluded from data analysis. NMR imaging with a 1.5K gauss resistive magnet at 2, 3, 4, and 5 weeks after injection demonstrated increasing tumor mass. Saturation recovery (SR), inversion recovery (IR), and spin echo (SE) pulse sequence images and T/sub 1/ calculation were done for tumor characterization. (Tumor size was too small to identify at 2 weeks.) 3 rats were sacrificed after the last 3 imaging periods for histological studies, done to distinguish solid tumor mass from necrosis. Planimetry of tumor areas showed that as tumors grew in size, the ratio of necrotic area to area of solid tumor increased (week 3 = .3 +- .11; week 4 = .45 +- .07; week 5 = .51 +- 05); simultaneous calculated T/sub 1/ values also increased (week 3 = .35 +- .15; week 4 = .45 +- .06; week 5 = .42 +- 03). Qualitative NMR image T/sub 1/ values also increased as evidenced by progression of SR and IR tumor image intensity from very bright compared to the rest of the body at week 3 to less intense than other structures at week 5. These findings indicate that change in T/sub 1/ may be secondary to the pathophysiological change in the tumor (the increasing in necrosis, associated with increased free water). Thus, the range of T/sub 1/ values obtained in tumors in this study (and in previous studies) may be due to change in tumor physiology and anatomy. Careful correlation of histological with NMR data may allow ultimate use of NMR relaxation characteristics for determination of the physiological state of tumors.

  11. The clopidogrel after surgery for coronary artery disease (CASCADE) randomized controlled trial: clopidogrel and aspirin versus aspirin alone after coronary bypass surgery [NCT00228423

    PubMed Central

    Kulik, Alexander; Le May, Michel; Wells, George A; Mesana, Thierry G; Ruel, Marc

    2005-01-01

    Background Saphenous vein graft disease remains a major limitation of coronary artery bypass graft surgery. The process of saphenous vein intimal hyperplasia begins just days after surgical revascularization, setting the stage for graft atherosclerotic disease and its sequalae. Clopidogrel improves outcomes in patients with atherosclerotic disease, and is effective at reducing intimal hyperplasia in animal models of thrombosis. Therefore, the goal of this study will be to evaluate the efficacy of clopidogrel and aspirin therapy versus aspirin alone in the prevention of saphenous vein graft intimal hyperplasia following coronary artery bypass surgery. Methods Patients undergoing multi-vessel coronary artery bypass grafting and in whom at least two saphenous vein grafts will be used are eligible for the study. Patients will be randomized to receive daily clopidogrel 75 mg or placebo, in addition to daily aspirin 162 mg, for a one year duration starting on the day of surgery (as soon as postoperative bleeding has been excluded). At the end of one year, all patients will undergo coronary angiography and intravascular ultrasound assessment of one saphenous vein graft as selected by randomization. The trial will be powered to test the hypothesis that clopidogrel and aspirin will reduce vein graft intimal hyperplasia by 20% compared to aspirin alone at one year following bypass surgery. Discussion This trial is the first prospective human study that will address the question of whether clopidogrel therapy improves outcomes and reduces saphenous vein graft intimal hyperplasia following cardiac surgery. Should the combination of clopidogrel and aspirin reduce the process of vein graft intimal hyperplasia, the results of this study will help redefine modern antiplatelet management of coronary artery bypass patients. PMID:16219100

  12. Coronary Artery Disease

    MedlinePLUS

    Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death ... both men and women. CAD happens when the arteries that supply blood to heart muscle become hardened ...

  13. Coronary artery disease

    MedlinePLUS Videos and Cool Tools

    ... heart muscle itself. Damage to or blockage of a coronary artery can result in injury to the heart. Normally, blood flows through a coronary artery unimpeded. However, a process called atherosclerosis ...

  14. Carotid Artery Disease

    MedlinePLUS

    ... cerebrovascular disease, stroke, transient ischemic attacks (TIA) Carotid artery disease is a form of disease that affects ... to the brain by the 2 large carotid arteries in the front of your neck and by ...

  15. Polyether-polyester graft copolymer

    NASA Technical Reports Server (NTRS)

    Bell, Vernon L. (inventor)

    1987-01-01

    Described is a polyether graft polymer having improved solvent resistance and crystalline thermally reversible crosslinks. The copolymer is prepared by a novel process of anionic copolymerization. These polymers exhibit good solvent resistance and are well suited for aircraft parts. Previous aromatic polyethers, also known as polyphenylene oxides, have certain deficiencies which detract from their usefulness. These commercial polymers are often soluble in common solvents including the halocarbon and aromatic hydrocarbon types of paint thinners and removers. This limitation prevents the use of these polyethers in structural articles requiring frequent painting. In addition, the most popular commercially available polyether is a very high melting plastic. This makes it considerably more difficult to fabricate finished parts from this material. These problems are solved by providing an aromatic polyether graft copolymer with improved solvent resistance and crystalline thermally reversible crosslinks. The graft copolymer is formed by converting the carboxyl groups of a carboxylated polyphenylene oxide polymer to ionic carbonyl groups in a suitable solvent, reacting pivalolactone with the dissolved polymer, and adding acid to the solution to produce the graft copolymer.

  16. Endovascular repair of a life-threatening radiation-induced ruptured false aneurysm of the intrathoracic left subclavian artery: case report

    PubMed Central

    Hizette, Pascale; Horn, David; Lemaitre, Jean; Segers, Bernard

    2015-01-01

    Massive hemorrhage in tracheostomy patients is generally described as a result of a tracheoinnominate artery fistula. Other etiologies for rupture of a false aneurysm are rare. The classical procedure for subclavian artery aneurysm is open surgery. Endovascular techniques have been accepted by several authors as a possible minimally invasive alternative. We report a life-threatening radiation-induced ruptured false aneurysm of the intrathoracic subclavian artery successfully treated by endovascular stent graft through left brachial access in a tracheostomy patient. PMID:25878503

  17. Immune cell location and function during post-natal mammary gland development

    PubMed Central

    Reed, Johanna R.; Schwertfeger, Kathryn L.

    2014-01-01

    Post-natal mammary gland development requires complex interactions between the epithelial cells and various cell types within the stroma. Recent studies have illustrated the importance of immune cells and their mediators during the various stages of mammary gland development. However, the mechanisms by which these immune cells functionally contribute to mammary gland development are only beginning to be understood. This review provides an overview of the localization of immune cells within the mammary gland during the various stages of post-natal mammary gland development. Furthermore, recent studies are summarized that illustrate the mechanisms by which these cells are recruited to the mammary gland and their functional roles in mammary gland development. PMID:20730636

  18. Depression and Geographic Status as Predictors for Coronary Artery Bypass Surgery Outcomes

    ERIC Educational Resources Information Center

    Dao, Tam K.; Chu, Danny; Springer, Justin; Hiatt, Emily; Nguyen, Quang

    2010-01-01

    Purpose: To examine the relationships between depression, geographic status, and clinical outcomes following a coronary artery bypass grafting (CABG) surgery. Methods: Using the 2004 Nationwide Inpatient Sample database, we identified 63,061 discharge records of patients who underwent a primary CABG surgery (urban 57,247 and rural 5,814). We…

  19. Early Effects of Arterial Hemodynamic Conditions on Human Saphenous Veins Perfused Ex Vivo

    E-print Network

    Chesler, Naomi C.

    Early Effects of Arterial Hemodynamic Conditions on Human Saphenous Veins Perfused Ex Vivo Kreton of saphenous vein grafts. Using matched pairs of freshly isolated human saphenous vein, we analyzed the early.01) and MMP-2 (44 6%, P 0.005) levels relative to matched vein pairs maintained ex vivo under venous perfusion

  20. Endovascular Treatment of a Vertebral Artery Pseudoaneurysm in a Drug User

    SciTech Connect

    Mourikis, Dimitrios; Chatziioannou, Achilleas; Doriforou, Ortansia; Skiadas, Vasilios Koutoulidis, Vasilios; Katsenis, Konstantinos; Vlahos, Lampros

    2006-08-15

    A 26-year-old drug abuser who presented with sepsis was found to have a pseudoaneurysm in the left vertebral artery. This aneurysm was presumed to be post-traumatic, since the patient reported multiple attempts to inject drugs in the left jugular vein 15 days prior to admission. The pseudoaneurysm was treated effectively with stent-graft placement.