Peter Heider - Academia.edu (original) (raw)
Papers by Peter Heider
Journal of Vascular Surgery, 2006
The adhesion molecules P selectin, E selectin, intercellular adhesion molecule, vascular cellular... more The adhesion molecules P selectin, E selectin, intercellular adhesion molecule, vascular cellular adhesion molecule (VCAM), and monocyte chemoattractant protein 1 play a important role in the development of arteriosclerotic lesions and are considered main contributors to restenosis after angioplasty. We expected that the serum levels of these markers would increase in the early phase of the first few weeks after angioplasty. Methods: We assessed prospectively the levels of soluble forms of adhesion molecules on the day before and then 24 hours and 2 and 4 weeks after angioplasty in arteries of the lower limb by using enzyme-linked immunosorbent assays. We investigated the distribution pattern of these markers in 44 patients (25 male and 19 female; age, 67.7 ؎ 8.5 years [mean ؎ SD]) presenting with intermittent claudication (Fontaine stage IIb). Twelve patients (27.3%) underwent diagnostic angiography, 32 (72.2%) received interventional treatment, 22 (68.8%) received balloon angioplasty, and 10 (31.2%) required stent placement. Results: Ten (31.3%) of the treated patients developed restenosis within 6 months. These patients had significantly higher levels of P selectin (P ؍ .034), E selectin (P ؍ .006), and VCAM (P ؍ .050) at all time points. E selectin, VCAM, and monocyte chemoattractant protein 1 levels increased between 24 hours and 4 weeks after angiographic procedures, thus indicating that the angiographic procedure itself leads to activation and inflammation of the endothelium. Conclusions: This study emphasizes a meaningful role of the adhesion molecules E selectin, P selectin, and VCAM as interesting contributors to restenosis formation after percutaneous transluminal angioplasty.
Prostaglandins & Other Lipid Mediators, 2009
The aim of the study was to investigate prospectively the microcirculation after angioplasty and ... more The aim of the study was to investigate prospectively the microcirculation after angioplasty and its improvement with additional Prostaglandin E1 (PGE1) therapy assessed by transcutaneous pressure of oxygen. 45 patients with intermittent claudication eligible for angioplasty were enrolled in a prospective randomised controlled clinical trial. Patients received either intra-arterial bolus of 40 microg PGE1 in addition to angioplasty or a 40 microg PGE1 intravenous infusion. Control group received no trial medication. Additional 15 patients undergoing intra-arterial angiography were also investigated. tcpO(2) values were recorded distal to the PTA region before, during the intervention, 24h, 2 and 4 weeks after intervention. Clinical endpoint was the change of tcpO(2) values 4 weeks after intervention. During the 4 week follow-up tcpO(2) values decreased in patients treated with angioplasty. At the same time tcpO(2) increased significantly in those patients additionally treated with intra-arterial PGE1 bolus injection as well as with intravenous PGE1 infusion. Impaired microcirculation after angioplasty can be improved with additional intravenous as well as intra-arterial PGE1 administration.
Prostaglandins & Other Lipid Mediators, 2009
The aim of the study was to investigate prospectively the microcirculation after angioplasty and ... more The aim of the study was to investigate prospectively the microcirculation after angioplasty and its improvement with additional Prostaglandin E1 (PGE1) therapy assessed by transcutaneous pressure of oxygen. 45 patients with intermittent claudication eligible for angioplasty were enrolled in a prospective randomised controlled clinical trial. Patients received either intra-arterial bolus of 40 microg PGE1 in addition to angioplasty or a 40 microg PGE1 intravenous infusion. Control group received no trial medication. Additional 15 patients undergoing intra-arterial angiography were also investigated. tcpO(2) values were recorded distal to the PTA region before, during the intervention, 24h, 2 and 4 weeks after intervention. Clinical endpoint was the change of tcpO(2) values 4 weeks after intervention. During the 4 week follow-up tcpO(2) values decreased in patients treated with angioplasty. At the same time tcpO(2) increased significantly in those patients additionally treated with intra-arterial PGE1 bolus injection as well as with intravenous PGE1 infusion. Impaired microcirculation after angioplasty can be improved with additional intravenous as well as intra-arterial PGE1 administration.
European Journal of Vascular and Endovascular Surgery, 2010
Objectives: The search for markers predicting risk of plaque rupture in carotid atherosclerosis i... more Objectives: The search for markers predicting risk of plaque rupture in carotid atherosclerosis is still ongoing. Previous findings showed that pregnancy-associated plasma protein-A (PAPP-A) levels correlate with an adverse plaque morphology. However, the role of PAPP-A in plaque destabilisation is still uncertain. Material and methods: Patients with carotid artery stenosis involved in the study were asymptomatic (n Z 29) and symptomatic (n Z 37). Carotid plaques were characterised by histology (n Z 33). Immunohistochemistry (n Z 17) was used to determine expression of PAPP-A and CD68 within the plaques. Serum levels of PAPP-A were measured by the enzyme-linked immunosorbent assay (ELISA). Results: Circulating PAPP-A levels were significantly higher in patients with unstable versus stable plaques (0.10 AE 0.06 vs. 0.07 AE 0.04 mg ml À1 , p Z 0.047) and interestingly, in asymptomatic versus symptomatic patients (0.11 AE 0.05 vs. 0.069 AE 0.09 mg ml À1 , p Z 0.025). These differences remained statistically significant after adjustment for age, gender and degree of stenosis (p Z 0.050). PAPP-A expression in plaques correlated significantly with CD68 positive macrophages, cap-thickness and its serological values (r Z þ0.291, p < 0.001, r Z À0.639, p < 0.001 and r Z 0.618, p < 0.008, respectively). Furthermore, PAPP-A serum values demonstrated a significant positive predictive value of 68.8% for unstable plaques.
Background. Financial pressure and economic responsibility for budgets demand that different trea... more Background. Financial pressure and economic responsibility for budgets demand that different treatments for the same condition be compared for cost effectiveness. In the sector of vascular medicine a cost comparison of carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid stenosis is of particular interest. Methods. We compared the total internal costs and the staff and material costs incurred for 30 CEAs (7 female patients) and 30 CASs (8 female patients). Symptomatic stenosis of the carotid artery was present in 14 of the 30 patients in the CEA group and 26 of the 30 in the CAS group. The average age was 70.2 years in the CEA group and 68.4 years in the CAS group. Results. On average the total internal cost was EUR 3617,61 for CEA and EUR 4,551,67 for CAS. Total procedural costs were EUR 508,61 for CEA and EUR 2142,67 for CAS; CAS involved EUR 1983,81 for material costs, while CEA involved 276,71 for material costs and EUR 448 for anaesthesia in addition. The ...
Gef�sschirurgie
ABSTRACT HintergrundDie Karotis-TEA ist das Verfahren der Wahl fr die Behandlung hochgradiger Kar... more ABSTRACT HintergrundDie Karotis-TEA ist das Verfahren der Wahl fr die Behandlung hochgradiger Karotisstenosen als Ursache transienter neurologischer Symptome in der jngeren Anamnese. Bei Patienten mit akuten neurologischen Ausfllen, die einer vaskulren Insuffizienz der A.carotis zuzuordnen sind, ist die Indikation zur notfallmigen Operation dagegen weiterhin strittig.Patienten und MethodikIm Zeitraum vom 01.01.1995 bis 30.06.2003 wurden bei 621Patienten 656Karotisdesobliterationen bei 330 symptomatischen (50,3%) und 326 asymptomatischen (49,7%) Stenosen durchgefhrt. Die Indikation zum Notfalleingriff wurde bei 30Patienten (4,6%) mit Crescendo-TIA (n=11) oder inkonstantem neurologischen Defizit (n=19) innerhalb von 4–24h nach Beginn der Symptome durchgefhrt. Klinische Selektionskriterien fr den Notfalleingriff waren ein akuter Beginn der neurologischen Symptomatik bei uneingeschrnkter Bewusstseinslage, der Nachweis einer hochgradigen Karotisstenose, ein Blutungsausschluss im CT sowie kardiopulmonale Stabilitt.ErgebnisseDie fachneurologische Untersuchung ergab als Frhergebnis eine komplette Remission der Symptome bei 12 und eine Verbesserung mit nicht behindernder Restsymptomatik bei 9Patienten. Die neurologischen Defizite von 6Patienten blieben postoperativ unverndert. 3Patienten erlitten eine Verschlechterung (1komplette, 2inkomplette Hemiparese). 24/30Patienten konnten innerhalb von 8Tagen aus der stationren Behandlung entlassen werden. Innerhalb einer mittleren Nachbeobachtungszeit von 54Monaten verstarben 9/30Patienten. Bei 1Patienten kam es zu einem erneuten zerebralen Ereignis, whrend es bei 7Patienten zu einer weiteren Verbesserung der neurologischen Symptomatik kam.SchlussfolgerungDiese Analyse zeigt, dass sich mit der operativen Therapie der akuten Karotisinsuffizienz bei einem selektionierten Krankengut unter optimalen Bedingungen der Diagnostik, des intraoperativen Managements und der perioperativen berwachung gute bis sehr gute Ergebnisse erzielen lassen.BackgroundCarotid endarterectomy (CEA) is well established as the elective treatment for moderate or severe carotid stenoses with a history of neurological symptoms. In contrast, the merits of carotid revascularization performed as an emergency procedure in patients with acute stroke or fluctuating neurological deficit remain controversial.Patients and methodsA total of 656 CEAs were performed on 621 patients for 330 (50.3%) symptomatic and 326 (49.7%) asymptomatic carotid stenoses within an 8-year period between January 1995 and June 2003. Of the latter, emergency CEA was performed on 30 patients (4.6%). Eleven patients presented with a crescendo TIA, and 19 patients presented with progressive neurological deficits corresponding to contralateral carotid stenosis within 4–24h after the onset of symptoms. Patients selected for urgent surgery fulfilled the following criteria: acute onset of fluctuating hemispheric neurological symptoms, significant carotid pathology, absence of cerebral hemorrhage, uncompromised vigilance, and stable cardiopulmonary conditions.ResultsFollowing CEA, the neurological deficits improved instantaneously to complete recovery in 12 patients. The symptoms of nine patients improved to non-disabling deficits, remained unchanged in one, and worsened in three patients (one complete and two incomplete hemipareses). Of 30 patients, 24 were discharged within 8days after admission. The neurological status after discharge deteriorated in only one of the patients during follow-up of 54 months, but improved in 7 of the patients.ConclusionOur retrospective study suggests that rescue CEA may be beneficial for selected patients with stroke in evolution and fluctuating neurological deficits. Careful adherence to selection criteria, intraoperative shunting, and intensive care post surgery surveillance are recommended.
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren
Gefasschirurgie, 2003
ABSTRACT Der Schlaganfall ist in Europa nach wie vor die dritthufigste Todesursache nach den kard... more ABSTRACT Der Schlaganfall ist in Europa nach wie vor die dritthufigste Todesursache nach den kardiovaskulren und Krebserkrankungen und die hufigste Ursache fr lebenslange Behinderungen.In Deutschland erleiden nach vorliegenden Schtzungen etwa 250.000 Menschen pro Jahr einen Schlaganfall. Angaben zur Inzidenz liegen fr Deutschland nur aus einigen Studien und speziellen Bevlkerungsregistern vor. Danach muss mit Inzidenzraten von etwa 8/100.000 in der Altersgruppe von 25–34Jahren, ber 20/100.000 im Alter von 35–44Jahren und 120/100.000 im Alter von 45–54 Jahren gerechnet werden. In den Altersgruppen >55Jahre steigt die Inzidenzrate stark an und sie erreicht Werte von 200–400/100.000 in der Altersgruppe von 55–64Jahren und 600–1.000/100.000 in den hheren Lebensjahren. Danach betrgt das Schlaganfallrisiko fr ber 65-jhrige bis zu 20%.Die derzeit hohe Mortalittsrate und die erheblichen Kosten, welche bei Schlaganfallpatienten fr die medizinische Behandlung und der sich anschlieenden langjhrigen Rehabilitation anfallen, machen den Schlaganfall nicht nur zu einem medizinischen Problem, sondern auch zu einer der weltweit teuersten Erkrankungen.Das Vorkommen schlaganfallbedingter Behinderungen in der Bevlkerung lsst sich am effizientesten durch prventive Manahmen verringern. Manahmen zur Primrprvention mssen von solchen zur Verhtung eines Rezidivinsultes nach bereits erlittenem Schlaganfall differenziert werden. Die Wirksamkeit prventiver Manahmen setzt die Identifizierung von Risikofaktoren voraus, deren Vorliegen statistisch das Auftreten von Insultereignissen begnstigt. Die Art der primr- und sekundrprventiven Therapieform sollte nach Abwgen von Nutzen und Risiko in Abhngigkeit von den Ergebnissen der einzelnen therapeutischen Optionen erfolgen.Stroke is still the third leading cause of death in Europe followed by cardiovascular and cancer diseases and is a principal cause of long-term disability. In Germany, at least 250,000 persons suffer from new or recurrent stroke annually. Data on the incidence are available for Germany from only a few studies and special population registers.Accordingly, incidence rates of approximately 8/100,000 in the age cohort of 25–34years, over 20/100,000 in the age cohort of 35–44years, and 120/100,000 in the age cohort of 45–54years are to be expected. In the age cohort >55years, the incidence rate surges to values from 200–400/100,000 (age cohort of 55–64years) to 600–1,000/100,000 (older than 65). According to these data, the risk of ischemic stroke is about 20% for seniors over 65years.The present high mortality rate and the substantial costs thereby incurred by patients with carotid-related strokes for medical treatment and subsequent long-term rehabilitation defines stroke not only as a medical problem, but particularly with regard to the financial impact as an economic determinant.The occurrence of stroke-related handicaps in the population can be reduced most efficiently by preventive measures. Measures for primary prevention must be differentiated from those for preventing a recurrent stroke. The effectiveness of preventive measures presupposes the identification of risk factors, which favor statistically the occurrence of stroke. The form of primary and secondary prevention should be performed after deliberating on the risks of the individual therapeutic options.
Journal of Nuclear Medicine, May 1, 2008
Society of Nuclear Medicine Annual Meeting Abstracts, May 1, 2008
The Journal of cardiovascular surgery
The Propaten European Product Evaluation (PEPE II) study was a product evaluation intended to cha... more The Propaten European Product Evaluation (PEPE II) study was a product evaluation intended to characterize the performance of the GORE PROPATEN vascular graft in above-knee (AK) and below-knee bypass (BK) surgery. This prospective multicenter trial enrolled 142 patients with peripheral arterial disease. In 87 patients AK and in 52 patients BK bypasses (including 15 femorocrural) were implanted (67.6% males, 32.4% females). The one-year overall primary and secondary patency rates were 80% and 84.7%, respectively. Overall limb salvage rate at 12-months was 96.2%. The primary patency rate for AK bypasses was 82.7%, for BK femoro-popliteal bypasses 74.2% and for BK tibial-peroneal bypasses 79.4%. Secondary patency rates were 87.3%, 78.8% and 85.1%, respectively. Primary patency rates decreased depending on the number of patent run-off vessels (three 84.3%, two 80.8%, one 73.3%). Subgroup analysis showed that female patients had a significantly higher primary patency rate for BK bypasses...
Gef�sschirurgie, 2003
ABSTRACT Im Stadium der chronisch kritischen Ischmie ist die Anlage eines gelenkberschreitenden B... more ABSTRACT Im Stadium der chronisch kritischen Ischmie ist die Anlage eines gelenkberschreitenden Bypasses oft die einzige Chance fr den Extremittenerhalt. Trotz erzielter Fortschritte in den letzten Jahrzehnten sind die Ergebnisse hinsichtlich der Bypassfunktionalitt z.T. unbefriedigend und in der Diskussion. Es gibt zahlreiche Hinweise in der Literatur ber die Beeinflussung der Offenheitsraten durch bestimmte Begleitfaktoren, insbesondere durch das verwendete Bypassmaterial.In unserer retrospektiven Analyse aus den Jahren 1994–1999 an 110Patienten mit insgesamt 127 gelenkberschreitenden Bypssen zeigte sich ein statistisch signifikanter Einfluss auf die 3-Jahres-Offenheitsraten durch das verwendete Bypassmaterial. Dies gilt sowohl fr die primre als auch fr die sekundre Offenheitsrate (Eigenvene primr 72%, sekundr 77%; alloplastisch primr 45%, sekundr 55%) unabhngig von der distalen Anschlussregion. Von signifikantem Einfluss auf die Offenheitsraten war auch der Status einer ipsilateralen gefchirurgischen Voroperation (primr: 82% vs. 36%, sekundr 84% vs. 50%).Keinen statistisch signifikanten Einfluss hatten folgende Risiko- und Begleitfaktoren: Diabetes mellitus, arterielle Hypertonie, Nikotin, Hyperlipidmie, generalisierte Arteriosklerose, Anschlussregion, 3-Gefausstrom oder 2 und weniger bei poplitealem Anschluss, Form der Antikoagulation (ASS vs. Marcumar).In the case of chronic critical limb ischemia, surgical treatment with below-knee bypass is often the last chance for limb salvage. Although progress has been achieved in the last few years, the results concerning functionality and patency of the bypasses often remain insufficient and are still under discussion. In the literature many factors that influence the patency of below-knee bypasses have been described, especially the choice of graft material.In our retrospective study of 110 patients and 127 below-knee bypasses performed between 1994 and 1999, we analyzed the influence of several factors on the 3-year primary and secondary patency rates. Of all factors analyzed, only the graft material (patency rates for autologous greater saphenous vein primary 72%, secondary 77%, prosthetic grafts primary 45%, secondary 55%) and the fact of having had a ipsilateral vascular surgical operation on the lower extremity (primary patency 82% vs 36% and 84% vs 50%) showed a statistically significant influence on the patency rate.There was no statistically significant influence found for the following factors: diabetes, high blood pressure, smoking, hyperlipidemia, systemic atherosclerosis, site of proximal and distal anastomosis, runoff, and anticoagulation (ASS vs coumarin).
Annals of vascular surgery, Jan 10, 2008
Journal of Vascular Surgery, 2006
The adhesion molecules P selectin, E selectin, intercellular adhesion molecule, vascular cellular... more The adhesion molecules P selectin, E selectin, intercellular adhesion molecule, vascular cellular adhesion molecule (VCAM), and monocyte chemoattractant protein 1 play a important role in the development of arteriosclerotic lesions and are considered main contributors to restenosis after angioplasty. We expected that the serum levels of these markers would increase in the early phase of the first few weeks after angioplasty. Methods: We assessed prospectively the levels of soluble forms of adhesion molecules on the day before and then 24 hours and 2 and 4 weeks after angioplasty in arteries of the lower limb by using enzyme-linked immunosorbent assays. We investigated the distribution pattern of these markers in 44 patients (25 male and 19 female; age, 67.7 ؎ 8.5 years [mean ؎ SD]) presenting with intermittent claudication (Fontaine stage IIb). Twelve patients (27.3%) underwent diagnostic angiography, 32 (72.2%) received interventional treatment, 22 (68.8%) received balloon angioplasty, and 10 (31.2%) required stent placement. Results: Ten (31.3%) of the treated patients developed restenosis within 6 months. These patients had significantly higher levels of P selectin (P ؍ .034), E selectin (P ؍ .006), and VCAM (P ؍ .050) at all time points. E selectin, VCAM, and monocyte chemoattractant protein 1 levels increased between 24 hours and 4 weeks after angiographic procedures, thus indicating that the angiographic procedure itself leads to activation and inflammation of the endothelium. Conclusions: This study emphasizes a meaningful role of the adhesion molecules E selectin, P selectin, and VCAM as interesting contributors to restenosis formation after percutaneous transluminal angioplasty.
Prostaglandins & Other Lipid Mediators, 2009
The aim of the study was to investigate prospectively the microcirculation after angioplasty and ... more The aim of the study was to investigate prospectively the microcirculation after angioplasty and its improvement with additional Prostaglandin E1 (PGE1) therapy assessed by transcutaneous pressure of oxygen. 45 patients with intermittent claudication eligible for angioplasty were enrolled in a prospective randomised controlled clinical trial. Patients received either intra-arterial bolus of 40 microg PGE1 in addition to angioplasty or a 40 microg PGE1 intravenous infusion. Control group received no trial medication. Additional 15 patients undergoing intra-arterial angiography were also investigated. tcpO(2) values were recorded distal to the PTA region before, during the intervention, 24h, 2 and 4 weeks after intervention. Clinical endpoint was the change of tcpO(2) values 4 weeks after intervention. During the 4 week follow-up tcpO(2) values decreased in patients treated with angioplasty. At the same time tcpO(2) increased significantly in those patients additionally treated with intra-arterial PGE1 bolus injection as well as with intravenous PGE1 infusion. Impaired microcirculation after angioplasty can be improved with additional intravenous as well as intra-arterial PGE1 administration.
Prostaglandins & Other Lipid Mediators, 2009
The aim of the study was to investigate prospectively the microcirculation after angioplasty and ... more The aim of the study was to investigate prospectively the microcirculation after angioplasty and its improvement with additional Prostaglandin E1 (PGE1) therapy assessed by transcutaneous pressure of oxygen. 45 patients with intermittent claudication eligible for angioplasty were enrolled in a prospective randomised controlled clinical trial. Patients received either intra-arterial bolus of 40 microg PGE1 in addition to angioplasty or a 40 microg PGE1 intravenous infusion. Control group received no trial medication. Additional 15 patients undergoing intra-arterial angiography were also investigated. tcpO(2) values were recorded distal to the PTA region before, during the intervention, 24h, 2 and 4 weeks after intervention. Clinical endpoint was the change of tcpO(2) values 4 weeks after intervention. During the 4 week follow-up tcpO(2) values decreased in patients treated with angioplasty. At the same time tcpO(2) increased significantly in those patients additionally treated with intra-arterial PGE1 bolus injection as well as with intravenous PGE1 infusion. Impaired microcirculation after angioplasty can be improved with additional intravenous as well as intra-arterial PGE1 administration.
European Journal of Vascular and Endovascular Surgery, 2010
Objectives: The search for markers predicting risk of plaque rupture in carotid atherosclerosis i... more Objectives: The search for markers predicting risk of plaque rupture in carotid atherosclerosis is still ongoing. Previous findings showed that pregnancy-associated plasma protein-A (PAPP-A) levels correlate with an adverse plaque morphology. However, the role of PAPP-A in plaque destabilisation is still uncertain. Material and methods: Patients with carotid artery stenosis involved in the study were asymptomatic (n Z 29) and symptomatic (n Z 37). Carotid plaques were characterised by histology (n Z 33). Immunohistochemistry (n Z 17) was used to determine expression of PAPP-A and CD68 within the plaques. Serum levels of PAPP-A were measured by the enzyme-linked immunosorbent assay (ELISA). Results: Circulating PAPP-A levels were significantly higher in patients with unstable versus stable plaques (0.10 AE 0.06 vs. 0.07 AE 0.04 mg ml À1 , p Z 0.047) and interestingly, in asymptomatic versus symptomatic patients (0.11 AE 0.05 vs. 0.069 AE 0.09 mg ml À1 , p Z 0.025). These differences remained statistically significant after adjustment for age, gender and degree of stenosis (p Z 0.050). PAPP-A expression in plaques correlated significantly with CD68 positive macrophages, cap-thickness and its serological values (r Z þ0.291, p < 0.001, r Z À0.639, p < 0.001 and r Z 0.618, p < 0.008, respectively). Furthermore, PAPP-A serum values demonstrated a significant positive predictive value of 68.8% for unstable plaques.
Background. Financial pressure and economic responsibility for budgets demand that different trea... more Background. Financial pressure and economic responsibility for budgets demand that different treatments for the same condition be compared for cost effectiveness. In the sector of vascular medicine a cost comparison of carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid stenosis is of particular interest. Methods. We compared the total internal costs and the staff and material costs incurred for 30 CEAs (7 female patients) and 30 CASs (8 female patients). Symptomatic stenosis of the carotid artery was present in 14 of the 30 patients in the CEA group and 26 of the 30 in the CAS group. The average age was 70.2 years in the CEA group and 68.4 years in the CAS group. Results. On average the total internal cost was EUR 3617,61 for CEA and EUR 4,551,67 for CAS. Total procedural costs were EUR 508,61 for CEA and EUR 2142,67 for CAS; CAS involved EUR 1983,81 for material costs, while CEA involved 276,71 for material costs and EUR 448 for anaesthesia in addition. The ...
Gef�sschirurgie
ABSTRACT HintergrundDie Karotis-TEA ist das Verfahren der Wahl fr die Behandlung hochgradiger Kar... more ABSTRACT HintergrundDie Karotis-TEA ist das Verfahren der Wahl fr die Behandlung hochgradiger Karotisstenosen als Ursache transienter neurologischer Symptome in der jngeren Anamnese. Bei Patienten mit akuten neurologischen Ausfllen, die einer vaskulren Insuffizienz der A.carotis zuzuordnen sind, ist die Indikation zur notfallmigen Operation dagegen weiterhin strittig.Patienten und MethodikIm Zeitraum vom 01.01.1995 bis 30.06.2003 wurden bei 621Patienten 656Karotisdesobliterationen bei 330 symptomatischen (50,3%) und 326 asymptomatischen (49,7%) Stenosen durchgefhrt. Die Indikation zum Notfalleingriff wurde bei 30Patienten (4,6%) mit Crescendo-TIA (n=11) oder inkonstantem neurologischen Defizit (n=19) innerhalb von 4–24h nach Beginn der Symptome durchgefhrt. Klinische Selektionskriterien fr den Notfalleingriff waren ein akuter Beginn der neurologischen Symptomatik bei uneingeschrnkter Bewusstseinslage, der Nachweis einer hochgradigen Karotisstenose, ein Blutungsausschluss im CT sowie kardiopulmonale Stabilitt.ErgebnisseDie fachneurologische Untersuchung ergab als Frhergebnis eine komplette Remission der Symptome bei 12 und eine Verbesserung mit nicht behindernder Restsymptomatik bei 9Patienten. Die neurologischen Defizite von 6Patienten blieben postoperativ unverndert. 3Patienten erlitten eine Verschlechterung (1komplette, 2inkomplette Hemiparese). 24/30Patienten konnten innerhalb von 8Tagen aus der stationren Behandlung entlassen werden. Innerhalb einer mittleren Nachbeobachtungszeit von 54Monaten verstarben 9/30Patienten. Bei 1Patienten kam es zu einem erneuten zerebralen Ereignis, whrend es bei 7Patienten zu einer weiteren Verbesserung der neurologischen Symptomatik kam.SchlussfolgerungDiese Analyse zeigt, dass sich mit der operativen Therapie der akuten Karotisinsuffizienz bei einem selektionierten Krankengut unter optimalen Bedingungen der Diagnostik, des intraoperativen Managements und der perioperativen berwachung gute bis sehr gute Ergebnisse erzielen lassen.BackgroundCarotid endarterectomy (CEA) is well established as the elective treatment for moderate or severe carotid stenoses with a history of neurological symptoms. In contrast, the merits of carotid revascularization performed as an emergency procedure in patients with acute stroke or fluctuating neurological deficit remain controversial.Patients and methodsA total of 656 CEAs were performed on 621 patients for 330 (50.3%) symptomatic and 326 (49.7%) asymptomatic carotid stenoses within an 8-year period between January 1995 and June 2003. Of the latter, emergency CEA was performed on 30 patients (4.6%). Eleven patients presented with a crescendo TIA, and 19 patients presented with progressive neurological deficits corresponding to contralateral carotid stenosis within 4–24h after the onset of symptoms. Patients selected for urgent surgery fulfilled the following criteria: acute onset of fluctuating hemispheric neurological symptoms, significant carotid pathology, absence of cerebral hemorrhage, uncompromised vigilance, and stable cardiopulmonary conditions.ResultsFollowing CEA, the neurological deficits improved instantaneously to complete recovery in 12 patients. The symptoms of nine patients improved to non-disabling deficits, remained unchanged in one, and worsened in three patients (one complete and two incomplete hemipareses). Of 30 patients, 24 were discharged within 8days after admission. The neurological status after discharge deteriorated in only one of the patients during follow-up of 54 months, but improved in 7 of the patients.ConclusionOur retrospective study suggests that rescue CEA may be beneficial for selected patients with stroke in evolution and fluctuating neurological deficits. Careful adherence to selection criteria, intraoperative shunting, and intensive care post surgery surveillance are recommended.
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren
Gefasschirurgie, 2003
ABSTRACT Der Schlaganfall ist in Europa nach wie vor die dritthufigste Todesursache nach den kard... more ABSTRACT Der Schlaganfall ist in Europa nach wie vor die dritthufigste Todesursache nach den kardiovaskulren und Krebserkrankungen und die hufigste Ursache fr lebenslange Behinderungen.In Deutschland erleiden nach vorliegenden Schtzungen etwa 250.000 Menschen pro Jahr einen Schlaganfall. Angaben zur Inzidenz liegen fr Deutschland nur aus einigen Studien und speziellen Bevlkerungsregistern vor. Danach muss mit Inzidenzraten von etwa 8/100.000 in der Altersgruppe von 25–34Jahren, ber 20/100.000 im Alter von 35–44Jahren und 120/100.000 im Alter von 45–54 Jahren gerechnet werden. In den Altersgruppen >55Jahre steigt die Inzidenzrate stark an und sie erreicht Werte von 200–400/100.000 in der Altersgruppe von 55–64Jahren und 600–1.000/100.000 in den hheren Lebensjahren. Danach betrgt das Schlaganfallrisiko fr ber 65-jhrige bis zu 20%.Die derzeit hohe Mortalittsrate und die erheblichen Kosten, welche bei Schlaganfallpatienten fr die medizinische Behandlung und der sich anschlieenden langjhrigen Rehabilitation anfallen, machen den Schlaganfall nicht nur zu einem medizinischen Problem, sondern auch zu einer der weltweit teuersten Erkrankungen.Das Vorkommen schlaganfallbedingter Behinderungen in der Bevlkerung lsst sich am effizientesten durch prventive Manahmen verringern. Manahmen zur Primrprvention mssen von solchen zur Verhtung eines Rezidivinsultes nach bereits erlittenem Schlaganfall differenziert werden. Die Wirksamkeit prventiver Manahmen setzt die Identifizierung von Risikofaktoren voraus, deren Vorliegen statistisch das Auftreten von Insultereignissen begnstigt. Die Art der primr- und sekundrprventiven Therapieform sollte nach Abwgen von Nutzen und Risiko in Abhngigkeit von den Ergebnissen der einzelnen therapeutischen Optionen erfolgen.Stroke is still the third leading cause of death in Europe followed by cardiovascular and cancer diseases and is a principal cause of long-term disability. In Germany, at least 250,000 persons suffer from new or recurrent stroke annually. Data on the incidence are available for Germany from only a few studies and special population registers.Accordingly, incidence rates of approximately 8/100,000 in the age cohort of 25–34years, over 20/100,000 in the age cohort of 35–44years, and 120/100,000 in the age cohort of 45–54years are to be expected. In the age cohort >55years, the incidence rate surges to values from 200–400/100,000 (age cohort of 55–64years) to 600–1,000/100,000 (older than 65). According to these data, the risk of ischemic stroke is about 20% for seniors over 65years.The present high mortality rate and the substantial costs thereby incurred by patients with carotid-related strokes for medical treatment and subsequent long-term rehabilitation defines stroke not only as a medical problem, but particularly with regard to the financial impact as an economic determinant.The occurrence of stroke-related handicaps in the population can be reduced most efficiently by preventive measures. Measures for primary prevention must be differentiated from those for preventing a recurrent stroke. The effectiveness of preventive measures presupposes the identification of risk factors, which favor statistically the occurrence of stroke. The form of primary and secondary prevention should be performed after deliberating on the risks of the individual therapeutic options.
Journal of Nuclear Medicine, May 1, 2008
Society of Nuclear Medicine Annual Meeting Abstracts, May 1, 2008
The Journal of cardiovascular surgery
The Propaten European Product Evaluation (PEPE II) study was a product evaluation intended to cha... more The Propaten European Product Evaluation (PEPE II) study was a product evaluation intended to characterize the performance of the GORE PROPATEN vascular graft in above-knee (AK) and below-knee bypass (BK) surgery. This prospective multicenter trial enrolled 142 patients with peripheral arterial disease. In 87 patients AK and in 52 patients BK bypasses (including 15 femorocrural) were implanted (67.6% males, 32.4% females). The one-year overall primary and secondary patency rates were 80% and 84.7%, respectively. Overall limb salvage rate at 12-months was 96.2%. The primary patency rate for AK bypasses was 82.7%, for BK femoro-popliteal bypasses 74.2% and for BK tibial-peroneal bypasses 79.4%. Secondary patency rates were 87.3%, 78.8% and 85.1%, respectively. Primary patency rates decreased depending on the number of patent run-off vessels (three 84.3%, two 80.8%, one 73.3%). Subgroup analysis showed that female patients had a significantly higher primary patency rate for BK bypasses...
Gef�sschirurgie, 2003
ABSTRACT Im Stadium der chronisch kritischen Ischmie ist die Anlage eines gelenkberschreitenden B... more ABSTRACT Im Stadium der chronisch kritischen Ischmie ist die Anlage eines gelenkberschreitenden Bypasses oft die einzige Chance fr den Extremittenerhalt. Trotz erzielter Fortschritte in den letzten Jahrzehnten sind die Ergebnisse hinsichtlich der Bypassfunktionalitt z.T. unbefriedigend und in der Diskussion. Es gibt zahlreiche Hinweise in der Literatur ber die Beeinflussung der Offenheitsraten durch bestimmte Begleitfaktoren, insbesondere durch das verwendete Bypassmaterial.In unserer retrospektiven Analyse aus den Jahren 1994–1999 an 110Patienten mit insgesamt 127 gelenkberschreitenden Bypssen zeigte sich ein statistisch signifikanter Einfluss auf die 3-Jahres-Offenheitsraten durch das verwendete Bypassmaterial. Dies gilt sowohl fr die primre als auch fr die sekundre Offenheitsrate (Eigenvene primr 72%, sekundr 77%; alloplastisch primr 45%, sekundr 55%) unabhngig von der distalen Anschlussregion. Von signifikantem Einfluss auf die Offenheitsraten war auch der Status einer ipsilateralen gefchirurgischen Voroperation (primr: 82% vs. 36%, sekundr 84% vs. 50%).Keinen statistisch signifikanten Einfluss hatten folgende Risiko- und Begleitfaktoren: Diabetes mellitus, arterielle Hypertonie, Nikotin, Hyperlipidmie, generalisierte Arteriosklerose, Anschlussregion, 3-Gefausstrom oder 2 und weniger bei poplitealem Anschluss, Form der Antikoagulation (ASS vs. Marcumar).In the case of chronic critical limb ischemia, surgical treatment with below-knee bypass is often the last chance for limb salvage. Although progress has been achieved in the last few years, the results concerning functionality and patency of the bypasses often remain insufficient and are still under discussion. In the literature many factors that influence the patency of below-knee bypasses have been described, especially the choice of graft material.In our retrospective study of 110 patients and 127 below-knee bypasses performed between 1994 and 1999, we analyzed the influence of several factors on the 3-year primary and secondary patency rates. Of all factors analyzed, only the graft material (patency rates for autologous greater saphenous vein primary 72%, secondary 77%, prosthetic grafts primary 45%, secondary 55%) and the fact of having had a ipsilateral vascular surgical operation on the lower extremity (primary patency 82% vs 36% and 84% vs 50%) showed a statistically significant influence on the patency rate.There was no statistically significant influence found for the following factors: diabetes, high blood pressure, smoking, hyperlipidemia, systemic atherosclerosis, site of proximal and distal anastomosis, runoff, and anticoagulation (ASS vs coumarin).
Annals of vascular surgery, Jan 10, 2008