Evaluation of Thromboendarterectomy in Treatment of Obliterative Arterial Disease

We use the intra-arterial route with 4 objects in view: (1) Analgesic action.(2) Vasodilatory action. (3) Antibiotic action. (4) Anticoagulant action.Analgesic. Procaine hydrochloride is preferred with direct action and greater tolerance than by any other route. Vasodilatory. Intra-arterial injections of any medicament induce a transitory vasoconstrictor phenomenon and secondarily a vasodilatation which varies in intensity in proportion to the intensity of the vasoconstrictor phenomenon. The vasomotor phenomena to which we have made reference are null when procaine is used as a vehicle. They are very intense when hypertonic solutions above 25 per cent are used. The secondary vasodilatation we have referred to, induced by procaine or with such drugs as Priscol, Hydergine, Roniacol, etc., is of great importance since a greater degree of irrigation is obtained in the sector where it is needed (hemometakinesia).Milan6s-L6pez and his collaborators have proved this in recent experiments, taking 20 patients with peripheral vascular disorders, thromboangiitis obliterans and arteriosclerosis obliterans. In 10 of these cases various vasodilatator drugs-Lambral, Priscol, Hydergine, Roniacol-were used intramuscularly and intravenously, and it was observed that these vasodilators did not modify the cutaneous temperature of the limb in which the circulation was more precarious but, on the contrary, raised the temperature in the healthy member by more than 4°C. The remaining 10 cases were treated by prolonged regional vasodilatation and an increase was obtained in the cutaneous temperature of the affected limb which demonstrated conclusively the truth of the phenomenon of hemometakinesia described by DeBakey and his collaborators in 194'T.1Antibiotic. The sanguineous concentrations obtained by the intra-arterial at Harvard Libraries on June 26, 2015 ang.sagepub.com Downloaded from

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“…4. There does not exist any other procedure that brings about an analgesic and anti-infective action more intense than that proposed by us.…”

Section: Technique For Aortamentioning

confidence: 77%

Vasodilatation and Regional Heparinization by Arterial Catheterization in Peripheral Vascular Disorders

Carrillo¹,

Milanés-López²,

McCook³

1957

Angiology

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“…3) and 4 patients had chronic thrombosis in distal arteries, arteriographically demonstrated (figs. 4-6).…”

Section: Methodsmentioning

confidence: 92%

“…Prevention of thrombosis in the distal area by injecting a 25 mg intraarterial heparin solution while inflating a sphygmomanometer placed under the site of the operation to 90 mm pressure, with the object of arresting venous return and maintaining the anticoagulant at that level throughout the operation. 4. Anticoagulants of the Dicumarol type are used by us only after the regional heparinization in patients operated upon at the level of femoral and popliteal arteries.…”

Section: Methodsmentioning

confidence: 99%

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Thromboendarterectomy in Segmental Arteriosclerotic Thrombosis

J¹,

Milanés-López²,

Castillo³

et al. 1958

Angiology

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Thromboendarterectomy as described in 1947 by Joao Cid Dos Santos consists of the extirpation of a thrombus together with a portion of the endothelium. The advisability of this operation is based on the demonstration of the existence of a cleavage plane on the internal elastic lamina level, together with the possibility of administering anticoagulants later on, in order to avoid a new thrombosis on the operated segment. This is in accordance with the result of a previous arteriographic study permitting the demonstration of the segmentary character of the obstruction.This study points out our experience with the operation at the Vascular Diseases Service of the Lila Hidalgo Hospital and is intended to put forth the two factors that, in our judgement, greatly influenced the results obtained; i.e., patient selection and postoperative anticoagulant therapy. MATERIALIn each of our patients there was a history of a chronic ischemia syndrome, in which intermittent claudication was the chief complaint. Fifty per cent showed, in addition, trophic lesions of an ulcerative type or preexisting gangrene. In each of them, pre-and postoperative studies of the oscillometric readings and arteriograms (for the topographic diagnosis of lesions) were made, because only those patients with segmental lesions between the aorta-iliac bifurcation and the popliteal bifurcation were considered suitable for the operation. In some instances of iliac occlusion (figs. 1 and 2) the arteriographic study was completed by injecting the dye into the femoral artery-after previous dissection and puncturing of same-in the now of and against circulation to check the distal circulatory condition and the lower limit of the obstruction.Clinical and electrocardiographic checks were conducted to verify the cardiac status in order to discard the possibility of operation in patients with severe lesions, or take the necessary precautions in connection with the type of anesthesia and medication. TECHNIQUE . The first patients were treated according to the technique of continuous incisions along the length of the obstructed segment of Reboul,i which practice was abandoned promptly because it prolongs the operation. Thereafter the preferred technique was that of Joao Cid Dos Santosl 3 relative to discontinuous incisions.Once the cleavage plane was found and the thrombus dissected with the endothelium, the latter was cut obliquely on the level of the distal end, to avoid the necessity of fixing the thrombus with U-sutures according to the Kunlin and Leriche technique in order to prevent dissecting hematoma.Frequent irrigations were made of the operative area with 10 mg per cent of heparin solution, closing the arteriotomy with everting continuous suture made with Deknatel 5-0 silk. On our recent patients who had femoral occlusion, we successfully performed the Cannon and Barker2 technique.In the majority of our patients, especially those with iliac occlusion, we perform a lumbar sympathectomy, which, while increasing the velocity of circulation in the endarterecto...

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Surgical Treatment of Thrombotic Occlusion of Aorta and Iliac Arteries

Erskine¹

1959

AMA Arch Surg

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Evaluation of Thromboendarterectomy in Treatment of Obliterative Arterial Disease

Cited by 8 publications

References 7 publications

Vasodilatation and Regional Heparinization by Arterial Catheterization in Peripheral Vascular Disorders

Vasodilatation and Regional Heparinization by Arterial Catheterization in Peripheral Vascular Disorders

Thromboendarterectomy in Segmental Arteriosclerotic Thrombosis

Surgical Treatment of Thrombotic Occlusion of Aorta and Iliac Arteries

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