Papers by Sven Ross Mathisen
The Journal of Thoracic and Cardiovascular Surgery, Jul 1, 1986
Prevention of retrosternal adhesions after pericardiotomy Because repeat sternotomies are becomin... more Prevention of retrosternal adhesions after pericardiotomy Because repeat sternotomies are becoming much more prevalent with repeat coronary bypass operations, prevention of direct adhesions of the heart and grafts to the back of the sternum by use of synthetic or xenograft material to close the pericardiotomy has become a matter for investigation. In thisstudy bovine andequine glutaraldehyde-processed xenografts were implanted bilaterally in dogs for implant intervals of 6 weeks and3, 6, 9, and 12 months. The bovine and equine xenografts both performed weD in resisting the adhesion of the heart to their inner surfaces and less weD in resisting adhesion of the lung andchest waDto their outer surfaces. The bovine xenograft had a higher percentage of adhesion-free surface on aD the surfaces evaluated; however, one of our 12-month bovine pericardial xenograft implants exhibited significant multifocal calcific degeneration. Although pericardial xenografts generally have performed weD when implanted in the dog, GaDo, Artiiiano, and Duran recently expressed concern about their performance in humans. Along with our finding of calcification, their concern suggests a cautious approach to clinical application.
[Primary peritonitis in children]
Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke, 1991
Primary peritonitis occurs rarely in childhood. The causative microbe is usually either streptoco... more Primary peritonitis occurs rarely in childhood. The causative microbe is usually either streptococcus or pneumococcus. However, the incidence of gram negative anaerobic bacteria is increasing. The bacteria are cultured from fluid taken from the abdominal cavity during celiotomy. The abdominal viscera are normal, which excludes secondary peritonitis. We discuss the case of an infant who presented this disease entity.
Healing of Synthetic and Biological Prostheses in the Cardiovascular System. An Experimental Study
En anleggsarbeider med akutte knesmerter
Tidsskrift for Den Norske Laegeforening, 2006
A Single Center Study of ProGlide Used for Closure of Large-Bore Puncture Holes After EVAR for AAA
Vascular and Endovascular Surgery, 2021
Purpose: The objective of this study was to evaluate the primary and assisted secondary percutane... more Purpose: The objective of this study was to evaluate the primary and assisted secondary percutaneous and non-invasive technical success of the ProGlide device on all-comers in a consecutive case series of percutaneous endovascular aortic aneurysm repair (P-EVAR). Method: A single-center consecutive case series where 434 elective and acute P-EVAR procedures were registered prospectively between May 2011 and July 2017. The mean age was 74.5 years ± SD 11.4 years. 82.3% of the patients were male. All patients were pre-planned from CT angiography. Percutaneous access punctures, performed in local anesthesia in the common femoral artery, with a final introducer size between 12-22 Fr OD were included and stratified in 2 groups, 12-16 Fr and 17-22 Fr. Results: By screening 868 access groins 22 groins were excluded. Of the remaining 846 groins, intended to be treated with ProGlide, 9 groins were excluded peri-procedurally and treated with the Fascia Suture Technique or surgical cutdown. The...
European Journal of Vascular and Endovascular Surgery, 2020
A 74 year old female with coronary heart disease presented with left lower quadrant abdominal pai... more A 74 year old female with coronary heart disease presented with left lower quadrant abdominal pain. Computed tomography angiography (CTA) revealed a 6.5 cm ruptured abdominal aortic aneurysm (RAAA). Endovascular aneurysm repair with an Endurant stent graft (Medtronic, Santa Rosa, CA, USA) was performed. She remained clinically unstable with hypotension and falling haemoglobin levels. A new CTA showed contrast in the RAAA lumen (horizontal arrow) and the left abdominal haematoma (vertical arrow). The stent graft was removed. Four large lumbar arteries were oversewn. A 16 mm straight tube polyester prosthesis was sewn in. The type II endoleak was contained and the patient stabilised in the intensive care unit.
European Journal of Vascular and Endovascular Surgery, 2016
surgery. The incidence of these DWI lesions was compared between the shunting and the non-shuntin... more surgery. The incidence of these DWI lesions was compared between the shunting and the non-shunting group. A subgroup analysis was performed to differentiate between asymptomatic and symptomatic carotid stenosis. Results: Shunt use was similar in both asymptomatic and symptomatic carotid stenosis group (21.8% vs. 26.2%, respectively; p ¼ 0.38). The overall incidence of emboligenic DWI lesions is 8.7% (32/366). In the non-shunting group (n ¼ 280), a 7.1% incidence is reported, whereas in the shunting group (n ¼ 86), a 14.0% incidence is seen (borderline non-significant difference; p ¼ 0.08). In the asymptomatic carotid stenosis group, there were significantly more emboligenic DWI lesions when a shunt was used, compared to when no shunt was used (16.3% vs. 5.7% incidence, respectively; p ¼ 0.03). In the symptomatic carotid stenosis group, no difference in incidence of emboligenic DWI lesions was found when a shunt was used or not (10.8% vs. 9.6%; p ¼ 0.76). Only one patient with an emboligenic DWI lesion presented with a stroke; all other lesions were clinically silent (31/32; 97%). Conclusion: There is a tendency for higher incidence of emboligenic DWI lesions when using a shunt during CEA. Subgroup analysis for the asymptomatic carotid stenosis group shows a statistically significant higher incidence of emboligenic DWI lesions when a shunt was used, compared to when no shunt was used. Most of these emboligenic DWI lesions are clinically silent. The clinical relevance of cerebral embolization during CEA is still under debate. Therefore, the use of a shunt during CEA must be carefully considered especially in asymptomatic patients.
Vascular Medicine, 2017
In this single center, retrospective cohort study we wished to compare early and total mortality ... more In this single center, retrospective cohort study we wished to compare early and total mortality for all patients treated for abdominal aortic aneurysms (AAA) with open surgery who were taking statins compared to those who were not. A cohort of 640 patients with AAA was treated with open surgery between 1999 and 2012. Patients were consecutively recruited from a source population of 390,000; 21.3% were female, and the median age was 73 years. The median follow-up was 3.93 years, with an interquartile range of 1.79–6.58 years. The total follow-up was 2855 patient-years. An explanatory strategy was used. The propensity score (PS) was implemented to control for selection bias and confounders. The crude effect of statin use showed a 78% reduction of the 30-day mortality. A stratified analysis using the Mantel–Haenszel method on quintiles of the PS gave an adjusted effect of the odds ratio equal to 0.43 (95% CI: 0.18–0.96), indicating a 57% reduction of the 30-day mortality for statin us...
European Journal of Vascular and Endovascular Surgery, 2017
WHAT THIS PAPER ADDS This prospective study covers > 99% of surgical treatment of symptomatic car... more WHAT THIS PAPER ADDS This prospective study covers > 99% of surgical treatment of symptomatic carotid stenosis in a whole nation during 1 year. This constitutes a more solid base than previous observations, even if the numbers are similar, showing that only 61.7% of patients are treated surgically within the national guidelines time limit of 2 weeks. The delays are mainly due to in hospital logistics, and also to patients not seeking medical advice immediately. The study adds to increasing evidence that dual antiplatelet therapy protects against new neurological events in symptomatic patients. The findings constitute a firm platform for implementing coordinated national improvement measures. Objective/Background: The objective was to observe for 1 year all patients in Norway operated on for symptomatic carotid stenosis with respect to (i) the time from the index event to surgery and neurological events during this time; (ii) the level in the healthcare system causing delay of surgical treatment; and (iii) the possible relationship between peri-operative use of platelet inhibitors and neurological events while awaiting surgery. Methods: This was a prospective national multicentre study of a consecutive series of symptomatic patients. Patients were eligible for inclusion when referred for surgery. An index event was defined as the neurological event prompting contact with the healthcare system. All 15 departments in Norway performing carotid endarterectomy (CEA) participated. Results: Three hundred and seventy one patients were eligible for inclusion between 1 April 2014 and 31 March 2015, and 368 patients (99.2%) were included. Fifty-four percent of the patients contacted their general practitioner on the day of the index event. Primary healthcare referred 84.2% of the patients to hospital on the same day as examined. In hospital median time from admission to referral for vascular surgery was 3 days. Median time between referral to the operating unit and actual CEA was 5 days. Overall, 61.7% of the patients were operated on within 2 weeks of the index event. Twelve patients (3.3%) suffered a new neurological event while awaiting surgery. The percentage of patients on dual antiplatelet therapy was lower (25.0%) in this group than among the other patients (62.6%) (p ¼ .008). The combined 30 day mortality and stroke rate was 3.8%.
Kissing stents in the common femoral artery bifurcation for critical limb ischemia: technical description and report of three cases
Vascular
The purpose of this article is to describe three cases of kissing stent placement in the common f... more The purpose of this article is to describe three cases of kissing stent placement in the common femoral artery bifurcation in patients unsuitable for open endarterectomy and patch plasty. In three patients with critical limb ischemia, caused by primary atherosclerotic disease or dissection-related injury when performing a lower extremity intervention, a technique of kissing stents was used to treat the flow-obstructing lesion in the common femoral artery bifurcation. Technical success was uniform, and during follow-up (4.5-8 months), all patients showed improved symptoms, wound healing, and duplex ultrasonography-verified patency of the stents. Kissing stents in the common femoral artery bifurcation are a feasible treatment option in patients with limited mobililty or contraindications to open repair. The short-term results seem promising, but longer follow-up and an increased number of patients will be needed to assess the durability of the reconstruction.
[A construction worker with acute knee pain]
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 25, 2006
Out of all peripheral arterial aneurysms, 70% are located in the popliteal artery; less than 4% o... more Out of all peripheral arterial aneurysms, 70% are located in the popliteal artery; less than 4% of these rupture. Ruptured popliteal aneurysms may be mistaken for deep venous thrombosis. From March until June 2001 three patients were primarily admitted with a diagnosis of venous thrombosis. This delayed the appropriate treatment of a ruptured popliteal aneurysm considerably. Two patients were first anticoagulated with warfarin before being transferred to the surgical ward. All the patients were operated on with the exclusion of the popliteal aneurysm and a femoropopliteal bypass conduit. The haematoma from a ruptured popliteal aneurysm presenting with pain and venous swelling is easily mistaken for a deep venous thrombosis. In these three patients the correct diagnosis was made respectively 18, 2 and 20 days after the onset of swelling and pain. Ruptured popliteal aneurysms can be mistaken for a venous thrombosis or a Baker cyst. A Duplex scan will most often lead to a correct diagn...
Influence on healing in the canine thoracic aorta of three substances used to close the interstices of macroporous Dacron grafts
The American surgeon, 1986
The influence on healing of three materials for closure of interstices in a macroporous Dacron ar... more The influence on healing of three materials for closure of interstices in a macroporous Dacron arterial prosthesis were evaluated by 56-day implantation in the canine descending thoracic aorta. The materials studied were: the nondenatured fibrin deposited as a result of a 4-step preclot with autogeneic blood (n = 6), heat-coagulated autogeneic blood deposited by autoclaving the blood-soaked prosthesis (n = 6), and cross-linked human albumin (n = 6). Healing of autogeneic fibrin was superior with little difference between the other two materials.
A five-to seven-year experience with externally-supported Dacron prostheses in axillofemoral and femoropopliteal bypass
Annals of Vascular Surgery, 1986
We have examined the clinical results of 56 externally-supported (EXS) Dacron grafts in the axill... more We have examined the clinical results of 56 externally-supported (EXS) Dacron grafts in the axillofemoral position and 117 in the femoropopliteal position. Results have been analyzed from two perspectives: primary patency concerns only those grafts that had never occluded; extended patency refers to all open grafts including those whose continued patency is the result of thrombectomy. The 5-to 7-year life-table patency rates are: axillofemoral 8 mm and 6 mm bypass: primary 75% and extended 97%; above-knee femoropopliteal 6 mm bypass: primary 78% and extended 93%; below-knee 6 mm femoropopliteal bypass: primary 41% and extended 91%. In contrast, the results for the 5 mm grafts used for femoropopliteal bypass were inferior to the 6 mm grafts: femoropopliteal 5 mm bypasses had an above-knee primary patency rate of 44% and an extended rate of 55%, with a below-knee primary patency rate of 15% and an extended rate of 32%. Rendering the noncrimped porous Dacron prosthesis kink and compression resistant by an external support coil appears to increase its potential for successful use, especially in 8 mm axillofemoral and 6 mm femoropopliteal bypasses.
Internal Sealing of Acute Aortic Bleeding with a Catheter-Delivered Liquid to Solid Embolic Agent (Onyx)
Vascular, 2010
Occasionally, standard stent grafts are not usable in emergency aortic bleeding, and custom-made ... more Occasionally, standard stent grafts are not usable in emergency aortic bleeding, and custom-made stent grafts are not practical as a replacement. We describe a novel technique for the repair of such aneurysms by using the catheter-delivered liquid to solid embolic agent Onyx (Micro Therapeutics Inc., Irvine, CA). Two patients with ruptured aortic aneurysm, where endovascular or open repair was not considered as feasible, were treated by internal sealing of the aneurysm with Onyx, resulting in stoppage of bleeding and further expansion of the aneurysm-the plugging and sealing technique.
Stroke, 1986
This study characterizes the effect of dazmegrel, a thromboxane synthetase inhibitor, on platelet... more This study characterizes the effect of dazmegrel, a thromboxane synthetase inhibitor, on platelet function in the dog and introduces its potential use in combination with aspirin therapy. Ex vivo testing of dazmegrel alone was performed with three dosages and three administration regimens. Platelet aggregation response, malondialdehyde formation and prostaglandin metabolites generation were evaluated. To maintain complete thromboxane A2 inhibition, dazmegrel had to be given 3 times per day at dosages of not less than 6 mg/kg. The same result was achieved with a single daily administration of combined dazmegrel and aspirin in equal dosages of 3 mg/kg. Dazmegrel, both alone and with aspirin, increased and sustained heightened levels of prostacyclin, unlike the simultaneous inhibition of both prostaglandin metabolites seen with aspirin therapy alone. Because the combination of dazmegrel and aspirin effectively blocks thromboxane A2 formation and also enhances prostacyclin formation, th...
Journal of Vascular Surgery, 1986
This study was designed to establish the influence of the recipient's thrombotic potential on the... more This study was designed to establish the influence of the recipient's thrombotic potential on the patency of small-caliber prostheses and to evaluate the subsequent improvement of graft performance by medicinally altering the prostaglandin balance in subjects predisposed to graft occlusion. Mongrel dogs were pretested and classified as low and high responders according to their thrombotic potential, measured as prostaglandin metabolite balance and platelet aggregability. High responders were randomly divided into two groups. Those assigned to serve as the medicated subjects were pretreated 1 week before surgery with a single oral daily administration of combined dazmegrel (UK-38,485) and ,,~ ~pirin in equal dosages of 3 mg/kg. Medication was continued throughout the experiment. Dacron grafts were implanted bilaterally in the carotid artery site in all subjects. Following a 3-week implantation period, the patency rate for the group with low thrombotic potential was 100%. In the animals with high thrombotic potential the patency rate was 10% for nonmedicated subjects and 100% for medicated subjects. These data support the concept that the thrombotic potential largely determines the capacity of the recipient's blood to thrombose small-caliber prostheses. Effective medicinal alteration of prostaglandin balance results in exceptionally increased patency of synthetic grafts. (J VAse SURG 1986; 3:311-21.) During the past several years we have become increasingly concerned about the unpredictable nature of synthetic graft performance in the canine population. The repeated observations of marked similarity in graft performance of different synthetic materials implanted experimentally in the same recipient support the concept that the inherent thrombotic ~%tential of the blood largely determines the success or failure of the prosthesis. A question arises as to which is bg: ~g tested: the graft material or the thrombotic capacity of the recipient's blood. Blood platelets play a major role in the formation of early arterial thrombi.l-8 Thromboxane A2 (TxA2) released from platelets during aggregation further promotes platelet activation and can serve as an index of ongoing thrombotic events. 9a° Prostacyclin (PGI2), which originates from the same precursor as
Journal of Vascular Surgery, 1986
Eight currently used arterial prostheses with differing constructions and materials were implante... more Eight currently used arterial prostheses with differing constructions and materials were implanted in the descending thoracic aorta of mongrel dogs. The prostheses were Gore-Tex (polytetrafluoroethylene), DeBakey Woven, Cooley Woven, Meadox Woven Double Velour, Cooley Knitted Double Velour, Microvel, Vasculour II, and Bionit II. Five series of these eight prostheses were serially implanted in heparinized subjects. During the 40 implantations, attention was focused on three major characteristics: preclotting efficiency, surgical handling characteristics, and healing. Gore-Tex is impervious to blood. The DeBakey and Cooley woven grafts are nearly so. The remaining prostheses required preclotting. The Meadox Woven Double Velour became impervious after two preclotting steps, the Cooley Knitted Double Velour and the Bionit II required three, and the Vas-¢axlour II and the Microvel required four. The surgical handling characteristics of the knitted prostheses clearly surpassed those of the DeBakey and Cooley woven and Gore-Tex prostheses. Although the Meadox Woven Double Velour prosthesis had better conformability than the nonveloured woven, the tendency of its cut edge to fray was more pronounced. Healing was much more advanced in the knitted and woven prostheses than in the Gore-Tex. (J VASC SURG 1986; 4:33-41.) The large number of arterial prostheses currently available attests to a lack of consensus conceming optimal graft design features. In an effort to better appreciate the attributes of several of the prostheses presently in use, we have sought to examine them critically under controlled experimental circumstances from three aspects: preclotting efficiency, surgical handling characteristics, and healing. MATERIAL AND METHODS Prostheses The vascular prostheses included in this study were the polytetrafluoroethylene (PTFE) Gore-Tex
Carvedilol reduces ischaemic skeletal muscle necrosis
Journal of Orthopaedic Research, 1999
Carvedilol is an alpha1 and nonselective beta-adrenergic receptor antagonist with antioxidative p... more Carvedilol is an alpha1 and nonselective beta-adrenergic receptor antagonist with antioxidative properties known to protect against reperfusion injury in the heart, brain, and kidneys. The aim of this study was to test the hypothesis that carvedilol improves postischaemic reperfusion and tissue survival in skeletal muscle. Sixteen Wistar rats underwent tourniquet ischaemia of the left hindlimb for 3 hours and 15 minutes at 27 degrees C. Single-fiber laser Doppler probes were inserted in the left and right anterior tibial muscles, and microvascular perfusion was measured until 2 hours after removal of the tourniquet. Perfusion indices for each 15-minute interval were calculated for the left hindlimb (tourniquet ischaemia) by dividing the postischaemic by the pre-ischaemic laser Doppler flowmetry values, and the geometrical areas under the curves representing a plot of perfusion index relative to time, measured in arbitrary units, were compared. Laser Doppler flowmetry values for the right anterior tibial muscle were compared. Tissue damage was measured by histomorphometry of necrotic areas and no-reflow zones in cross sections from the anterior tibial muscle 72 hours after ischaemia. Neutrophils were counted in the same sections. The treatment group received 1 mg carvedilol/kg body weight before ischaemia and 1 mg/kg immediately before removal of the tourniquets. The areas under the curves representing the plot of perfusion index relative to time were larger for the rats treated with carvedilol: 9.5 compared with 3.0 arbitrary units (p = 0.0003). Treatment did not change the laser Doppler flowmetry values for the right hindlimbs. The histomorphometric areas of necrosis in cross sections from the muscles were reduced from 88% (38-96%) in the control animals to 41% (7-85%) in those treated with carvedilol (p = 0.01), and the area of no-reflow was reduced from 20% (2-52%) to 0% (0-7%) (p = 0.006). The number of neutrophils did not differ between groups. The study supports the hypothesis that carvedilol improves early reperfusion and protects skeletal muscle subjected to 3 hours and 15 minutes of ischaemia.
Journal of Endovascular Therapy, 2012
To assess the rate of complications associated with the fascia closure technique for femoral acce... more To assess the rate of complications associated with the fascia closure technique for femoral access sites in which 18-F or 20-F sheaths were introduced during endovascular aneurysm repair (EVAR). Methods: A retrospective analysis was done of 50 consecutive patients (41 men; median age 75 years, range 62-85) who received Excluder stent-grafts in planned percutaneous EVAR procedures from May 2006 until December 2009. The fascia closure technique was routinely used for all femoral access sites in which large bore (18-F and 20-F) introducers were employed. One patient with extremely calcified and narrowed vessels was converted to primary cutdown bilaterally after percutaneous access failed. In the 49 remaining patients, 81 femoral access sites were closed with the fascia closure technique; 17 sites with smaller 12-F introducers were closed using other techniques. Computed tomographic angiography (CTA) was performed within 30 days, at 6 months, and at 1, 2, and 3 years. Results: Of the 81 femoral access sites closed with the fascia closure technique, only 1 patient had persistent bleeding that required an immediate cutdown and suture repair of the deep femoral artery (99.0% technical success rate). In the immediate postoperative period, 5 patients required additional interventions for bleeding (n52), occlusion (n52), or a pseudoaneurysm [92.6% 30-day technical success]. At 30 days, 11 (13.9%) of 79 access sites had pseudoaneurysms, all of which resolved within a year; none required a secondary intervention. Later surveillance scans did not detect pseudoaneurysms. Conclusion: The fascia closure technique during EVAR is safe and has few complications. The low frequencies of pseudoaneurysms and other access site complications make the femoral closure technique a durable alternative.
A rapidin vitro test of thein vivo healing potential of vascular prostheses
Journal of Biomedical Materials Research, 1987
ABSTRACT An in vitro method for comparing the penetration of bovine fibroblasts seeded on the ext... more ABSTRACT An in vitro method for comparing the penetration of bovine fibroblasts seeded on the external surface of porous vascular prostheses was devised. The effects of water porosity reduction and differing manufacturing constructions (warp-knit Dacron, woven Dacron and polytetrafluoroethylene) on the ability of the bovine fibroblasts to penetrate transmurally was investigated. Of the warp-knit external-veloured Dacron prostheses, the highest porosity 140-denier prototype had the highest luminal surface cell count and the lowest porosty 280-denier prototype the lowest luminal surface cell count. The intermediate prototypes had values between these two extremes. The woven Dacron prostheses, which were of even lower porosity but with a much thinner wall, had cell counts midway between the 140-denier and the 280-denier prototypes. The microporous polytetrafluoroethylene prostheses did not allow fibroblast penetration despite adherence of cells to the outer surface. These findings agree with in vivo healing studies of the same materials in the descending thoracic aorta of the dog, demonstrating that this rapid in vitro assay method can help predict the healing potential of a vascular prosthesis.
Uploads
Papers by Sven Ross Mathisen