RESUMEN
11 cases of subclavian vessel injuries are reported. The problems of operative approach are discussed. Two out of 11 cases have been operated on by extraanatomical bypass from the common carotid artery to the subclavian or axillary artery. There resulted no problems by temporarily clamping the common carotid artery, no postoperative carotid steal syndrome was seen. In our opinion carotid-subclavian bypass - well known as standard procedure in chronical disease of the proximal subclavian artery - can also be applied in case of acute trauma of the subclavian artery. Thus the direct riskfull approach for these often polytraumatized patients can be avoided.
Asunto(s)
Derivación Arteriovenosa Quirúrgica/métodos , Arteria Subclavia/lesiones , Adulto , Vena Axilar/cirugía , Prótesis Vascular , Arterias Carótidas/cirugía , Femenino , Humanos , Persona de Mediana Edad , Radiografía , Rotura , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugíaRESUMEN
In 90 patients a total of 100 reconstructions of the carotid artery had been performed between 1972 and 1977. No patient died from the operation, 3 suffered central nervous complications, and 33 had transitory defects of cranial nerves. These defects were reversible in all but two patients. After an average observation period of 20 months 11 patients had died (6 from cardiac infarction, 2 from stroke, and 3 from unknown reasons). Of the 31 patients with clinical stage II, 24 were without symptoms, 5 had only rare transient ischaemic attacks, and two patients had the same frequency of attacks as preoperatively. Among the 39 stage III patients 35 showed complete or partial regression of symptoms whereas 4 had had repeat strokes. 55 of the 59 corrected stenoses were patent as shown by Doppler ultrasound. In contrast attempts to correct complete internal carotid artery occlusions showed unsatisfactory results.
Asunto(s)
Arteriopatías Oclusivas/cirugía , Enfermedades de las Arterias Carótidas/cirugía , Anciano , Arteriopatías Oclusivas/complicaciones , Enfermedades de las Arterias Carótidas/complicaciones , Infarto Cerebral/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Ataque Isquémico Transitorio/complicaciones , Masculino , Persona de Mediana Edad , Examen Neurológico , Complicaciones Posoperatorias , UltrasonografíaRESUMEN
Our report describes the results of 35 extra-anatomic bypass operations for the treatment of aortoiliac occlusion in high-risk patients. This operation is an alternative to amputation for the therapy of claudication intermittens or gangrene. Long-term results are difficult to obtain, as many patients in this group die early from other causes. The problem of iatrogenic steal phenomenon is discussed. We consider Doppler ultrasound assessment a very valuable method for excluding aortoiliac insufficiency of the donor limb, not detected by other means.
Asunto(s)
Enfermedades de la Aorta/cirugía , Arteriopatías Oclusivas/cirugía , Anciano , Prótesis Vascular , Arteria Femoral/cirugía , Humanos , Masculino , Métodos , Persona de Mediana Edad , Riesgo , UltrasonografíaRESUMEN
The 240 reconstructions of the femoral artery, performed within the last 4 1/2 years, involved 26 patients (27 bypasses) with combined femoral and peripheral vascular occlusions. The bypasses were connected with a segment of either the popliteal or the tibial artery. There was no operative mortality. The mean period of follow-up was 13 months: 18 of the bypasses were patent (2 patients died with open bypass), while 7 bypasses occluded (3 patients died). The authors feel, that isolated artery segment should always be explored. Only an autogenous vein graft should be implanted.