RESUMEN
The creation of a temporary axillofemoral bypass in a patient undergoing surgery for an 8.1 cm symptomatic infrarenal aortic aneurysm is described. This adjunctive procedure, rarely used in abdominal aortic surgery, may have contributed to minimizing variations in afterload in a patient with a 20% ejection fraction and severe mitral regurgitation.
Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico , Infarto del Miocardio/cirugía , Aneurisma de la Aorta Abdominal/etiología , Aneurisma de la Aorta Abdominal/cirugía , Arteria Axilar/cirugía , Puente de Arteria Coronaria , Urgencias Médicas , Arteria Femoral/cirugía , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral , Infarto del Miocardio/complicaciones , Volumen SistólicoRESUMEN
Inferior pancreaticoduodenal aneurysms are uncommon. A 77-year-old woman was seen with a 1-week history of sharp pain in the right lower abdominal quadrant radiating to the back, associated with malaise, anorexia, vomiting and nonbloody diarrhea. Appendicitis was diagnosed, but at laparotomy a large retroperitoneal hematoma was found; no aneurysm was identified. The abdomen was closed and aortography was done. An aneurysm of the inferior pancreaticoduodenal artery arcade was demonstrated, with occlusion of the celiac artery at its origin. The arc of Buehler was patent and enlarged and supplied the hepatic and splenic arteries. Embolization with Gianturco coils placed proximal to the aneurysm was successful.
Asunto(s)
Aneurisma Roto/terapia , Duodeno/irrigación sanguínea , Embolización Terapéutica , Páncreas/irrigación sanguínea , Anciano , Aneurisma Roto/diagnóstico , Arterias , Diagnóstico Diferencial , Embolización Terapéutica/instrumentación , Urgencias Médicas , Femenino , HumanosRESUMEN
This article reviews the most immediate postoperative complications after abdominal aortic aneurysm surgery. Acute limb ischemia, thromboembolism and pulmonary embolism, postoperative bleeding, and compartment syndrome are described with the associated nursing implications. Prosthetic graft problems are discussed and suggestions for prevention are offered.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Evaluación en Enfermería , Complicaciones Posoperatorias/prevención & control , Síndromes Compartimentales/etiología , Síndromes Compartimentales/prevención & control , Extremidades/irrigación sanguínea , Humanos , Isquemia/etiología , Isquemia/prevención & control , Embolia Pulmonar/etiología , Embolia Pulmonar/prevención & control , Infección de la Herida Quirúrgica/prevención & control , Tromboflebitis/etiología , Tromboflebitis/prevención & controlRESUMEN
An overview of abdominal aortic aneurysm surgery and the immediate perioperative problems are described. Cardiovascular complications are discussed, with the underlying theme being one of prevention. Clinical nursing algorithms are presented and the salient points of nursing care are summarized.
Asunto(s)
Aneurisma de la Aorta Abdominal/enfermería , Cuidados Intraoperatorios/enfermería , Algoritmos , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal/fisiopatología , Aneurisma de la Aorta Abdominal/cirugía , Hemodinámica , Humanos , Cuidados Posoperatorios , Factores de RiesgoRESUMEN
The proper teaching of operative skills to surgical residents is increasingly constrained by operative time, complex procedures and medicolegal concerns. A technical-skills program was developed and introduced over a 3-year period to 28 1st-year residents in general surgery. To introduce the residents to the principles of surgical techniques in a simulated environment outside the operating room, the program consisted of a combination of two didactic sessions and six "wet labs" taking 3 to 4 hours per week for 8 weeks between January and March each year. The didactic sessions included instruction on suture material and the use of stapling devices; the "wet lab" used a "hands-on" approach. Educational objectives in the "wet lab" included instruction on preparation of the patient and draping, aseptic technique, principles of bowel anastomosis, incisions, instrument use and handling, principles of hemostasis, intraoperative surgical emergencies, surgical assisting and overall conduct in the operating room. The residents' surgical technique and skills improved over the course period. The overall value, teaching and understanding of surgical principles were rated highly. Problems cited during resident feedback were the use of live animals and insufficient time to practise. The efficacy of a surgical-skills program has been demonstrated, but its effectiveness requires further evaluation.