RESUMEN

OJECTIVES: The purpose of this study was to evaluate the outcomes of endoscopically harvested saphenous vein (EHSV) for lower extremity bypass (LEB) surgery. METHODS: Data from 91 consecutive patients who underwent LEB using EHSV between February 2003 and November 2012 were analyzed. Outcomes of interest were wound infection, patency, re-intervention and limb loss. RESULTS: Fifty-eight (64%) and 33 (36%) patients underwent femoropopliteal (FP) and femorotibial (FT) bypass using EHSV. Three (3%) patients had superficial and 1 (1%) deep wound infection. Primary and primary assisted patency at 5 years was 68% and 71% in the FP group and 56% and 65% in the FT group. Six (6%) patients underwent major amputation. No predicting factors for wound infection or graft patency were found. CONCLUSIONS: EHSV carries a low incidence of perioperative wound complication and has a reasonable mid-to-long-term patency regardless of the length of vein harvested.

Asunto(s)

Endoscopía/métodos , Isquemia/cirugía , Pierna/irrigación sanguínea , Vena Safena/trasplante , Recolección de Tejidos y Órganos/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Femenino , Humanos , Incidencia , Isquemia/diagnóstico , Masculino , New York/epidemiología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Vena Safena/diagnóstico por imagen , Vena Safena/fisiopatología , Ultrasonografía Doppler Dúplex , Grado de Desobstrucción Vascular

RESUMEN

BACKGROUND: A coil in the internal carotid artery (ICA), defined as a circular configuration or exaggerated S shape of the ICA, is occasionally encountered during endarterectomy for carotid bifurcation lesions. The significance of coils as an etiology for symptoms is difficult to determine. It is thought, however, that the failure to correct coils and kinks during routine carotid endarterectomy (CE) may lead to turbulence and failure of the CE. Various techniques have been discussed to repair coils. METHODS: Our technique consisted of complete dissection of the coil, routine use of a Javid shunt, standard endarterectomy, resection of the redundant ICA, re-approximation of the posterior wall of the ICA and patch angioplasty of the anterior wall. Three hundred and fifteen patients underwent CE between August, 1998 and February, 2000. Fifteen patients (4.7%) had a carotid coil that was repaired. There were ten men and five women. Mean age was 72.6+/-6.1 years. Ten patients had an asymptomatic stenosis. Four patients had lateralizing symptoms and one patient had dizziness. Fifteen patients underwent preoperative duplex scanning and 14 of these patients had MRA scans performed. All patients had a preoperative stenosis of 80-99% by duplex on the operated side. The right carotid artery was repaired in 12 patients. The left in three patients. The length of resected artery varied from 1.2-2.8 cm (1.93+/-0.49 cm). RESULTS: All patients survived surgery. One patient developed a cerebellar stroke on the third postoperative day. A postoperative carotid duplex scan demonstrated a widely patent repair. There were no cranial nerve injuries in this series. One patient died seven months after surgery from cardiac events with no follow-up duplex exam. There have been no long term strokes or anastomotic complications. Follow-up duplex scans demonstrated widely patent repairs (1-15% stenosis) in seven patients and low end 15-49% stenosis in five patients. CONCLUSIONS: Resection of redundant ICA with re-anastomosis of the posterior wall and patch reconstruction of the anterior wall gives acceptable perioperative and long term results.

Asunto(s)

Arteria Carótida Interna/cirugía , Estenosis Carotídea/cirugía , Endarterectomía Carotidea/métodos , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Arteria Carótida Interna/diagnóstico por imagen , Infarto Cerebral/cirugía , Femenino , Humanos , Ataque Isquémico Transitorio/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Retrospectivos , Ultrasonografía Doppler Dúplex

RESUMEN

Renal artery stenosis has long been recognized as a cause of systemic hypertension, and has more recently been identified as a cause of progressive renal insufficiency. The diagnosis of renal artery stenosis often has been overlooked because of the difficulty in establishing the diagnosis. Until recently, surgical intervention has been the only therapeutic modality available. This article will review some recent advances in imaging modalities, particularly duplex ultrasound and magnetic resonance angiography, which have allowed easier visibility of the renal vessels. Second, the introduction of renal percutaneous transluminal angioplasty, with and without stent placement, has made operative intervention more attractive. The early and short-term results of this procedure are discussed and compared with surgical experience. Finally, the implications for using these newer interventional techniques for minimally symptomatic renal artery stenosis are reviewed.

Asunto(s)

Hipertensión Renovascular/terapia , Obstrucción de la Arteria Renal/terapia , Angioplastia , Humanos , Hipertensión Renovascular/etiología , Hipertensión Renovascular/fisiopatología , Obstrucción de la Arteria Renal/complicaciones , Obstrucción de la Arteria Renal/fisiopatología , Insuficiencia Renal/etiología , Insuficiencia Renal/terapia , Stents

RESUMEN

BACKGROUND: The value of carotid patching in carotid endarterectomy in achieving low perioperative morbidity and long-term freedom from restenosis is controversial. We hypothesized that if large internal carotid arteries were closed primarily and smaller arteries selectively patched, there would be no difference in early or long-term results between the two groups. METHODS: A retrospective analysis of 133 carotid endarterectomies performed by one surgeon in a community teaching hospital was performed to evaluate a selective approach to patching vs primary closure. Primary closure was performed if the arteriotomy could be closed without tension over a Javid shunt. Seventy-seven arteries underwent primary closure and 56 underwent patching (Vein-14, PTFE-17, Dacron-25). Postoperative (>6 month) duplex scans were available on 46/77 (60%) patients undergoing primary closure, and 33/56 (59%) of patients with patch repair. RESULTS: There were 2 perioperative neurologic deficits, both in the patch group. Restenosis of equal or greater than 50% at 11 months occurred in 5/46 (10.8%) of patients with primary closure and 2/34 patients (5.9%) with patch closure (p=ns). No patient in either group had a late neurologic event or required a redo operation. CONCLUSIONS: Selective primary closure is not associated with increased risk of perioperative neurologic events or statistically significant evidence of late postoperative stenosis if primary closure is performed in large internal carotid arteries.

Asunto(s)

Implantación de Prótesis Vascular , Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Anciano , Angiografía de Substracción Digital , Arteria Carótida Interna/cirugía , Estenosis Carotídea/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/cirugía , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

Splenic vein aneurysms are rare and are usually caused by portal hypertension. Symptoms are unusual, but may include rupture or abdominal pain. Diagnosis can usually be made either by means of duplex ultrasonography or computed tomography scanning. Treatment varies from noninvasive follow-up to aneurysm excision. We report an expanding splenic vein aneurysm in a young woman with abdominal and back pain and no history of portal hypertension. She was treated with aneurysm excision and splenectomy.

Asunto(s)

Aneurisma/cirugía , Vena Esplénica , Dolor Abdominal/etiología , Aneurisma/complicaciones , Aneurisma/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Vena Esplénica/diagnóstico por imagen , Vena Esplénica/cirugía , Tomografía Computarizada por Rayos X

RESUMEN

Twenty-four patients who underwent surgery for pararenal aortic aneurysms between January 1992 and April 1997 are reviewed. Eighteen patients had primary atherosclerotic aneurysms, three patients had symptomatic infected aneurysms, two patients had an aneurysm proximal to a prior aortic repair, and one patient had a pseudoaneurysm of a proximal aortic graft anastomosis. Thirteen patients underwent elective operation, five had an urgent operation, and six patients underwent an emergency procedure. Five patients had the proximal aortic clamp placed between the renal arteries (Group I), three patients had it placed between the superior mesenteric and the renal arteries (Group II), and 16 patients had it placed in a supraceliac location (Group III). Aneurysm size, age, sex, preoperative blood chemistries (including hemoglobin, hematocrit, liver function studies, and coagulation studies) were similar in all groups. Two patients in Group III were on hemodialysis preoperatively. Preoperative renal function (blood urea nitrogen and creatinine) was the same in all groups. Visceral ischemic time was 43.4 +/- 9.37 min to the distal kidney in Group I, 26.6 +/- 7.63 min in Group II, and 24.5 +/- 6.22 min in Group III. Mean transfusion requirements were similar in all groups. Two patients in Group I required postoperative hemodialysis. No patient in either Group II or III developed renal insufficiency. Mortality was the same in each group but was related to the urgency of operation (elective 7.6%, urgent 40%, emergent 50%). Intrarenal clamping (Group I) was associated with more renal and gastrointestinal complications than either suprarenal or supraceliac clamping. Although suprarenal and supraceliac clamping had similar results, our preference is supraceliac clamping because it is technically easy to achieve and is associated with few end-organ complications.

Asunto(s)

Aneurisma de la Aorta Abdominal/cirugía , Arteria Celíaca/cirugía , Urgencias Médicas , Isquemia/etiología , Riñón/irrigación sanguínea , Complicaciones Posoperatorias/cirugía , Anciano , Aneurisma Falso/mortalidad , Aneurisma Falso/cirugía , Aneurisma Infectado/mortalidad , Aneurisma Infectado/cirugía , Aneurisma de la Aorta Abdominal/mortalidad , Arteriosclerosis/mortalidad , Arteriosclerosis/cirugía , Femenino , Oclusión de Injerto Vascular/mortalidad , Oclusión de Injerto Vascular/cirugía , Humanos , Isquemia/mortalidad , Fallo Renal Crónico/etiología , Fallo Renal Crónico/mortalidad , Pruebas de Función Renal , Masculino , Arteria Mesentérica Superior/cirugía , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Recurrencia , Arteria Renal/cirugía , Reoperación , Tasa de Supervivencia , Resultado del Tratamiento

Asunto(s)

Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/cirugía , Disección Aórtica/etiología , Disección Aórtica/cirugía , Puente de Arteria Coronaria/efectos adversos , Enfermedad Iatrogénica , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Aorta/lesiones , Humanos , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Factores de Tiempo

RESUMEN

The etiology of perioperative stroke in patients undergoing isolated coronary artery bypass grafting (CABG) is multifactorial. One significant cause is thought to be high-grade internal carotid artery stenosis. Between April 1992 and June 1995, 1686 patients undergoing isolated CABG underwent preoperative carotid duplex scanning. This represented 77% of patients who underwent CABG during that time period (2188 patients). Sixty-eight patients (4.0%) had 80%-99% stenosis of at least one carotid artery. Fifteen patients underwent CABG without carotid intervention (Group I) and 53 patients underwent either carotid endarterectomy prior to CABG or simultaneous with CABG (Group II). Age, sex, history of prior neurologic events, ejection fraction, number of distal bypasses performed, total pump time, and aortic cross clamp times were similar between the two groups. Three patients in Group I developed a permanent postoperative neurologic deficit (20%) and one patient developed a transient deficit. The defect was focal and ipsilateral to high-grade stenosis in three patients and global in one. No patient in Group II developed either a transient or permanent neurologic deficit. There was one death in Group I in the patient who developed a global neurologic deficit and one death in Group II 2 weeks after CABG in a patient who had undergone prophylactic preCABG-carotid endarterectomy. Statistical analysis (Fisher's exact test, 2-tail) demonstrated a significant decrease both in total neurologic events (p = 0.001) and permanent neurologic defects (p = 0.005) in those patient undergoing prophylactic CE (Group II). Patients with 80%-99% carotid stenosis undergoing CEA prior to or in conjunction with isolated CABG have a decreased incidence of neurologic events postoperatively.

Asunto(s)

Estenosis Carotídea/complicaciones , Estenosis Carotídea/cirugía , Trastornos Cerebrovasculares/prevención & control , Puente de Arteria Coronaria , Enfermedad Coronaria/complicaciones , Endarterectomía Carotidea , Complicaciones Posoperatorias/prevención & control , Anciano , Estenosis Carotídea/diagnóstico por imagen , Trastornos Cerebrovasculares/etiología , Enfermedad Coronaria/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Ultrasonografía Doppler Dúplex

RESUMEN

Twenty-five patients who underwent resection of a thoraco-abdominal aneurysm between 1985-1993 were reviewed to study determinants of survival in patients undergoing the procedure in a community hospital. Twelve procedures were performed electively, six urgently and seven emergently. Type I aneurysm was present in one patient (n = 1), Type II n = 7; Type III n = 5 and Type IV = 12. Hypertension (n = 17), cardiac disease (n = 10) and renal insufficiency (n = 4) were most common risk factors. Aneurysms were repaired using inclusion method without special techniques for renal or spinal cord preservation. Eighteen patients survived and were discharged; four patients died 30 days and three patients died 30 days. Causes of death were multisystem failure (n = 3), acute myocardial infarction (n = 2) coagulopathy (n = 1) and bowel infarction (n = 1). Major complications included renal failure (n = 2) myocardial infarction (n = 3), bleeding (n = 3), paraplegia (n = 1). Statistical significance was determined using Fisher's exact test-2 tail. Risk factors for death and complication included emergency or urgent surgery (4 deaths-emergent, 2 deaths-urgent) and preoperative renal insufficiency (2 deaths; 1 dialysis) 52% of patients in a community hospital setting underwent emergent or urgent operation and this accounted for 87% of deaths and most morbidity. Mortality in elective procedures was 8%. Based on this data, we believe that thoracoabdominal aneurysm resection can be reasonably undertaken in a community-type hospital.

Asunto(s)

Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Rotura de la Aorta/cirugía , Anciano , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Torácica/mortalidad , Rotura de la Aorta/mortalidad , Urgencias Médicas , Femenino , Estudios de Seguimiento , Hospitales Comunitarios , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Factores de Riesgo , Factores de Tiempo

Asunto(s)

Anemia Diseritropoyética Congénita/complicaciones , Hematopoyesis Extramedular , Neoplasias del Mediastino/etiología , Adolescente , Humanos , Masculino , Neoplasias del Mediastino/diagnóstico

RESUMEN

Spontaneous dissection of the infradiaphragmatic abdominal aorta is a rare form of aortic dissection. Its natural history and management are not well defined. We have recently treated five patients with spontaneous aortic dissection. Two patients had acute dissections and three had chronic dissections. Three patients developed saccular aneurysms and underwent resection. Two patients had stable dissections and were treated medically. All patients are alive and well at 6 months to 5 years. We think that spontaneous aortic dissection can be treated as a variant of type III dissection with initial medical management, reserving surgery for those patients in whom a saccular aneurysm or a complication of the dissection develops.

Asunto(s)

Aneurisma de la Aorta Abdominal/cirugía , Disección Aórtica/cirugía , Anciano , Anciano de 80 o más Años , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aortografía , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Reoperación , Tomografía Computarizada por Rayos X

RESUMEN

The effect of descending thoracic aortomyoplasty using conditioned latissimus dorsi muscle on cardiac output in five mongrel dogs with pharmacologically induced congestive heart failure was evaluated. A neurovascular left latissimus dorsi flap was lifted and through a left thoracotomy placed around the proximal descending thoracic aorta. The flap was conditioned for 4-6 weeks with a neurostimulator using the following parameters: amplitude 0.5 V, pulse width 210 microseconds and frequency 2 Hz. The neurostimulator was then removed and a cardiomyostimulator inserted and programmed to burst-stimulate the muscle during diastole. Baseline measurements of central venous pressure, heart rate, mean arterial blood pressure, pulmonary capillary wedge pressure, and cardiac output were obtained with the cardiomyostimulator off and on (study 1). Heart failure was induced with a combination of propranolol and verapamil, and measurements again taken with the stimulator off and on. The neurostimulator was reimplanted to continue stimulation of the latissimus dorsi muscle, and another set of measurements taken at 6 weeks with the cardiomyostimulator off and on (study 2). Counterpulsation in control conditions (before cardiac failure) in both studies demonstrated no significant increase in cardiac output. However, mean(s.d.) cardiac output was significantly (P < 0.1) increased by muscle stimulation in dogs with heart failure (study 1: from 2.39(1.10) to 3.14(1.41)l/min; study 2: from 1.89(0.64) to 2.38(0.57)l/min). There was no significant difference in the increase in cardiac output associated with muscle stimulation between studies 1 and 2. The results indicate that the model can increase cardiac output in heart failure and that this improvement is constant over a 4-6 week period, suggesting that muscle fatigue may not occur.

Asunto(s)

Gasto Cardíaco/fisiología , Insuficiencia Cardíaca/cirugía , Contracción Muscular/fisiología , Músculos/trasplante , Animales , Aorta Torácica/fisiopatología , Aorta Torácica/cirugía , Diástole/fisiología , Perros , Estimulación Eléctrica , Insuficiencia Cardíaca/fisiopatología , Hemodinámica/fisiología , Contracción Miocárdica/fisiología , Sístole/fisiología

RESUMEN

This study attempted to evaluate the efficacy of chronic extra-aortic counterpulsation with a latissimus dorsi neuro vascular flap. Five dogs had a preliminary procedure consisting of the creation of a latissimus dorsi flap and a thoracotomy in which the flap was wrapped around the descending aorta just distal to the left subclavian artery. An epicardial lead was placed on the left ventricle and a nerve stimulating lead placed around the thoraco-dorsal nerve. Three weeks later, both leads were connected to a cardiomyostimulator programmed to function in a counterpulsation mode with a 1:2 assist frequency. Hemodynamic measurements were made at 6 and 8 and 10 and 12 weeks and the dogs were sacrificed. Three dogs had all sets of hemodynamic measurements made. Two of the three dogs demonstrated diastolic augmentation at 6 and 8 and 10 and 12 weeks average 20 to 25 mmHg. The third dog failed to demonstrate any change. All dogs were sacrificed at 12 weeks and specimens were submitted for histologic evaluation. The muscle flap was preserved in all animals. The aorta subjacent to the flap showed, (1) normal intima with no evidence of disruption or thrombus in all animals, (2) in the animals in whom counterpulsation was observed, there appeared to be thinning of the media in the aorta subjacent to the muscle flap, and (3) no evidence of distal emboli. This study demonstrated that chronic counterpulsation can be obtained with a latissimus dorsi flap. The actual hemodynamic benefits are not determined from this study. The medial thinning in the aortic wall may limit the long-term benefit of this procedure.

Asunto(s)

Contrapulsación/métodos , Músculos/irrigación sanguínea , Colgajos Quirúrgicos/métodos , Animales , Aorta/fisiopatología , Perros , Hemodinámica/fisiología , Contracción Muscular/fisiología , Músculos/fisiopatología , Marcapaso Artificial , Periodo Posoperatorio , Factores de Tiempo

RESUMEN

The aim of this study was to evaluate the hemodynamic effects of extraaortic counterpulsation with a latissimus dorsi (LD) neurovascular flap in a canine heart failure model. Five dogs (8-18 kg) had a left LD neurovascular muscle flap raised. The muscle was brought into the chest through the second interspace and wrapped around the aorta. Parameters studied were heart rate (HR), systolic pressure (SP), diastolic pressure (DP) pulmonary artery pressure (PAP), mixed venous oxygen saturation (MVO2), and cardiac output (CO). Baseline measurements were obtained with the muscle nonstimulated and stimulated by a prototype burst stimulation. The only parameter that changed significantly with muscle stimulation was DP (55.8 +/- 3.8 mmHg to 72.4 +/- 4.8 mmHg, p less than 0.05). Propranolol (3-4 mg/kg) and verapamil (2-3 mg) were given intravenously to induce heart failure. Mean blood pressure decreased from 64.12 +/- 5.03 mmHg to 43.3 +/- 9.28 mmHg (p less than 0.05). Repeat measurements were obtained. With stimulation of the muscle flap there was an increase in DP from 36.8 +/- 9.2 mmHg to 55.4 +/- 19.3 mmHg (p less than 0.05). Although CO increased from 8% to 18% in all animals (1.42 +/- 0.33 L/mm to 1.58 +/- 0.34 L/mm) this did not reach statistical significance. This data indicates that both DP and CO can be improved by this method of cardiac assist in a heart failure model.

Asunto(s)

Aorta/fisiología , Gasto Cardíaco Bajo/fisiopatología , Contrapulsación , Hemodinámica , Colgajos Quirúrgicos/fisiología , Animales , Gasto Cardíaco Bajo/inducido químicamente , Gasto Cardíaco Bajo/cirugía , Diástole , Modelos Animales de Enfermedad , Perros , Colgajos Quirúrgicos/métodos

RESUMEN

Changes in atrial adenosine triphosphate (ATP) and the presence of postoperative arrhythmias were studied in 14 patients during routine coronary artery bypass grafting to 1) attempt to evaluate atrial preservation, and 2) determine if a relationship exists between changes in ATP and the development of postoperative arrhythmias. Atrial biopsies were obtained at the time of cannulation (preischemic sample) and after the removal of the aortic crossclamp (postischemic sample). Methods of myocardial protection included systemic hypothermia (28 degrees C), periodic reinfusion of crystalloid cardioplegia into the aortic root and completed vein grafts, and iced slush in the pericardial well. Atrial temperature was monitored. Preischemic ATP was 0.412 +/- 0.32 mu mol/gm, and the postischemic value was 0.220 +/- 0.13 mu mol/gm (p less than .02). Atrial temperature routinely decreased to 13-18 degrees C after cardioplegic infusion but rose to 24 degrees C between infusions. There was no correlation between postoperative supraventricular arrhythmias (4 patients) and changes in ATP. In conclusion, routine coronary artery bypass grafting with standard methods of cardiac preservation does not appear to satisfactorily preserve atrial tissue. The clinical correlation and significance of this remains to be elucidated.

Asunto(s)

Adenosina Trifosfato/análisis , Paro Cardíaco Inducido , Miocardio/enzimología , Arritmias Cardíacas/enzimología , Arritmias Cardíacas/etiología , Biomarcadores/análisis , Biopsia , Puente de Arteria Coronaria , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/enzimología , Creatina Quinasa/sangre , Paro Cardíaco Inducido/métodos , Atrios Cardíacos/enzimología , Atrios Cardíacos/patología , Humanos , Miocardio/patología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/metabolismo , Espectrofotometría

Asunto(s)

Neoplasias Pulmonares , Metástasis Linfática , Paraganglioma , Adulto , Femenino , Humanos , Paraganglioma/secundario

Asunto(s)

Enfermedades de las Arterias Carótidas/diagnóstico , Ultrasonografía , Anciano , Arterias Carótidas/fisiopatología , Enfermedades de las Arterias Carótidas/fisiopatología , Constricción Patológica , Humanos , Masculino , Flujo Sanguíneo Regional

RESUMEN

Nursing documentation in the medical record is an important source of information for the medical record coder. Coded data are necessary for quality assurance, risk management, research and statistical purposes, as well as for proper DRG assignment for reimbursement. Facts gleaned from nursing documentation, supported by physician documentation and laboratory data, can often result in increased reimbursement for the hospital.

Asunto(s)

Grupos Diagnósticos Relacionados , Documentación , Registros de Enfermería/normas , Parto Obstétrico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Femenino , Humanos , Infusiones Intravenosas/efectos adversos , Trabajo de Parto , Errores de Medicación , Flebitis/economía , Flebitis/etiología , Embarazo , Sistema de Pago Prospectivo , Índice de Severidad de la Enfermedad , Estados Unidos

RESUMEN

Crossover femoral-popliteal or femoral-tibial bypass has been employed as an alternative extra-anatomic bypass in 3 patients who had occlusion of an iliac artery with subsequent occlusion of the ipsilateral femoral artery with patency of either a popliteal or tibial artery and a patency of the contralateral common femoral artery. Each patient had a contraindication to a more conventional type of procedure. All procedures were performed with reinforced PTFE grafts. All grafts have remained patent for 6 months to 3 years. This operation should be considered as an alternative extra-anatomic reconstructive procedure in patients with the appropriate anatomy and who are not candidates for more standard types of vascular reconstruction.

Asunto(s)

Arteriopatías Oclusivas/cirugía , Arteria Femoral/cirugía , Arteria Ilíaca/cirugía , Arteria Poplítea/cirugía , Anciano , Prótesis Vascular , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

The presence of a bruit after carotid endarterectomy may indicate a persistent or recurrent lesion. The authors noninvasively evaluated, by Duplex scanning, 18 asymptomatic postoperative patients who underwent a total of 23 carotid endarterectomies and who developed a postoperative bruit to determine the significance of the bruit. Eleven men and seven women were studied from 6 weeks to 2 years postsurgery. Ages ranged from 49 to 75 years (63.6 +/- 8.0 years). Indications for endarterectomy were: transient ischemic attacks (including amaurosis fugax), 17 vessels; completed stroke with significant functional recovery and residual carotid disease, 3 vessels; and asymptomatic bruit with hemodynamically significant carotid stenosis, 3 vessels. Each patient had a Duplex scan performed to noninvasively evaluate the carotid artery. All scans were independently reviewed by two observers. Real-time B images were interpreted as normal in 14 vessels, mild thickening in eight vessels, and moderate thickening in only one vessel. Doppler recordings demonstrated a spectral range of 15-40 cm/sec (26 +/- 8 cm/sec). Ratio of velocity in the internal carotid artery to common carotid artery (VIC/VCC) ranged from 0.389 to 1.281 (0.779 +/- 0.250). This study demonstrates that the presence of a postoperative carotid bruit does not necessarily signify the presence of residual carotid disease or a hemodynamically significant lesion.

Asunto(s)

Arterias Carótidas/cirugía , Enfermedades de las Arterias Carótidas/diagnóstico , Endarterectomía , Ultrasonografía , Anciano , Auscultación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Recurrencia