1,721,007 research outputs found
Early and Late Results in Patients with Carotid Disease Undergoing Myocardial Revascularization
No full textA ten-year review of 1,360 patients undergoing coronary artery bypass grafting (CABG) by the same surgeon was undertaken. Sixty-two patients with symptoms of coronary artery insufficiency underwent carotid endarterectomy prior to or at the time of CABG (Group I). Ninety-seven patients had asymptomatic carotid bruits but did not undergo carotid endarterectomy (Group II). Sixty of these patients were studied by ultrasonic duplex scanning or ocular pneumoplethysmography or both, and hemodynamically significant stenosis was detected in 50 (Group IIa). Group III included 80 patients without carotid artery disease matched with Group II for sex, age, and clinical status. Group IV consisted of 200 patients without carotid artery disease randomly selected from our series. Follow-up ranged from 3 to 120 months (median, 41 months). In patients with proven carotid artery disease (Groups I and IIa), operative mortality was greater than in the patients randomly selected (Group IV) (p < 0.05) but similar to that in the matched Group III. Late neurological deficits were greater in patients with carotid disease not undergoing carotid endarterectomy (p < 0.01). Patients with carotid artery disease had lower survival than Group IV patients (p < 0.01) but similar survival to that in the matched Group III. This study suggests that (1) asymptomatic patients with carotid artery disease who undergo CABG are not at increased risk of perioperative stroke; (2) these same patients are at increased risk of late neurological deficit; and (3) carotid artery disease is an indirect sign of severe associated disease and therefore is associated with increased operative mortality and decreased life expectancy. © 1988, The Society of Thoracic Surgeons. All rights reserved
Popliteal aneurysm presenting as thrombophlebitis of the lower extremity: a case report.
No full textCombined Aortofemoral and Extended Deep Femoral Artery Reconstruction: Functional Results and Predictors of Need for Distal Bypass
No full textIn patients with combined aortoiliac and femoropopliteal occlusive disease, severe involvement of the deep femoral artery (DFA) has often been considered an indication for simultaneous aortofemoral and femorodistal bypass grafting. In 73 patients (87 limbs) with multilevel disease, extended DFA reconstruction was performed with aortofemoral bypass. Five-year actuarial patency of the reconstructions and overall five-year actuarial limb salvage were 62.2% and 60.2%, respectively. Of 20 variables tested, four were significantly associated with the functional outcome of the procedures. Multivariate analysis identified two factors as predictive of outcome independently from other variables: preoperative ankle-brachial pressure index and angiographic status of the below-knee popliteal artery. However, in case of reoperation for occluded aortofemoral graft, these factors lost their validity. Extended DFA reconstruction is a valuable and durable procedure able to provide an adequate outflow and distal perfusion. Careful judgment in each clinical situation will aid in selecting a small group of patients in which simultaneous femorodistal bypass is required. © 1988 American Medical Association. All rights reserved
Carotid endarterectomy in octogenarians and nonagenarians
No full textExperience with carotid endarterectomy (CE) in patients 80 years of age and older is analyzed by reviewing results in terms of patient survival, quality of life and recurrence of symptoms of cerebral ischemia. During a 12 year period, 90 octogenarians underwent CE. Ages ranged from 80 to 93 years with a mean of 83 years. Two groups of patients younger than 80 years of age were selected from the series for comparison. There were no differences between age groups with respect to operative mortality and morbidity, with two deaths and one stroke in the elderly group. Follow-up periods ranged from one to 120 months with a mean of 39 months. There were two late strokes in patients older than 80 years of age. At late follow-up study, 87 per cent of patients operated upon for hemispheric symptoms were free of neurologic deficits; in contrast, only 67 per cent of those operated upon for nonhemispheric symptoms were symptom-free (p less than 0.05). The incidence of occlusive disease of the intracranial portion of the internal carotid artery was higher in the elderly group (p less than 0.01). The presence of intracranial occlusive disease represented an unfavorable factor in regard to the results of CE in patients with nonhemispheric symptoms. The over-all five year survival rate was 60 per cent. These data indicate that advanced age alone should not be considered a contraindication to CE. Excellent results should be expected in instances of operations performed for hemispheric symptoms. In instances of nonhemispheric symptoms, results are less encouraging because of the high incidence of intracranial carotid occlusive disease
Thoracic aorta as source of inflow in reoperation for occluded aortoiliac reconstruction
No full textWe reviewed our experience with reoperations for recurrent obstruction occurring after aortoiliac or aortofemoral reconstruction. Patients who underwent successful transfemoral thrombectomy of the aortofemoral graft or femorofemoral crossover graft were excluded from the study. A more proximal source of inflow to revascularize the ischemic limbs was required in the remaining 35 patients. Bilateral reconstruction was performed in 22 patients. Operative indications was rest pain or necrosis in 36 limbs and severe claudication in 21 limbs. Preoperative ankle/brachial pressure index (API) ranged from 0.05 to 0.61. Thirteen patients (21 limbs, group I) underwent transabdominal reoperation. Since the transabdominal approach was considered hazardous because of multiple previous operations, the remaining patients underwent retroperitoneal descending thoracic aorta-femoral artery bypass (15 patients, 25 limbs; group II) or axillofemoral bypass graft (7 patients, 11 limbs; group III). No statistically significant difference was present between the three groups in regard to the operative indication, API, and angiographically determined outflow (analysis of variance, p > 0.2). Axillofemoral bypass was preferred in patients with severe chronic pulmonary disease. Postoperative deaths (2 of 35 patients) and morbidity (6 of 35 patients) had a similar incidence in the three groups (p > 0.2). Follow-up ranged from 3 to 120 months (mean 37 months). The 5-year actuarial patency rate was 80.5% for group I and 80.2% for goup II. In group III it was statistically lower (32.9%, p < 0.05). Serial measurement showed a significant decrease of API in group III compared with group I and group II. We conclude that retroperitoneal descending thoracic aorta-femoral artery bypass is a valid alternative to transabdominal reoperation when exposure or availability of the abdominal aorta poses a specific hazard and is preferable to axillofemoral bypass in terms of long-term patency and hemodynamic results
Surgical Treatment of Infected Aortofemoral Grafts: A Fifteen-Year Experience
No full textDuring the last fifteen years, we performed a total of 855 aortofemoral re constructions. Fifteen (1.75%) grafts were surgically removed (completely or partially) owing to a severe infection (Szilagyi: Grade 3) at a mean of 66.3 months (SD ± 37.9) after their implantation. Diagnosis was always clinically evident. In 10 patients, the graft was partially removed (one or two limbs). In 3 of the 10, graft infection progressed requiring complete graft removal after a mean of 18.6 days. In the other 5 patients, the graft was removed “in toto” at the time of the first operation. In 9 cases, revascularization was accomplished by means of a “remote” takeoff reconstruction (thoracic aorta or axillary ar tery), whereas in 8 cases (3 recurred) reconstruction was performed with a “local” takeoff reconstruction (stump or aortoiliofemoral arteries). One patient was not revascularized, because the limb was already amputated. Recurrence of infection was higher in the patients treated by partial removal of the graft (p < 0.05), even though the stump sterility was always evaluated by means of intraoperative culture. The mortality of patients with recurrence of infection was 66.6%. Multiple operations of the femoral site were considered a factor in causing aortofemoral graft infection (p < 0.01). Diabetes was not considered a factor in causing infection (p n.s.). Grafts with remote takeoff reconstruction have better long-term results in terms of limb salvage and survival when compared with local takeoff recon struction (p < 0.05). © 1987, Sage Publications. All rights reserved
Endothelial cell seeding after carotid endarterectomy in a canine model reduces platelet uptake
No full textPost-endarterectomy platelet deposition may play an important role not only in vessel wall healing, but also in the development of progressive stenosis. Using a canine model, we investigated the effect of endothelial cell seeding on platelet deposition on endarterectomised arteries. Thirteen dogs underwent bilateral carotid intimectomy (5 cm long) and one side was seeded with an average of 2 × 106 viable freshly harvested endothelial cells. Blood flow was restored 20 min after seeding. On the contralateral side, a sham-seeding was performed. Deposition of 111indium-labelled autologous platelets was studied with sequential gamma camera images 3-5h, 1, 2, 3, 4 days and 4 weeks after surgery. Platelet uptake was statistically reduced on the seeded side. Animals were killed at 4 weeks (nine dogs) and 5 weeks (four dogs) after surgery. Seven arteries for each group were found to be occluded. We conclude that endothelial cell seeding on endarterectomised arteries is feasible and reduces platelet uptake. Improvement in the efficiency of seeding and reduction of endothelial cell loss might permit clinical application of this technique. © 1992 Grune & Stratton Ltd
Importance of ulceration of carotid plaque in determining symptoms of cerebral ischemia
No full textIn order to investigate the relationship between carotid plaque morphology and symptoms of cerebral ischemia, a prospective clinicopathological study was performed. Ninety consecutive intact carotid plaques obtained from surgery and 43 carotid plaques from cadavers without symptoms of cerebral ischemia were evaluated. Ulceration and mural thrombus were the only morphologic findings statistically correlated to the presence of hemispheric symptoms (p less than 0.02). Intramural hemorrhage was more common in patients with hemispheric symptoms but this difference was not statistically significant (p = 0.31). Plaque causing high degree stenosis had a higher incidence of intramural hemorrhage (p = 0.04) and ulceration (p less than 0.02). Ulceration of plaque plays a major role in the onset of hemispheric symptoms. The results of our study support the hypothesis that in the majority of the cases, hemispheric symptoms are embolic in nature
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