Utilization of the distal profunda femoris artery in redo arterial bypass procedures

In the present study, an experience with 12 cases of difficult redo vascular reconstruction was described, where the distal profunda femoris artery was utilized. They were nine males and three females with a mean age of 55 years. The indication for vascular reconstruction was limb-threatening ischemia in all cases [rest pain in 42% of the cases, tissue necrosis and gangrene in 58% of the cases]. The primary reason for using the distal profunda was to avoid dense groin scarring. The number of prior groin operations ranged from two to four procedures per patient. An additional groin scarring was present due to radiation therapy in one patient, infected sinus and a local rotational flap procedure in another patient. The distal profunda was used as a donor vessel to originate a distal bypass in eight cases. In two cases, the distal profunda was used as a recipient vessel for a proximal bypass graft. In the remaining two cases, it was used both as a recipient vessel for an ilio-profunda bypass and sequentially as a donor vessel for a profunda-popliteal bypass graft. An anterolateral approach for distal profunda exposure was used in two cases and an anteromedial approach was used in two cases. The study concluded that the utilization of the distal profunda femoris artery in vascular reconstruction is particularly useful in cases of reoperative surgery when the common femoral moral artery is embedded in scar tissue or inflammatory reaction. Furthermore, the distal profunda can serve as a proximal anastomotic site for distal bypass grafts when the available autogenous vein is of a limited length

Comparative study of thoracoscopic versus open surgical approach for upper dorsal sympathectomy

Upper dorsal sympathectomy has been performed for a wide variety of indications, the most common of which is palmer hyperhydrosis. With the development of video-assisted thoracic surgery, its application has extended to include thoracoscopic sympathectomy. In the present study we describe our experience with this recent technique and evaluate its results in comparison with the standard open surgical supraclavicular approach. Forty-five cases of thoracoscopic sympathectomy lucre studied in comparison with 20 cases of open supraclavicular sympathectomy performed for various indications. The two groups were well matched regarding age, sex, side of surgery, and indication for the procedure [p>0.05]. Relief of symptoms was achieved in 42 patients [93.3%] in the thoracoscopic group versus 18 patients [90%] in the open surgical group [p>0.05]. Recurrent hyperhydrosis occurred in one patient in the thoracoscopic group six months after the procedure. No perioperative deaths or major complications were encountered in either group. Horner's syndrome occurred in three patients in the thoracoscopic group and in two patients in the open surgical group [p>0.05]. Minor complications included surgical emphysema [one patient], and intercostal neuralgia [one patient] in the thoracoscopic group. In the open surgical group, minor wound complications [hematoma, ehylous discharge] occurred in two cases. The mean operative time was significantly shorter for time thoracoscopic technique compared to the open surgical procedure [32.9 +/- 11.6 mm. versus 73.3 +/- 33.3 min, p<0.0001]. The mean hospital stay was also significantly shorter for the thoracoscopic group compared to the open surgical group [1.12 +/- 0.4 days versus 2.81 +/- 2.5 days, p<0.0001]. In conclusion, time present study supports the superiority of the thoracoscopic approach for upper dorsal sympathectomy. Its technical ease, increased patient acceptance, minimal morbidity, and excellent results make it the approach of choice for this procedure

Regional delivery of local anesthetic agents for postoperative analgesia following femoropopliteal arterial reconstruction

This study describes a new concept for postoperative analgesia following femoropopliteal arterial reconstruction by placing an indwelling catheter along the surgical wound, through which pulses of a local anesthetic agent can be delivered in the postoperative period. Twenty-five patients undergoing femoropopliteal bypass grafting with saphenous vein for superficial femoral arterial occlusive disease were included [16 males, 9 females. Mean age 59 +/- 6 years]. Patients were randomized into two groups for postoperative pain relief: Group I [n=12]: were assigned to regional delivery of Bupivicaine 0.25% 5cc every 8 hours via an indwelling catheter placed along the wound for 48 hours. Group II [n-13]: received Pethidine 1mg/Kg IM every 8 hours for 48 hours. Patients experiencing breakthrough pain during the 8-hour period between doses received IM injection of Diclofenac potassium 75mg. Postoperative pain was rated by means of a visual analog scale. The pain score during the first 48 hours following surgery was 3.25 +/- 0.87 for Group I compared to 5.08 +/- 1.04 for Group II, p<0.0001. Only two patients in Group I required Diclofenac doses for breakthrough pain compared to 8 patients in Group II, p < 0.05. The mean dose of Diclofenac per patient was 31.25 +/- 74.7mg for Group I vs 103.85 +/- 89.5mg for Group II, p < 0.05. There was no significant difference between the two groups regarding wound problems or hospital stay. Regional delivery of a local anesthetic [Bupivicaine] via an indwelling catheter following femoropopliteal bypass surgery is a simple, safe and effective method for providing prolonged postoperative analgesia. This technique should be considered for wider use among these patients

Evaluation of carotid endarterectomy in post cerebral stroke patients with significant carotid artery lesions

This study was carried out to evaluate the results of carotid endarterectomy after recovery from prior stroke due to a significant carotid artery lesion. Thirty-seven patients with prior for cerebral stroke were included [26 males: 11 females, mean age = 64.5 years]. All patients had good functional recovery with minimal residual deficits. A corresponding significant carotid stenosis [> 70%] was present in 32 patients [86%] and an unstable ulcerated plaque in 5 patients [14%]. Carotid endarterectomy was done 30 days to 6 months post-stroke. Risk factors included smoking [73%], hypertension [68%], diabetes mellitus [57%], coronary artery disease [35%] and hyperlipidemia [41%]. Mean follow up was 18 months [range 6-37 months]. There was one postoperative death as a result of intraoperative stroke and another from myocardial infarction resulting in a combined perioperative stroke/mortality of 5.4%. No other neurological events were encountered during the rest of the follow up period. Complications related to the procedure included reactionary hemorrhage [2.7%], hoarseness of voice [5.4%], and transient ramus mandibularis palsy [2.7%]. This experience supports the benefit of carotid endarterectomy in post-stroke patients with significant carotid artery lesions. It is a safe and reliable procedure in preventing recurrent stroke in this group of patients

Salvage of synthetic vascular access grafts with puncture site infection

Infection of synthetic vascular access grafts often results in removal of the graft. When infection is localized to puncture sites however, salvage of the graft may be possible. In the present study 11 patients [7 males: 4 females, mean age 44 +/- 7 years] with puncture site infection of PTFE grafts were managed be local excision of the infected segment and interposition of a new graft segment in a distant subcutaneous tunnel. Mean follow-up period was 13 months [rang 3-21 months]. Graft salvage as successful in 8 cases [73%] and dialysis was resumed within a period of 3-6 weeks, In 3 cases extension of the infective process necessitated graft removal. Secondary hemorrhage was not seen in any of the cases, The isolation of Pseudomonas as the offending organism as well as the presence of diabetes were associated with a higher risk for graft loss [p = 0.05]. In conclusion local excision and bypass of the infected segment of vascular access grafts is a useful technique for graft salvage in selected cases of puncture site infection