Early Graft Failure

The highest incidence of graft occlusion occurs in the early post-operative period [less than 30 days]. The aim of this work is to study the causes of early graft failure and how to manage these cases and the impact of this on the post-operative results. In this study, there were 2 main causes of early graft failure namely, poor run-off [43 9%] and technical error [16 9%]. Other causes were-narrowing at the anastomotic suture line [9 7%] neglected ischaemia [7 3%] elevated intimal flap [4 8%] postoperative hypotension [4.8%], compression of the graft within the tunnel [2.4%] and 14.6% [6cases] were due to unknown cause. Management and the results had been discussed and these had led to the conclusion that an aggressive surgical approach is appropriate in early graft thrombosis, because early patency can usually be established yielding a limb salvage rate of 54% in threatened extremities. Subsequent long-term patency can not be predicted on the basis of presumed cause of failure

problem of cryptogenic arterial embolism

In 5-10% of cases with acute embolic ischemia, the specific source of an embolus can not be determined clinically or even at autopsy. In this study, 100 cases of proved acute embolic ischemia of the extremity have been studied spotting more light on cases with unknown source of embolism [cryptogenic arterial embolism]. The mean age was 60 years in cases of cryptogenic arterial embolism and this is higher than in cases with known source of embolism [45 years]. In cases with known source of embolism there is male predominance by 1.78, while in cases of cryptogenic embolism, there is female predominance by 1.33. Rheumatic heart diseases represented the main underlying cause of cardioarterial embolism [60.2%] followed by myocardial infarction with mural thrombosis [39.78%]. The amputation rate was 42.86% in cases of cryptogenic arterial embolism, while it was 4.3% in cases with known source of embolism. The overall mortality rate in this series was 12%