surgical benefits of cervical block anesthesia for carotid endartrectomy

This randomized study was performed to evaluate the benefits of cervical block anesthesia on the surgical technique and outcome of carotid endarterectomy [CEA] aiming to develop a safe and reliable anesthetic and surgical approach for patients undergoing CEA. From May 1997 to May 2001, 36 patients indicated for CEA due to the presence of internal carotid stenosis were randomized into two groups: In group I [18 patients], CEA was done under cervical block anesthesia; while in group II [18 patients], CEA was done under general anesthesia. Hemodynamic measurements and stump pressure were estimated for all cases. The need for shunt, operative time, early postoperative complications and hospital stay was evaluated in both groups. In group I, there was more stable systolic and diastolic blood pressure during the operation. 89% of group I patients tolerated carotid cross clamping without the need for carotid shunt and this method was more accurate than the measurement of stump pressure. Shunt was used in 38.8% of group II patients and this resulted in an intimal dissection in two cases. The operative time was significantly less in group I than group II and discharge from the ICU was earlier

therapeutic end point of pta: angiographic features versus pressure gradient

To compare the adequacy of use of angiographic features versus the use of the pressure gradient in assessment of the therapeutic end point of iliac artery angioplasty. The study was done on 24 iliac stenoses of category I or II according to SCVIR classification. In 12 cases the angiographic features alone were used to determine the therapeutic end point while in the other 12 measurement of pressure gradient unilateral pull back technique was used to determine the same point. Initial success rate in the angiography group was 83.3% while it was 100% in the pressure gradient group. Two cases occluded in the immediate postprocedure period in the first group. There were significant differences between the change in the ABI and the clinical stage in both groups, in favor of the second group. The use of pressure gradient to determine the therapeutic end point of angioplasty seems to be adequate, safe, and cost effective

Management of peripheral traumatic arterio-venous fistulas

Twenty five cases of traumatic peripheral arteriovenous fistulae are presented. Some of them presented acutely while the others presented after a variable period of time [3 months 8 years]. Stab wound predominated as the causative agent. Common femoral and superficial femoral arteries are the most common sites of injury. The arteriovenous fistulae were investigated using arteriography and/or duplex scanning. Cases presented early, especially those with single stoma were subjected to transcatheter embolization, while surgery was done to cases presented in the causality section, cases in which transcatheter embolization failed or with recurrence after it and to cases with multiple stomas. Transcatheter embolization is a good alternative to surgery in special situations

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%