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1.
W V Med J ; 96(3): 458, 2000.
Article in English | MEDLINE | ID: mdl-14619139

ABSTRACT

Chlamydia pneumoniae is a recently discovered respiratory pathogen that has been found in a large (> 50) percentage of atherosclerotic plaques, aortic aneuryms and astenotic aortic valves. It is also found in Alzheimer plaques. C. pneumoniae should not be confused with chlamydia trachomatis, which is the cause of primarily a sexually transmitted disease. This article reviews the transmission and proliferation of C. pneumoniae and discusses its role in cardiovascular disease.


Subject(s)
Cardiovascular Diseases/immunology , Cardiovascular Diseases/microbiology , Chlamydophila Infections/immunology , Chlamydophila pneumoniae , Chlamydophila Infections/complications , Humans
3.
Am Surg ; 65(2): 164-7, 1999 Feb.
Article in English | MEDLINE | ID: mdl-9926752

ABSTRACT

This study reviews our experience in the management of deep vein thrombosis (DVT) of the lower extremity during pregnancy and analyzes the outcome of various treatment alternatives, including conventional full-dose heparin therapy and Greenfield filter insertion. Twenty-four patients treated over an 8-year period were reviewed. Fifteen patients were treated with conventional full-dose intravenous heparin therapy for 5 to 10 days, followed by subcutaneous low-dose heparin until labor, and continued for 6 weeks postpartum (Group A); Eleven patients had Greenfield filters inserted, followed by the same low-dose subcutaneous heparin regimen (Group B). There were 18 femoral or iliofemoral, 5 femoropopliteal, and 1 popliteal and below-knee DVT. The indications for Greenfield filter insertion included two patients in Group A (one with pulmonary embolism, despite adequate heparin therapy, and one with significant bleeding). Nine other patients had prophylactic indications: two for free-floating iliofemoral DVT, three with iliofemoral DVT (occurring just 1-2 weeks before labor), and four with femoropopliteal DVT. There were three immediate major complications (pulmonary embolism, bleeding, or death) in Group A; two with pulmonary embolism, one of which was fatal, and one with significant bleeding (3 of 15 patients; 20%). No major complications occurred in Group B. On long-term follow-up (mean, 61 months), 4 of 12 patients (33%) in Group A had significant leg swelling, with partial resolution of DVT in 2 patients and venous occlusion in 2 patients by duplex ultrasound. This is in contrast to 3 of 11 patients (27%) in Group B with significant leg swelling. There was no fetal morbidity or mortality in either group. Conventional full-dose heparin therapy for DVT of the lower extremity in pregnancy can carry significant morbidity and mortality. Greenfield filters may be used safely in some of these patients.


Subject(s)
Anticoagulants/therapeutic use , Heparin/therapeutic use , Pregnancy Complications, Cardiovascular/therapy , Venous Thrombosis/therapy , Adolescent , Adult , Anticoagulants/administration & dosage , Female , Heparin/administration & dosage , Humans , Injections, Subcutaneous , Leg , Pregnancy , Retrospective Studies , Treatment Outcome , Vena Cava Filters
4.
J Vasc Surg ; 27(2): 222-32; discussion 233-4, 1998 Feb.
Article in English | MEDLINE | ID: mdl-9510277

ABSTRACT

PURPOSE: This study examines the long-term clinical outcome and the incidence of recurrent stenosis (> or = 50%) after carotid endarterectomy (CEA) with primary closure (PC) versus vein patch closure (VPC), saphenous (SVP), and jugular vein (JVP) and polytetrafluoroethylene patch closure (PTFE-P). METHODS: A total of 399 CEAs were randomized into the following groups: 135 PC, 134 PTFE-P, and 130 VPC (SVP alternating with JVP). Postoperative duplex ultrasound scans were performed at 1, 6, and 12 months and every year thereafter. The mean follow-up was 30 months with a range of 1 to 62 months, and demographic characteristics were similar in all groups. Kaplan-Meier analysis was used to estimate the risk of restenosis and the stroke-free survival. RESULTS: The incidence of ipsilateral stroke was 5% (seven of 135) for PC, 1% (one of 134) for PTFE-P, and 0% for VPC (PC vs VPC, p = 0.008; PC vs PTFE-P, p = 0.034). Seven strokes occurred in the perioperative period. All three groups had similar mortality rates. The cumulative stroke-free survival rate at 48 months was 82% for PC, 84% for PTFE-P, and 88% for VPC (p < 0.01 for PC vs PTFE-P or VPC). PC had a higher incidence of recurrent stenosis and occlusion (34%) than PTFE-P (2%) and VPC (9%) (SVP 9%, JVP 8%) (p < 0.001). PTFE-P had a lower recurrent stenosis rate than VPC (p < 0.045). Restenoses necessitating a redo CEA were also higher for PC (11%) than for PTFE-P (1%) and VPC (2%) (p < 0.001). Women with PC had a higher recurrent stenosis rate than men (46% vs 23%, p = 0.008). Kaplan-Meier analysis showed that freedom from recurrent stenosis at 48 months was 47% for PC, 84% for VPC, and 96% for PTFE-P (p < 0.001). The SVP and JVP results were comparable. The mean operative diameter of the internal carotid artery was similar in patients with or without restenosis. Significantly more late internal carotid artery dilatations occurred in the VPC group compared with the PC group. CONCLUSIONS: Patch closure (VPC or PTFE-P) is less likely than PC to cause perioperative stroke. Patching was also superior in lowering the incidence of late recurrent stenoses, especially in women.


Subject(s)
Angioplasty/methods , Blood Vessel Prosthesis Implantation , Carotid Stenosis/surgery , Endarterectomy, Carotid , Jugular Veins/transplantation , Polytetrafluoroethylene , Saphenous Vein/transplantation , Carotid Artery, Internal , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/epidemiology , Cerebrovascular Disorders/epidemiology , Female , Follow-Up Studies , Humans , Incidence , Male , Prospective Studies , Recurrence , Risk Factors , Survival Rate , Time Factors , Ultrasonography
5.
Surgery ; 121(4): 366-71, 1997 Apr.
Article in English | MEDLINE | ID: mdl-9122865

ABSTRACT

BACKGROUND: Although a fever of unknown origin (FUO) is most often due to other causes, the few caused by pulmonary emboli, pelvic thrombophlebitis, or lower extremity venous thrombosis (DVT) present a diagnostic challenge. The purpose of this study was to evaluate the role of venous duplex imaging of the lower extremity in evaluating a large series of patients with FUO. This has not been reported previously in the English-language literature. METHODS: Medical records were analyzed of patients with FUO who were referred to the vascular laboratory for venous duplex imaging of the lower extremities to rule out DVT as a cause of their fever. A FUO was defined as a temperature of greater than 38.3 degrees C on several occasions for at least 3 weeks' duration that defied 1 week of hospital evaluation. DVT was considered as a probable cause of FUO if the following criteria were met: (1) a positive venous duplex image for acute DVT, (2) subsequent fever resolution within 7 days of anticoagulation therapy, and (3) a fever that was resistant to prior treatment. RESULTS: A total of 114 duplex examinations, gathered during a 2-year period, were analyzed. The 89 patients had a mean age of 58 years. Infections were the most common cause of FUO (57 of 89, 64%), and unknown causes constituted 19%. There were seven cases of DVT (8%), five (6%) of whom met the criteria for probable cause of FUO. The overall cost of venous duplex imaging examinations was $51,300 ($450 x 114 tests), with an average cost of $10,260 for each case of DVT detected as probable cause of FUO. CONCLUSIONS: Consistent with the literature, infections remain the most common cause of FUO; however, DVT was found to be a more common cause of FUO in our present series (6%). The cost of venous duplex imaging of the lower extremities in establishing DVT as a probable cause of FUO should be borne in mind when the work-up of these patients is planned.


Subject(s)
Fever of Unknown Origin/diagnostic imaging , Thrombophlebitis/diagnostic imaging , Adult , Aged , Aged, 80 and over , Female , Fever of Unknown Origin/economics , Fever of Unknown Origin/etiology , Humans , Male , Middle Aged , Thrombophlebitis/complications , Ultrasonography, Doppler, Duplex
6.
Am J Cardiol ; 79(6): 727-32, 1997 Mar 15.
Article in English | MEDLINE | ID: mdl-9070549

ABSTRACT

Four hundred seventy-three patients with acute myocardial infarction (AMI) were treated with either saruplase (80 mg/hour, n = 236) or alteplase (100 mg every 3 hours, n = 237). Comedication included heparin and acetylsalicylic acid. Angiography was performed at 45 and 60 minutes after the start of thrombolytic therapy. When flow was insufficient, angiography was repeated at 90 minutes. Coronary angioplasty was then performed if Thrombolysis In Myocardial Infarction (TIMI) trial 0 to 1 flow was seen. Control angiography was at 24 to 40 hours. Baseline characteristics were similar. Angiography showed comparable and remarkably high early patency rates (TIMI 2 or 3 flow) in both treatment groups: at 45 minutes, 74.6% versus 68.9% (p = 0.22); and at 60 minutes 79.9% versus 75.3% (p = 0.26). Patency rates at 90 minutes before additional interventions were also comparable (79.9% and 81.4%). Angiographic reocclusion rates were not significantly different: 1.2% versus 2.4% (p = 0.68). After rescue angioplasty, angiographic reocclusion rates of 22.0% and 15.0% were observed. Safety data were similar for both groups. Thus, (1) early patency rates were high for saruplase and alteplase treatment, (2) reocclusion rates for both drugs were remarkably low, and (3) complication rates were similar. Thus, saruplase seems to be as safe and effective as alteplase.


Subject(s)
Fibrinolytic Agents/administration & dosage , Myocardial Infarction/drug therapy , Plasminogen Activators/administration & dosage , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/administration & dosage , Urokinase-Type Plasminogen Activator/administration & dosage , Aged , Double-Blind Method , Europe/epidemiology , Female , Humans , Male , Middle Aged , Myocardial Infarction/mortality , Recombinant Proteins/administration & dosage , Recurrence , Thrombolytic Therapy/statistics & numerical data , Treatment Outcome
7.
J Laparoendosc Adv Surg Tech A ; 7(6): 363-7, 1997 Dec.
Article in English | MEDLINE | ID: mdl-9449086

ABSTRACT

Over the past few years, several cases of acute mesenteric ischemic events following laparoscopy have appeared in the literature. To date, no formal description of this phenomenon has been provided. In this article, we summarize and analyze the features of the five reported cases to date as well as a sixth case encountered at our institution. The probable cause of this complication involves changes in splanchnic hemodynamics related to elevated intra-abdominal pressure. A review of the relevant literature is provided.


Subject(s)
Laparoscopy/adverse effects , Mesenteric Vascular Occlusion/etiology , Acute Disease , Adult , Female , Humans , Mesenteric Vascular Occlusion/diagnostic imaging , Radiography
8.
J Vasc Surg ; 24(6): 998-1006; discussion 1006-7, 1996 Dec.
Article in English | MEDLINE | ID: mdl-8976353

ABSTRACT

PURPOSE: The early outcomes of carotid endarterectomy (CEA) with primary closure (PC) versus vein patch closure (saphenous vein [SVP] and jugular vein [JVP]) and polytetrafluoroethylene patch closure (PTFE-PC) were compared. METHODS: Three hundred ninety-nine CEAs were randomized into the following groups: 135 PC, 134 PTFE-PC, and 130 vein patch closure (SVP alternating with JVP). Surviving patients underwent a carotid color duplex ultrasonographic scan 1 month after surgery. Demographic characteristics were similar in all groups. RESULTS: The incidence of perioperative cerebrovascular accidents (CVAs) was 4.4% for PC, 0.8% for PTFE-PC, and 0% for vein patch closure (PC vs vein patch, p = 0.0165; PC vs all patching [vein and PTFE], p = 0.007). The perioperative CVA and reversible ischemic neurologic deficit (RIND) combined rates for all patching were superior to PC (1.5% vs 5.2%; p = 0.04). These combined rates were also superior for vein patch closure when compared with PC (0.8% vs 5.2%; p = 0.037). The mean diameter of the internal carotid artery was similar in patients who had perioperative neurologic deficits and those who did not. After 1 month of follow-up, 11.9% of the PC arteries were narrowed 50% or more in contrast to 2.3% for PTFE-PC, 3.1% for SVP, and 10.3% for JVP.


Subject(s)
Blood Vessel Prosthesis , Cerebrovascular Disorders/epidemiology , Endarterectomy, Carotid/methods , Jugular Veins/transplantation , Polytetrafluoroethylene , Postoperative Complications/epidemiology , Saphenous Vein/transplantation , Aged , Carotid Artery, Internal/diagnostic imaging , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/epidemiology , Female , Follow-Up Studies , Humans , Male , Postoperative Complications/diagnostic imaging , Prospective Studies , Time Factors , Treatment Outcome , Ultrasonography
9.
Cardiovasc Surg ; 4(6): 783-7, 1996 Dec.
Article in English | MEDLINE | ID: mdl-9013010

ABSTRACT

Spontaneous axillary-subclavian vein thrombosis in young patients produces long-term disability. Patients with secondary axillary-subclavian vein thrombosis usually require prolonged venous catheterization for chemotherapy or pacemaking. This study aimed to compare the early and late results of lytic versus anticoagulant therapy in the treatment of axillary-subclavian vein thrombosis, both spontaneous and secondary to central venous cannulation. Nine patients underwent conventional treatment (heparin and warfarin) (group 1), and 10 had initial lytic therapy followed by heparin and warfarin (group 2). Three patients had cervical or first rib resection. Thirteen patients had spontaneous thrombosis and six were secondary to central venous catheterization. The mean follow-up was 36 months. Two of nine patients (22%) in group 1 and eight of 10 patients (80%) in group 2 had total venous recanalization and symptom resolution (P = 0.018). In the spontaneous axillary-subclavian vein thrombosis subset, one of six patients (17%) in group 1 and five of seven patients (71%) in group 2 had total venous recanalization and symptom resolution (P = 0.078). The average difference in cost per patient between groups 1 and 2 was $19,039. In conclusion, lytic therapy appears superior to anticoagulation in the treatment of axillary-subclavian vein thrombosis. However, such treatment is more expensive and its benefits should be carefully weighed against the cost in each case.


Subject(s)
Anticoagulants/therapeutic use , Axillary Vein , Heparin/therapeutic use , Subclavian Vein , Thrombolytic Therapy , Thrombosis/drug therapy , Warfarin/therapeutic use , Adult , Catheterization, Central Venous/adverse effects , Cost-Benefit Analysis , Female , Follow-Up Studies , Humans , Male , Middle Aged , Thrombolytic Therapy/economics , Thrombosis/surgery , Time Factors , Treatment Outcome
10.
Ann Vasc Surg ; 10(4): 385-9, 1996 Jul.
Article in English | MEDLINE | ID: mdl-8879396

ABSTRACT

Ulcerated or irregular heterogeneous carotid plaque as seen by duplex ultrasound can cause hemispheric transient ischemic attacks (TIAs) and/or a cerebrovascular accident, even if only associated with nonsignificant carotid stenosis on arteriography. The purpose of this study was to review our experience in patients who underwent a carotid endarterectomy after medical treatment had failed, based on pathologic findings detected by carotid duplex ultrasound with minimal disease on arteriography. The medical records of 14 patients who underwent carotid endarterectomy for TIA symptoms related to ulcerated or irregular heterogeneous plaques were analyzed. All had had preoperative carotid duplex ultrasound, arteriography, and cardiac and neurologic workups to rule out other causes for their TIAs. Medical treatment had failed in all of them. There were 10 men and four women whose median age was 68 years. Carotid duplex ultrasound showed irregular heterogeneous carotid plaque in all patients associated with 20% to 50% stenosis in 12 and approximately 50% to 60% stenosis in two. All had normal to < 20% stenosis on arteriograms. The duplex ultrasound findings were all confirmed at operation. All had an uneventful postoperative course with relief of symptoms. Carotid duplex ultrasound is superior to carotid arteriography in detecting irregular or ulcerative heterogeneous plaque associated with nonsignificant stenosis. Carotid duplex ultrasound can be used to determine the desirability of carotid endarterectomy after failed medical treatment in patients with classical and persistent TIA symptoms despite normal or minimal disease on arteriograms. A successful endarterectomy appears to predict an asymptomatic postoperative course.


Subject(s)
Arteriosclerosis/surgery , Carotid Arteries/diagnostic imaging , Carotid Stenosis/surgery , Endarterectomy, Carotid , Ultrasonography, Doppler, Duplex , Aged , Aged, 80 and over , Angiography , Arteriosclerosis/complications , Arteriosclerosis/drug therapy , Carotid Stenosis/complications , Carotid Stenosis/drug therapy , Cerebrovascular Disorders/etiology , Feasibility Studies , Female , Follow-Up Studies , Forecasting , Humans , Ischemic Attack, Transient/etiology , Male , Middle Aged , Preoperative Care , Retrospective Studies , Sensitivity and Specificity , Treatment Failure
12.
Surg Laparosc Endosc ; 5(6): 463-7, 1995 Dec.
Article in English | MEDLINE | ID: mdl-8611994

ABSTRACT

A method of performing a laparoscopic splenectomy with the aide of intraabdominal manipulation is described. We believe that this is a versatile technique that compares quite favorably with a pure cannula approach. It is likely that this approach is safer because vascular control can readily be assured by the intraabdominal operator. It is also less costly because it is more rapid than a procedure done solely by cannula techniques. Moreover, it is reproducible by an experienced general surgeon. The results appear equal in terms of access morbidity and hospitalization time to those seen with a purely laparoscopic approach. Experience with 21 splenectomies is described and compared with 20 others performed by the traditional open approach.


Subject(s)
Laparoscopy/methods , Minimally Invasive Surgical Procedures/methods , Splenectomy/methods , Adult , Aged , Female , Forced Expiratory Volume , Hand , Hospitalization , Humans , Laparoscopes , Laparoscopy/adverse effects , Laparoscopy/economics , Length of Stay , Male , Middle Aged , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/economics , Minimally Invasive Surgical Procedures/instrumentation , Reproducibility of Results , Retrospective Studies , Splenectomy/adverse effects , Splenectomy/economics , Splenectomy/instrumentation , Survival Rate , Time Factors , Vital Capacity
14.
Am J Surg ; 169(3): 308-12, 1995 Mar.
Article in English | MEDLINE | ID: mdl-7879832

ABSTRACT

PURPOSE: To evaluate the filling of the Circle of Willis on preoperative arteriograms and to correlate this observation with the results of oculopneumoplethysmography (OPG) and severity of carotid stenosis as determined by duplex ultrasonography and angiography. PATIENTS AND METHODS: Ninety-five patients underwent OPG, duplex ultrasonography, and selective carotid and vertebral arteriography. RESULTS: In all, 45 (88%) patients with a positive OPG had interhemispheric cross-filling of the middle cerebral artery and anterior cerebral artery from a contralateral carotid injection in contrast with 10 (23%) patients with a negative OPG (P < 0.001). Of patients with carotid stenosis > or = 80% on duplex ultrasound, 39 (91%) had cross-filling from a contralateral carotid injection in contrast with 16 (31%) patients with < 80% stenosis (P < 0.001). Of patients with carotid stenosis > or = 80% on arteriogram, 37 (90%) had cross-filling from a contralateral carotid injection in contrast with 18 (33%) patients with < 80% stenosis (P < 0.001). CONCLUSION: These data suggest that the Circle of Willis is frequently incompetent as a collateral pathway and that arteriographic cross-filling is not a reliable index of this pathway. Patients with a positive OPG and corresponding carotid stenosis are likely to have a physiologically incompetent collateral pathway. Perhaps these patients should undergo surgery, even if the stenosis is less than 80%.


Subject(s)
Carotid Stenosis/physiopathology , Circle of Willis/physiopathology , Collateral Circulation , Adult , Aged , Aged, 80 and over , Carotid Stenosis/diagnosis , Cerebral Angiography , Circle of Willis/diagnostic imaging , Female , Humans , Male , Middle Aged , Ophthalmodynamometry , Plethysmography , Preoperative Care , Sensitivity and Specificity , Severity of Illness Index , Ultrasonography, Doppler, Duplex , Ultrasonography, Doppler, Transcranial
15.
W V Med J ; 91(1): 10-2, 1995 Jan.
Article in English | MEDLINE | ID: mdl-7856150

ABSTRACT

Celiac compression syndrome occurs when the median arcuate ligament of the diaphragm and/or periarterial neural tissue causes extrinsic compression of the celiac axis. In rare cases, this syndrome can cause upper abdominal angina. The classic triad of celiac compression syndrome consists of abdominal pain, an epigastric bruit, and angiographic evidence of celiac compression. Operative therapy consists of thorough exploration, transection of the median arcuate ligament, and either celiac dilatation or a bypass. This article describes a case of celiac compression syndrome which was treated successfully by transection of the median arcuate ligament and aortosplenic bypass.


Subject(s)
Abdominal Pain/etiology , Arterial Occlusive Diseases/complications , Celiac Artery , Ligaments/surgery , Arterial Occlusive Diseases/diagnosis , Constriction, Pathologic , Diaphragm , Female , Humans , Middle Aged
16.
Ann Vasc Surg ; 8(4): 372-9, 1994 Jul.
Article in English | MEDLINE | ID: mdl-7947064

ABSTRACT

This study includes our 12-year experience with chemical sympathetic blocks and surgical sympathectomies for causalgic pain of reflex sympathetic dystrophy (RSD) with emphasis on factors affecting clinical outcome. Medical records of patients undergoing sympathectomies for causalgic pain were analyzed. The patients were classified according to Drucker et al. as stage I, II, or III. Results of chemical and surgical sympathectomies were analyzed using both univariate and multivariate methods. Twenty-one patients had lumbar and seven had cervicodorsal sympathectomies for RSD. The mean duration between initial injury and chemical sympathetic block was 10 months with a mean of 11.4 months to surgical sympathectomy. Ten patients (36%) had overt extremity trauma as the precipitating event. Ten patients (36%) had a lumbar laminectomy, three of whom developed the syndrome bilaterally. There was no operative mortality; however, 25% had transient postoperative sympathetic neuralgia. The early and late (> 6 months) satisfactory outcomes after surgical sympathectomy were 82% and 71%, respectively. Patients with stage II presentations were significantly more likely to have satisfactory early (92%) and late (79%) outcomes than stage III patients, 0% and 0% (p = 0.019). Patients with an excellent response to chemical sympathetic block were more likely to have satisfactory early and late surgical outcomes. The time between injury and chemical block and surgical sympathectomy was significantly shorter in patients who had satisfactory early and late surgical outcomes (p < 0.0001). Multivariate analyses demonstrated that the most important independent factor in determining early and late satisfactory outcomes of sympathectomy was the time between injury and sympathectomy (p = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Reflex Sympathetic Dystrophy/surgery , Sympathectomy, Chemical/statistics & numerical data , Sympathectomy/statistics & numerical data , Adolescent , Adult , Aged , Causalgia/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Reflex Sympathetic Dystrophy/classification , Reflex Sympathetic Dystrophy/etiology , Remission Induction , Stellate Ganglion/surgery , Sympathectomy/adverse effects , Sympathectomy/methods , Sympathectomy, Chemical/adverse effects , Sympathectomy, Chemical/methods , Time Factors , Treatment Outcome
17.
Surg Laparosc Endosc ; 4(2): 103-5, 1994 Apr.
Article in English | MEDLINE | ID: mdl-8180759

ABSTRACT

We describe a method for performing laparoscopic staging laparotomy. We believe this minimally invasive approach can ease the transition between purely open and laparoscopic surgery, and it is applicable to a variety of intra-abdominal problems. The results are comparable to those of a standard staging laparotomy, with improvement in access morbidity and decreased hospitalization time.


Subject(s)
Abdomen/surgery , Laparoscopy/methods , Laparotomy/methods , Adult , Female , Hodgkin Disease/surgery , Humans , Male , Splenectomy/methods
18.
Ann Vasc Surg ; 7(6): 561-8, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8123459

ABSTRACT

Although anticoagulation remains the treatment of choice for acute pulmonary embolism, vena caval interruption represents an alternative for patients with contraindications and complications or in whom anticoagulation fails. The purpose of this study was to evaluate the effectiveness and safety of two types of caval interruption devices: the original stainless steel Greenfield filter and the Adams-DeWeese clip. Emphasis has been placed on maintaining caval patency with filters and clips and the patency of the femoral vein vs. the jugular vein after filter insertion. We retrospectively reviewed 161 patients who underwent caval interruption (92 filters and 69 clips) for both therapeutic and prophylactic reasons. The operative mortality and morbidity rates were 0% and 3.3% for filter patients and 8.7% and 2.9% for clip patients; no procedure-related mortalities occurred. The late caval patency rate as documented by duplex ultrasonography/venography was 100% for filter patients and 88% for clip patients (p = 0.011). Seven percent of the filter patients and 20% of the clip patients experienced late limb swelling postoperatively (p = 0.05). The incidence of recurrent late pulmonary embolism was 2.5% in the filter group and 1.9% in the clip group. In the filter group, 10% of patients experienced postoperative thrombosis at the femoral vein insertion site and 0% at the jugular vein insertion site. We found that both devices were effective in preventing pulmonary embolism, the filter provided better caval patency than the clip, and the jugular vein had a better patency than the femoral vein after filter insertion.


Subject(s)
Pulmonary Embolism/prevention & control , Pulmonary Embolism/surgery , Vena Cava Filters , Adult , Aged , Aged, 80 and over , Constriction , Female , Femoral Vein/physiology , Follow-Up Studies , Humans , Jugular Veins/physiology , Male , Middle Aged , Postoperative Complications/mortality , Pulmonary Embolism/mortality , Retrospective Studies , Vascular Patency
19.
W V Med J ; 89(10): 445-7, 1993 Oct.
Article in English | MEDLINE | ID: mdl-8266682

ABSTRACT

Deep vein thrombosis (DVT) of the lower extremity during pregnancy is infrequent, but its complication, pulmonary embolism, remains an important cause of maternal mortality. To evaluate the best method of caring for patients with DVT, we reviewed the records of patients at the Charleston Area Medical Center from 1987-1992 who were treated for this condition. Twelve patients were treated with conventional continuous intravenous heparin for 7 days-10 days followed by subcutaneous heparin until 6 weeks-8 weeks after delivery. The other group consisted of nine patients who were treated with lower dose subcutaneous heparin for 7 days-10 days and maintained as the first group, but a Greenfield filter was inserted for patients with iliofemoral DVT. The patients who received low-dose heparin and Greenfield filters tended to do better than those who received high-dose conventional heparin treatment. However, since there were so few patients evaluated, further verification is needed.


Subject(s)
Heparin/administration & dosage , Pregnancy Complications, Hematologic/drug therapy , Thrombophlebitis/drug therapy , Vena Cava Filters , Adult , Combined Modality Therapy , Dose-Response Relationship, Drug , Female , Humans , Infant, Newborn , Infusions, Intravenous , Injections, Subcutaneous , Pregnancy , Pregnancy Complications, Hematologic/mortality , Pulmonary Embolism/mortality , Pulmonary Embolism/prevention & control , Survival Rate , Thrombophlebitis/mortality
20.
Arch Surg ; 128(4): 417-22, 1993 Apr.
Article in English | MEDLINE | ID: mdl-8457154

ABSTRACT

One hundred thirty-seven polytetrafluoroethylene infrainguinal bypass grafts were performed over 2 years. The results were analyzed using univariate and multivariate analyses. Our operative mortality was 3.2% and the post-operative amputation rate was 5.8%. Forty-eight reconstructions were done for claudication, with a 5-year secondary patency rate of 64%, no early amputations, and a 2.9% (one limb) late amputation rate. Sixty-six reconstructions were done for rest pain with a 5-year secondary patency rate of 58% and a 3-year limb salvage rate of 77%. The 5-year secondary patency rate for 23 patients with trophic changes was 30%, and the 3-year limb salvage rate was 71%. Multivariate analysis identified the ankle-brachial index as the most important independent factor predicting both primary and secondary graft patency. The cumulative primary and secondary patency rates for patients with an ankle-brachial index of less than 0.5 at 78 months was 37% and 46%, respectively; and 57% and 68%, respectively for patients with an ankle-brachial index of 0.5 or more.


Subject(s)
Blood Vessel Prosthesis , Leg/blood supply , Polytetrafluoroethylene , Adult , Aged , Aged, 80 and over , Arteries/surgery , Blood Vessel Prosthesis/mortality , Female , Follow-Up Studies , Humans , Male , Middle Aged , Multivariate Analysis , Postoperative Complications , Reoperation , Retrospective Studies , Risk Factors , Survival Rate , Treatment Outcome , Vascular Patency
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