ABSTRACT
A retrospective case-control study was carried out to assess the importance of lymphatic fistulas that develop after vascular reconstruction and to determine the risk factors associated with them. The authors compared 35 patients who had lymphatic fistula after vascular reconstruction with 70 control patients, taken from the same database. They found a significant difference between the two groups only in age and indication for surgery: lymphatic fistulas were more likely to develop in older patients and in patients who underwent aortobifemoral bypass for limb salvage rather than for claudication (p less than 0.05).
Subject(s)
Fistula/etiology , Lymphatic Diseases/etiology , Postoperative Complications , Vascular Diseases/surgery , Aged , Case-Control Studies , Female , Follow-Up Studies , Humans , Length of Stay , Male , Middle Aged , Retrospective Studies , Risk Factors , Surgical Wound Infection/etiologyABSTRACT
A prospective study was undertaken to determine the cardiovascular response of a continuous alfentanil infusion during abdominal aortic surgery (AAS). Each subject (n = 20) received a beta-blocking drug preoperatively, and was premedicated with oral lorazepam. Anaesthesia was induced with alfentanil 50 micrograms.kg-1 and thiopentone 3 mg.kg-1, and was maintained with a variable rate infusion of alfentanil and 66 per cent nitrous oxide in oxygen. During the infusion, boluses of alfentanil, 7.5 micrograms.kg-1, were administered to maintain heart rate and blood pressure within 20 per cent of awake baseline values. Haemodynamic stability during surgery was achieved with infusion rates varying between 0.5 and 2.5 micrograms.kg-1, which resulted in mean alfentanil serum concentrations ranging from 186 +/- 53 to 315 +/- 98 ng.ml-1. The mean cumulative alfentanil dose was 15.4 +/- 6.2 mg.patient-1 for surgery which lasted an average of 141 +/- 41 min. Throughout surgery, no patient required inhalational anaesthetic agents or vasoactive drugs. Fifteen of the 20 patients had perioperative Holter monitoring. No myocardial ischaemia was detected during the intraoperative period. However, there was a 33 per cent incidence of myocardial ischaemia on the first postoperative day. There were no myocardial infarcts and no deaths. We conclude that in beta-blocked patients undergoing aortic reconstructive surgery, a variable rate alfentanil infusion administered with 66 per cent nitrous oxide provides anaesthesia characterized by good haemodynamic control without the need for supplemental agents or vasoactive drugs.
Subject(s)
Alfentanil/administration & dosage , Anesthesia, Intravenous , Aortic Diseases/surgery , Heart/drug effects , Alfentanil/blood , Alfentanil/pharmacology , Analysis of Variance , Anesthesia, Inhalation , Aorta, Abdominal , Blood Pressure/drug effects , Cardiac Output/drug effects , Electrocardiography, Ambulatory , Female , Heart Rate/drug effects , Humans , Infusions, Intravenous , Male , Middle Aged , Nitrous Oxide , Prospective Studies , Vascular Resistance/drug effectsABSTRACT
Operative injury to the popliteal artery after meniscal surgery on the knee has been described previously, but its occurrence after tibial osteotomy has not been reported. The authors describe two cases of the latter condition, both involving the formation of a false aneurysm at the site of injury. The pathogenesis of this condition, its clinical sequelae and its subsequent repair are discussed.
Subject(s)
Osteotomy/adverse effects , Popliteal Artery/injuries , Tibia/surgery , Adolescent , Aneurysm/diagnostic imaging , Aneurysm/etiology , Female , Humans , Knee Joint/abnormalities , Knee Joint/surgery , Male , Middle Aged , Osteoarthritis/surgery , Popliteal Artery/diagnostic imaging , RadiographyABSTRACT
To assess the prevalence of coexisting abdominal aortic aneurysm (AAA) within certain families, a retrospective review was carried out of patients who had undergone AAA repair over a 5-year period. Contact was made with 305 families (52%) and a positive history of an affected, first-degree relative was obtained in 34 (11%). A known AAA was reported to affect approximately 20% of siblings at risk when the proband had an affected parent or sibling. Siblings of patients with an affected first-degree relative represent a high-risk group that may benefit from a screening program for earlier detection and elective management of AAA.
Subject(s)
Aortic Aneurysm/genetics , Aorta, Abdominal/surgery , Aortic Aneurysm/surgery , Female , Humans , Male , Middle Aged , Pedigree , Retrospective StudiesABSTRACT
Six years' laboratory work resulted in devising a satisfactory experimental technique of direct left gastric-left renal diversion for esophagogastric venous decompression. The procedure was accomplished by interposing an autogenous vein graft between the distal transected left gastric and left renal veins, employing mechanical stapling for the venous anastomoses. A refined technique of left gastric caval diversion provided uniform late patency in a suitable animal model.
