Subject(s)
Heart Neoplasms/surgery , Hemangioma/surgery , Neoplasm Recurrence, Local/surgery , Aged , Heart Ventricles , Humans , MaleABSTRACT
AIM: Incidence evaluation of cutaneous neurologic symptoms in the lower limbs as a new event after great saphenous vein (GSV) harvesting for coronary artery bypass grafting (CABG). Each day we harvest the GSV for CABG. Some authors have reported the onset of saphenous neuralgia complex as a new event of which we would evaluate the incidence. METHODS: From January 2000, until June 2001, 2,091 patients underwent cardiac surgery; 1,326 underwent CABG, 1,227 of them using the GSV as a conduit for almost one graft. These patients were prospectively reviewed; all were preoperatively examined to determine the presence of normal sensation in the lower limbs and elude the presence of saphenous neuralgia. Then, we evaluated sensations in the lower limbs at 5 days, 8 weeks, and 5 months after operation to determine the new onset of saphenous neuralgia. The areas of sensory loss were recorded each time and reported in a diagram to obtain 3 areas. RESULTS: Hyperaesthesia and pain were noted in a few patients, especially at 5 days and 8 weeks control, but at 5 months none of them complained of real pain. CONCLUSION: This study demonstrates that saphenous neuralgia after harvesting the GSV for CABG is a rare consequence. The main symptom is anaesthesia but its duration is generally no longer than 2 months. Hyperaesthesia and pain, for the early onset and the early disappearance, are considered as a normal consequence of surgical procedure.
Subject(s)
Coronary Artery Bypass/adverse effects , Coronary Disease/surgery , Neuralgia/etiology , Saphenous Vein/transplantation , Adult , Age Distribution , Aged , Anastomosis, Surgical , Coronary Artery Bypass/methods , Coronary Disease/diagnosis , Female , Humans , Hyperesthesia/etiology , Hyperesthesia/physiopathology , Incidence , Lower Extremity , Male , Middle Aged , Neuralgia/epidemiology , Neuralgia/physiopathology , Pain Measurement , Prognosis , Prospective Studies , Risk Assessment , Severity of Illness Index , Sex Distribution , Time Factors , Tissue and Organ HarvestingABSTRACT
OBJECTIVES: The combination of endovascular and standard surgical techniques may facilitate the management of complex aortic disease although the long-term durability of this approach needs to be confirmed. DESIGN: A retrospective review of our experience in the treatment of patients with complex aortic pathology using a combined endovascular and surgical approach. MATERIALS AND METHODS: Between 1998 and 2001, 27 patients with thoracic aortic aneurysm underwent stent-graft implantation. Eight required combined endovascular and surgical procedure because of complex pathology. In 3 cases, combined repair was carried out for a concomitant abdominal aortic aneurysm or aorto-iliac-femoral occlusive disease. In the other 5 cases, vessel relocation was performed to obtain safe landing zones: left subclavian artery to left carotid artery translocation in 3 patients, celiac trunk to superior mesenteric artery translocation in one and aorto-celiac-mesenteric bypass grafting in one. RESULTS: One of the 8 patients died on 12th post-operative day of intestinal bleeding and bowel infarction. No neurological sequelae were reported. The other patients are currently well at 11 months mean follow-up time. CONCLUSIONS: Simultaneous surgical and endovascular procedure is a feasible and may be a valuable adjunct to the treatment of complex aortic and peripheral vessel anatomy.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/methods , Stents , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications , Treatment OutcomeABSTRACT
Between January 1990 and February 2001 a total of 323 patients underwent following operations at our Institution: respectively 256 on the ascending aorta, 13 on the transverse arch and 54 on thoracic descending aorta. Sixteen patients with thoracic aortic aneurysms underwent endovascular stent graft implantation. The overall in-hospital mortality was respectively: 7% for ascending aortic aneurysms, 7.7% in the aortic arch aneurysms group and 5.5% for descending aortic aneurysms. The mortality was greater in case of emergency surgery and in the subgroup of patients with acute type A dissection. Stroke with permanent dysfunction occurred in 1.5% of ascending aneurysms, 7.7% of arch aneurysms and in 3.7% of thoracic descending aneurysms. In the latter group, all the major neurological events were related to conventional surgical procedures only: really no mortality or neurological morbidity occurred with endovascular stent graft implantation. Even if modern physiologic monitoring devices and new surgical techniques have been developed in the last years, the treatment of thoracic aortic aneurysms remains challenging. Endoluminal placement of stent grafts has developed as an alternative procedure for the treatment of thoracic aortic aneurysms, even if longer term follow-up is still necessary to fully define the efficacy of this approach.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Cardiac Surgical Procedures/methods , Postoperative Complications , Adolescent , Adult , Aged , Aortic Aneurysm, Thoracic/epidemiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Morbidity , Pulmonary Disease, Chronic Obstructive/epidemiology , Renal Insufficiency/epidemiology , StentsABSTRACT
The authors report an aneurysm in the popliteal artery surgically treated with success. The operation consisted on the installation of one tubular prosthesis femoro-poplitea with a termino-terminal anastomosis. The follow-up to 3 and 6 months from the operation showed good functional recovery.
