Recurrent aortic graft infection following descending thoracic aorta to femoral artery bypass. A case report and review.

This paper presents a patient who developed a recurrent aortic graft infection after a descending thoracic aorta to femoral artery bypass. The patient had previously undergone successful management of an infected aortobifemoral bypass by removal of the graft and revascularization of the lower extremities with axillofemoral bypasses. A general discussion of the management of infected aortic grafts is presented and a discussion of the management of this particular patient is presented in detail.

Impending aortoenteric hemorrhage: the effect of early recognition on improved outcome.

Aortoenteric hemorrhage is the result of enteric erosion and necrosis of aortic wall or anastomotic site. Mechanical or bacteriologic causes may occur singly or in combination. The temporal sequence is such that warning symptoms, often including back pain, fever, hemotochezia, and anemia, are present long before exsanguinating hemorrhage occurs. Vigorous diagnostic efforts, including gallium-67 citrate nuclear scan and computerized axial tomography, lead to a correct diagnosis. This allows planned semielective corrective operation before severe hemorrhage begins. The ideal operation consists of extra-anatomic revascularization, excision of the infected prosthesis, bowel repair with decompression, and sump drainage. Appropriate antimicrobial therapy should be continued until healing is complete. With aggressive diagnostic and therapeutic intervention according to this plan, marked improvement in survival and limb preservation can be anticipated in patients having this complication of aortic surgery. In this series, 15 of 18 patiets having operation recovered, though delayed limb loss occurred in two.

Vascular access for cancer chemotherapy.

A persistent problem in caring for patients receiving long-term intravenous chemotherapy for cancer is the maintenance of access to the vascular system. At Emory University Hospital between January 1975 and December 1977, 48 cancer chemotherapy patients had upper-arm bovine arteriovenous fistulas created for vascular access. The heterografts were inserted from the distal brachial artery to the proximal brachial vein under local, regional block, or general anesthesia. Grafts were functioning satisfactorily in 81% of the subjects at the time of death or at termination of treatment. The mean duration of useful graft patency for the entire group was 4.6 months, with a range of 0 to 27 months. Thrombosis of the graft was the most frequently encountered complication; infection and bleeding occurred infrequently. Reoperation was required in 35% of grafts, of which one half were salvaged. No mortality was attributable to the operative procedures or to the presence of a chronic arteriovenous fistula.

Segmental aortic occlusion: An unusual lesion found in menopausal women.

A subgroup of patients with aortoiliac atherosclerosis are perimenopausal women in whom the lesions are confined to the midportion of the terminal aorta. The lesions occur in relatively small, though not hypoplastic, vessels, and it is speculated that the relatively small size of the terminal aorta functions as a long stenosis with resultant predisposition to atheroma formation. Other etiologic factors are not identified except for smoking. Endarterectomy results in satisfactory restoration of distal arterial flow. Recurrence has not been observed but the question exists as to whether replacement of the small segment with a larger prosthesis may be more appropriate in view of the possible etiology described.

Granular cell tumor of the abdominal wall musculature.

Granular cell tumor (myoblastoma) is a relatively frequent neoplasm found in many different anatomic locations. This is a case of such a tumor arising in the abdominal wall musculature, an extremely unusual site of occurrence. Excision with generous margins is required to prevent recurrence.