ABSTRACT
Venous thromboembolism is the most preventable illness among patients in hospital. We prepared guidelines for the prophylaxis of venous thromboembolism, based on previous experience of perioperative risk factors. The aim of this study was to evaluate the effectiveness of these guidelines. All 1,467 patients who underwent surgery for thoracic or cardiovascular disease between April 2002 and July 2004, before the prophylactic guidelines were implemented, were assigned to group A. Another 1,389 patients who had surgery between August 2004 and December 2006, after the guidelines had been implemented, formed group B. The incidences of venous thromboembolism perioperatively in the 2 groups were compared. Six (0.4%) patients in group A developed deep vein thrombosis or pulmonary embolism, whereas no patient in group B experienced thromboembolism. The difference between groups was significant, so we consider our guidelines for venous thromboembolism prevention in the perioperative period to be clinically useful.
Subject(s)
Anticoagulants/therapeutic use , Cardiac Surgical Procedures/adverse effects , Intermittent Pneumatic Compression Devices , Stockings, Compression , Thoracic Surgical Procedures/adverse effects , Venous Thromboembolism/prevention & control , Adult , Aged , Combined Modality Therapy , Female , Humans , Incidence , Male , Middle Aged , Practice Guidelines as Topic , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiologyABSTRACT
We describe a 58-year-old man who was successfully treated with a beta-adrenergic receptor blocking agent for intractable hemolysis due to paraprosthetic leakage. After replacement of a mitral prosthetic valve with another mechanical valve, the patient suffered intractable intravascular hemolysis resulting from recurrent paraprosthetic leakage. With oral administration of a beta-adrenergic receptor blocker, betaxolol hydrochloride, for 3 months, the hemoglobin value increased from 9.7 g x dL(-1) to 12.4 g x dL(-1), although glutamic oxaloacetic transaminase and lactic dehydrogenase values remained elevated.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Anemia, Hemolytic/drug therapy , Betaxolol/therapeutic use , Bioprosthesis , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis , Hemolysis/drug effects , Mitral Valve/surgery , Prosthesis Failure , Administration, Oral , Adrenergic beta-Antagonists/administration & dosage , Anemia, Hemolytic/blood , Anemia, Hemolytic/etiology , Aspartate Aminotransferases/blood , Betaxolol/administration & dosage , Device Removal , Heart Valve Prosthesis Implantation/instrumentation , Hemoglobins/metabolism , Humans , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Prosthesis Design , Reoperation , Stress, Mechanical , Treatment OutcomeABSTRACT
We retrospectively reviewed 41 patients with isolated iliac artery aneurysms presenting over a 21-year period. The mean age was 72 years. Mean aneurysmal diameter was 6.0 cm (range, 3.2-13 cm). The aneurysms were located in the common iliac artery in 31 patients, internal iliac artery in 7, and both arteries in 3. Rupture occurred in 20 patients (49%). The frequency of rupture of isolated iliac artery aneurysms was significantly higher than that of abdominal aortic aneurysms (8%) during the same period. The 30-day mortality was 9.8%; death in all 4 patients was due to rupture of the aneurysm. The surgical procedure was aneurysmectomy and replacement with a bifurcated prosthetic graft in 24 patients (59%), closure of the common iliac artery with a femorofemoral crossover in 7, minilaparotomy in 3, thromboexclusion in 6, and endoluminal stent-graft repair in one. In contrast to abdominal aortic aneurysms, isolated iliac artery aneurysms can be treated by various methods other than replacement with a bifurcated prosthetic graft. When selecting a strategy for such aneurysms, it is important to choose an approach appropriate to the location and risk, because of the frequency of rupture.
Subject(s)
Aneurysm, Ruptured/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Iliac Aneurysm/surgery , Stents , Vascular Surgical Procedures/instrumentation , Aged , Aged, 80 and over , Aneurysm, Ruptured/mortality , Aneurysm, Ruptured/pathology , Blood Vessel Prosthesis Implantation/adverse effects , Embolization, Therapeutic , Female , Humans , Iliac Aneurysm/mortality , Iliac Aneurysm/pathology , Ligation , Male , Middle Aged , Patient Selection , Retrospective Studies , Risk Assessment , Time Factors , Treatment Outcome , Vascular Surgical Procedures/adverse effectsABSTRACT
A 52-year-old man underwent the repair of a spontaneous rupture of the dorsalis pedis artery. We considered that untreated hypertension was one possible cause of the rupture. This is a rare case of spontaneous rupture in a peripheral artery.
Subject(s)
Aneurysm, False/diagnosis , Aneurysm, Ruptured/diagnosis , Foot/blood supply , Aneurysm, False/surgery , Aneurysm, Ruptured/surgery , Humans , Hypertension/complications , Male , Middle Aged , Vascular Surgical ProceduresABSTRACT
PURPOSE: We evaluated the effectiveness of a shorter skin incision technique for the treatment of infrarenal abdominal aortic aneurysms (AAA). The aim of the present study was to evaluate whether or not the difference in the length of the skin incision contributed to an early recovery after the operation. METHODS: Between October 2001 and December 2004, we performed 105 elective repairs for AAA. The patients were divided into three groups according to the length of the skin incision as follows: group A, less than 15 cm, group B, from 15 cm to less than 20 cm, and group C, 20 cm or more. RESULTS: There was no significant difference in the intraoperative course among the three groups. The duration of paralytic ileus was shorter in group A than in group C (2.0 +/- 0.9 days versus 3.2 +/- 2.3 days; P = 0.0428). Although the periods before removal of nasogastric suction and before starting a solid diet were slightly shorter in group A than in groups B and C, there were no statistically significant differences. CONCLUSION: We define minimally invasive vascular surgery as surgery performed with a small abdominal skin incision that does not expose the intestine to air while providing a good operative field that does not place any undue stress on the surgeon.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Dermatologic Surgical Procedures , Laparotomy/methods , Minimally Invasive Surgical Procedures/methods , Vascular Surgical Procedures/methods , Aged , Elective Surgical Procedures , Female , Follow-Up Studies , Humans , Male , Retrospective Studies , Treatment OutcomeABSTRACT
Starr-Edwards ball valves removed more than 15 years after implantation were retrospectively investigated macroscopically. Eight patients required re-operation. Valve models used in the initial operations were a non-cloth-covered valve in 2 patients and a cloth-covered valve in 6. Two patients had replacement of an aortic ball valve (model 1260 and model 2320) and 6 underwent mitral valve replacement (model 6120 in one, model 6320 in 5). The mean time to re-operation was 23.0 +/- 4.8 years after implantation. Cloth wear causing significant hemolysis was observed in all cloth-covered valves, regardless of valve position. Autologous tissue growth was noted on the orifice ring and struts in both aortic and mitral prostheses. Thrombus formation was not found in any of the valves. Ball variance in silicone rubber balls was mild in the non-cloth-covered valves, even in the aortic position. The most significant problem with the cloth-covered ball valve was cloth wear. Cloth wear should always be considered when 15 years or more have passed since valve implantation. Significant hemolysis, elevation of lactate dehydrogenase values, and echocardiographic detection of transvalvular regurgitation are diagnostic of cloth wear, and are indications for replacement of a cloth-covered ball valve.
Subject(s)
Aortic Valve , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis/adverse effects , Mitral Valve , Adult , Device Removal , Female , Humans , Male , Middle Aged , Prosthesis Failure , ReoperationABSTRACT
A 27-year-old woman, who had received mitral valve repair for mitral regurgitation resulting from infective endocarditis, was admitted for a close examination of abnormal echocardiographic findings in the left atrium. Transthoracic echocardiography showed trivial mitral regurgitation with normal left ventricular contraction and dilatation of the coronary sinus. Auscultation revealed a grade 2 continuous murmur along the left sternal border. Transesophageal echocardiography demonstrated a marked dilatation of the coronary sinus just behind the posterior wall of the left atrium and turbulent blood flow in the dilated coronary sinus. Cardiac catheterization showed no significant step-up of oxygen saturation in the right heart and normal pulmonary artery pressure. Coronary angiography revealed a markedly dilated and tortuous circumflex coronary artery connected to the coronary sinus through a fistula. A left circumflex artery with a fistulous connection to the coronary sinus is extremely rare.
Subject(s)
Coronary Aneurysm/diagnosis , Coronary Sinus/diagnostic imaging , Coronary Vessel Anomalies/diagnosis , Vascular Fistula/diagnosis , Adult , Cardiac Catheterization , Coronary Aneurysm/congenital , Coronary Angiography , Echocardiography, Transesophageal , Female , Humans , Vascular Fistula/congenitalABSTRACT
We report a case of pancreatic injury, caused by a stab wound, in which ductal injury and wound depth were clearly identified by intraoperative ultrasonography. A 65-year-old woman was emergently admitted to our hospital after stabbing herself in the abdomen in a suicide attempt. Preoperative computed tomography (CT) and laboratory examination revealed liver and pancreatic injury with massive abdominal bleeding and free air. Operative findings included injuries of the stomach, small bowel, colon, liver, and pancreas. The pancreatic lacerations were 1 cm in length, in the body. Intraoperative ultrasonography enabled the diagnosis of a lacerated main pancreatic duct with no damage to the major vessels posterior to the pancreas. Distal pancreatectomy; simple repairs of the liver, small bowel, and stomach; exteriorization of the injured colon; cholecystostomy; gastrostomy; and jejunostomy were performed. The patient recovered and was transferred to a psychiatric hospital 87 days after surgery. In this patient, intraoperative ultrasonography was successfully used to identify the degree of injury to the pancreatic duct, as well as the depth of the stab wound. In conclusion, intraoperative ultrasonography should be routinely performed to detect main pancreatic duct injury in penetrating pancreatic trauma.