ABSTRACT
Mortality and amputation rates from acute arterial occlusion are reported from 7 to 37 per cent and 10 to 30 per cent, respectively. Recent data from thrombolysis or peripheral arterial surgery suggest no significant differences between initial management with surgical or thrombolytic therapy. Mortality and amputation rates were in the above ranges. The last 230 procedures (216 patients) over 10 years were reviewed. All graft occlusions, cardiac catheterization injuries, and aortic balloon-related thromboses were excluded. Immediate and delayed amputation rates were 6.5 and 0.9 per cent. Death occurred in 21 patients (9.7%), with only 6 deaths over the last 6 years (3.8%). Except for transesophageal echocardiography, perioperative studies were of limited value. Long-term anticoagulation was also not effective in preventing recurrent episodes. A mortality rate of 9.7 per cent and amputation rate of 7.4 per cent justifies an early aggressive surgical approach. Limited perioperative studies and less prolonged anticoagulation may also improve cost containment.
Subject(s)
Arm/blood supply , Arterial Occlusive Diseases/surgery , Leg/blood supply , Thromboembolism/surgery , Acute Disease , Aged , Aged, 80 and over , Amputation, Surgical , Arm/surgery , Arterial Occlusive Diseases/drug therapy , Arterial Occlusive Diseases/etiology , Combined Modality Therapy , Echocardiography, Transesophageal , Female , Heart Diseases/complications , Heart Diseases/diagnostic imaging , Humans , Ischemia/etiology , Ischemia/surgery , Leg/surgery , Male , Retrospective Studies , Thromboembolism/drug therapy , Thromboembolism/etiology , Thrombolytic Therapy , Thrombosis/complications , Thrombosis/diagnostic imaging , Treatment OutcomeABSTRACT
From 1968 through 1982, 129 homologous vein grafts were used in 91 patients in the following positions: 75 in the femoropopliteal, tibial, or peroneal artery; 38 in the aortocoronary artery; 13 in the aortopulmonary artery; and one each in the atrioventricular fistula, carotid-subclavian artery, and brachial-radial artery. In the lower extremity patency ranged from 0 to 121 months (mean 22.4 +/- 4.4 months). All grafts were performed for limb salvage, and 75% of the patients had undergone previous operations. Cumulative patency by the life-table method showed that while 50% of grafts occluded by 1 year, 60% of the remaining grafts continued to be functional for more than 5 years. Fifty percent of the aortocoronary bypass grafts studied were occluded at 1 year. Eight of the 13 systemic pulmonary artery shunts were patent at time of death, revision, or total correction. Multiple revisions and thrombectomies are required to maintain patency of homograft veins. The outcome is variable and unpredictable. The inconsistency is due to the antigenicity of the graft. If one is committed to the necessary efforts required to ensure long-term patency, the homologous saphenous vein is a suitable substitute when autogenous tissue is unavailable.
Subject(s)
Saphenous Vein/transplantation , Arterial Occlusive Diseases/therapy , Arteriovenous Shunt, Surgical , Blood Vessel Prosthesis , Brachial Artery/surgery , Coronary Disease/therapy , Heart Defects, Congenital/therapy , Humans , Leg/blood supply , Transplantation, HomologousABSTRACT
Results of this study suggest that, when separated by 1 centimeter, the gastric wall situated between the two staple lines is relatively ischemic compared with the gastric wall outside the staple lines. The potential for perforation within this isolated segment is consequently greater. Therefore, placing two rows of staples 1 centimeter apart is dangerous and should be avoided. On the other hand, the gastric partitions can be safely reinforced by placing a double row of staples immediately adjacent to each other. Although placing two rows of staples 2 centimeters apart may be safe, there is little, if any, reinforcement of the proximal suture line, and it is not recommended.
