ABSTRACT
The need for all medical institutions that treat carotid artery occlusive disease to continuously monitor their surgical experience is quite evident. Nonetheless, a national survey in 1995 found that only 15% of physicians reported knowing the perioperative stroke rate at the hospitals where they perform or refer patients for carotid endarterectomy. Neurologic morbidity related to the performance of carotid endarterectomy has been continuously monitored at Howard County General Hospital for the past decade, but the true significance of this data could not be appreciated without a more comprehensive analysis of the clinical experience. The present study was undertaken with the intent of providing this information.
Subject(s)
Cerebrovascular Disorders/epidemiology , Endarterectomy, Carotid/mortality , Aged , Aged, 80 and over , Carotid Artery Diseases/surgery , Cerebrovascular Disorders/prevention & control , Female , Humans , Male , Maryland/epidemiology , Middle Aged , Retrospective StudiesABSTRACT
A new vascular access for chronic hemodialysis is developed by creating a fistula in the upper arm between the end of the relocated basilic vein and anterior aspect of the brachial artery. The procedure has been used 24 times in 23 patients over the past 15 months (average eight months) with minimal complications and low failure rates. This fistula provides a straight, long, easily accessible conduit with high flows; it has only one vascular anastomosis and maintains the anatomic continuity of its venous end with the axillary vein. It also obviates the need for autologous, prosthetic, or heterografts. The procedure is indicated when suitable vessels in the forearm have been exhausted or are unavailable. However, additional clinical trials and continued long-term follow-up are necessary for more definite conclusions.
