Management of abdominal aortic aneurysm.

A series of 245 patients was operated upon for abdominal aortic aneurysm during the years 1969-77, of whom 162 were elective cases while in 83 the aneurysm was leaking or had ruptured. The hospital mortality for the latter group fell from 77 per cent at the beginning of the study period to 30 per cent at the end. For elective operations, hospital mortality averaged 9.3 per cent, though during the last 2 years there were no deaths in the 51 consecutive cases. Operative methods and postoperative treatment changed during the years of the study, with few excision-replacement grafts and greater use of the inlay technique, most of the latter being simple unbranched Dacron tubes. Early graft infection, the most important and serious surgical complication, caused 9 deaths, an overall incidence of 3.7 per cent, of which 8 were in patients who received no perioperative antibiotics and only 1 among the patients who did receive them. All deaths were in the inlay group. The reasons for this are discussed. Since July 1976 perioperative antibiotic treatment has been routine for all arterial prosthetic graft patients in our hospital.

An objective assessment of common femoral endarterectomy and profundaplasty in patients with superficial femoral occlusion.

Common femoral endarterectomy with profundaplasty has become accepted as a useful operation in the treatment of ischemic arterial disease which is the result of superficial femoral occlusion. However, objective assessment of its long-term postoperative hemodynamic effects has not been reported. This study determines the effect of this operation on the resting pressure index, the walking distance on the treadmill, the fall in postexercise ankle pressure, and the recovery time. Measurements were made just before operation and 1 month later in 20 patients with severe claudication and superficial femoral occlusion. Sixteen patients were available for follow-up at 1 year. These patients were matched according to the resting pressure index to another group of 20 patients with superficial femoral occlusion followed up conservatively. The results indicate that common femoral endarterectomy with profundaplasty improves the distal perfusion pressure and, by inference, flow, which provides strong objective confirmation of the clinical impression that this operation is of value and help in determining its place in the management of severe lower limb ischemia.

The value of Doppler blood velocity tracings in the detection of aortoiliac disease in patients with intermittent claudication.

Velocity tracings obtained with a Doppler ultrasound probe located over the common femoral artery have been evaluated as to their ability to predict the state of the proximal aortoiliac segment. Aortography was used as the assessor of the extent of aortoiliac disease. Five parameters of the tracings sensitive only to aortoiliac disease were submitted to miltivariate analysis. The probability of the aortoiliac segment having greater or less than 10% stenosis was calculated. In 86% of limbs, a high probability of diagnostic value and practical use resulted.

The relationship of the dilute whole blood lysis time to the fibrinolytic activity of blood: effect of change in plasma fibrinogen.

The rate of digestion of fibrin was measured in vitro by an isotopic technique in 140 blood samples of differing fibrinogen concentration; the assessment of fibrinolytic activity thus obtained was compared with a standard method of measurement, the dilute whole blood lysis time. The lysis time was related exponentially to the fibrinolytic activity as measured by the isotopic technique, and further was influenced markedly by alteration in the plasma fibrinogen concentration. The relevance of these observations to the use of lysis time methods for the measurement of fibrinolytic activity is discussed.

Timed fibrin digestion: a simplified technique for the measurement of the fibrinolytic activity of the blood.

When the rate of fibrinolysis in vitro was measured by an isotopic technique, it was found that the amount of fibrin digested after incubation for three hours correlated closely with the overall rate of the digestion process. It is suggested that, using an isotopic technique, estimation of fibrin digestion after three hours' incubation provides a useful method for measuring the fibrinolytic activity of blood. A recommended technique is described and its advantages are discussed briefly.