Infrarenal aortofemoral bypass surgery: risk factors and mortality in 330 patients with abdominal aortic aneurysm or aortoiliac occlusive disease.

330 patients operated on for infrarenal abdominal aortic aneurysm (AAA) or aortoiliac occlusive disease (AIOD) between 1976-85 were retrospectively reviewed for early mortality and long-term survival. Data were analysed by crosstabulation and stepwise logistic regression methods for early mortality and by Kaplan-Meyer and Cox proportional hazard model for late survival. The 30-day mortality for elective AAA-patients was 9.6% and for ruptures 64.6%. For the AIOD-patients it was 2.0%. The principal cause of early death in the elective patients was acute myocardial infarction. The five-year survival rates for elective and ruptured AAA and AIOD-patients were 68%, 56% and 74%, respectively. The major late cause of death was coronary heart disease followed by pulmonary cancer. The risk factors for 30-day mortality were coronary heart disease, rupture, preoperative shock, excessive bleeding and aortic crossclamping time for the AAA-patients. In the rupture group the specialization of the surgeon had a significant impact on early mortality. Factors affecting the late survival were age, chronic cardiac failure, operation year, chronic pulmonary disease and previous malignancy in the whole study population. The late survival of both AAA and AIOD-patients after a successful operation was significantly shorter than that of an age- and sexmatched normal population. The late survival of AAA-patients was worse than that of AIOD-patients.

Long-term outcome of surgery for thoracic outlet syndrome.

BACKGROUND: Thoracic outlet syndrome (TOS) is one of the most controversial symptom complexes in surgery today. Even the existence of TOS is questioned and where it seems to exist, the incidence varies from one country to another. Surgery is often considered the primary treatment; however, the frequency of good results after surgery varies from 24% to 100%, and in recent years the surgical approach has been questioned. PATIENTS AND METHODS: In this study 45 patients who had undergone surgery for TOS symptoms over a period of 21 years were examined by an independent clinician an average of 8 years after the operation. RESULTS: Forty-three percent of the performed operations were found to have been successful. Preoperative nocturnal and neck pain were more frequent in the unsuccessful group; no other preoperative characteristics had a predictive value. Preoperative radiographic and neurophysiologic examinations were also not predictive of the outcome. CONCLUSION: It is recommended that the feasibility of conservative therapeutic approaches should be evaluated before undertaking surgery for TOS symptoms.

Femoropopliteal angioplasty in patients with claudication: primary and secondary patency in 140 limbs with 1-3-year follow-up.

PURPOSE: To determine the usefulness of percutaneous transluminal angioplasty in the femoropopliteal arteries in patients with claudication. MATERIALS AND METHODS: In a prospective study of 106 claudicants (71 men and 35 women, aged 41-90 years [mean, 67 years]), a total of 208 lesions in 140 limbs were treated. The patients were followed up for 12-36 months. The patency rates were based on determination of the ankle-brachial index. RESULTS: The hemodynamic success rate for all the treated limbs was 89%, 99% for femoropopliteal stenoses (n = 71) and 80% for femoropopliteal occlusions (n = 69). In multiple logistic regression analysis, a smaller number of diseased vessels (one to two vs three to seven) and milder lesion severity (stenosis vs occlusion) correlated favorably with early success. Survival analysis with the Kaplan-Meier method according to established criteria revealed 1-, 2-, and 3-year primary patency rates of 47% (27 of 57 limbs), 41% (14 of 34 limbs), and 43% (three of seven limbs), respectively. CONCLUSION: In selected cases, good primary success and acceptable long-term results can be achieved with femoropopliteal angioplasty in claudicants.

Axillary artery rupture complicating anterior dislocation of the shoulder. Case report.

Vascular injury is a rare complication of anterior dislocation of the shoulder joint. Two cases, both in elderly persons (65 and 74 years) were treated in our Department during a 5-year period. Atherosclerotic changes of the axillary artery and previous shoulder dislocation are predisposing factors for such injury.

CT-control of the H-graft interposition mesocaval shunt patency.

A method for assessing the patency of the H-graft interposition mesocaval shunts by computerized tomography is described. Five patients with such shunts were examined with a 5.5 second CT scanner. After locating the graft a 50 cc bolus of 76% diatrizoate was injected into a cubital vein and 3-4 scans were executed at a preselected level. A distinct vessel like enhancement appeared if the shunt was open. With dynamic CT-scanning the flow can be demonstrated in graphical form as time-density curves.

Sciatic pain from an aneurysm of the internal iliac artery.

A 66-year-old man suffered from sciatic pain in the right leg for many years. As a result he was operated upon 4 years ago but without obtaining permanent help. In spite of the operation and angiography the correct diagnosis was made by means of rectal palpation and computerized tomography. The diagnosis was confirmed by further angiography. The cause of the sciatic pain was a large aneurysm of the internal iliac artery which was subsequently operated upon. Proximal ligation of the internal iliac artery was performed and the pain disappeared completely post operatively.