RESUMEN
Fractures of the proximal humerus with concomitant vascular injury are rare in children. We describe the presentation, diagnosis, and treatment of a fracture of the proximal humerus in association with an axillary artery injury in a child.
Asunto(s)
Arteria Axilar/lesiones , Fracturas del Hombro/complicaciones , Adolescente , Arteria Axilar/cirugía , Arteria Braquial/cirugía , Hematoma/etiología , Hematoma/cirugía , Humanos , Masculino , Fracturas del Hombro/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: This study was undertaken to evaluate the outcome of infrainguinal arterial reconstruction in a high-risk subset of patients with end-stage renal disease. METHODS: We reviewed the medical records of 44 patients requiring maintenance dialysis and undergoing 57 infrainguinal bypass procedures for limb salvage from 1986 to 1992. These included 16 (28%) femoropopliteal and 41 (72%) tibial or pedal bypasses with autogenous (82%), prosthetic (12%), or composite (6%) graft materials. The principal indications for operation were ischemic ulceration or gangrene (79%) and rest pain (21%). Angiographic evaluation most frequently showed single-vessel runoff (56%). Risk factors included age (mean, 63 years), diabetes (75%), hypertension (93%), coronary artery disease (52%), smoking (39%), previous myocardial infarction (20%), and contralateral amputation (18%). Infection was present in 22 limbs (39%). RESULTS: Early (30-day) surgical morbidity rate was 39%, including wound breakdown (19%), graft thrombosis (9%), and major amputation (4%). Perioperative mortality rate was 9%. Cumulative primary graft patency rates were 71% and 63%, secondary patency rates were 80% and 66%, and limb salvage rates were 70% and 52% at 1 and 2 years, respectively. Limb loss correlated most highly with the presence of preoperative infection (p = 0.036; log-rank method). Patient survival rate was 52% at 2 years. CONCLUSIONS: Life-table analysis confirms a poor life expectancy for this population but indicates that an acceptable level of limb salvage may be achieved with arterial reconstruction in properly selected patients.
Asunto(s)
Conducto Inguinal/irrigación sanguínea , Isquemia/cirugía , Fallo Renal Crónico/complicaciones , Pierna/irrigación sanguínea , Adulto , Anciano , Anciano de 80 o más Años , Arterias/cirugía , Humanos , Técnicas In Vitro , Isquemia/etiología , Tablas de Vida , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
Deep venous thrombosis and its sequelae, pulmonary embolism, recurrence, and the postthrombotic syndrome, affects a staggering number of patients. Deep venous thrombosis is a frequent postoperative complication, especially after certain orthopedic operations. Pulmonary embolism is the third leading cause of death in the United States, and the postthrombotic syndrome effects an estimated 500,000 Americans. Prompt diagnosis and treatment of thromboembolic disease is important, but prevention may be the key to lessening the number of patients with venous disease in the future.