Temporary axillofemoral bypass: its use in high risk cardiac patients requiring urgent abdominal aneurysm repair.

The creation of a temporary axillofemoral bypass in a patient undergoing surgery for an 8.1 cm symptomatic infrarenal aortic aneurysm is described. This adjunctive procedure, rarely used in abdominal aortic surgery, may have contributed to minimizing variations in afterload in a patient with a 20% ejection fraction and severe mitral regurgitation.

Emergency embolization of a ruptured aneurysm of the pancreaticoduodenal arcade.

Inferior pancreaticoduodenal aneurysms are uncommon. A 77-year-old woman was seen with a 1-week history of sharp pain in the right lower abdominal quadrant radiating to the back, associated with malaise, anorexia, vomiting and nonbloody diarrhea. Appendicitis was diagnosed, but at laparotomy a large retroperitoneal hematoma was found; no aneurysm was identified. The abdomen was closed and aortography was done. An aneurysm of the inferior pancreaticoduodenal artery arcade was demonstrated, with occlusion of the celiac artery at its origin. The arc of Buehler was patent and enlarged and supplied the hepatic and splenic arteries. Embolization with Gianturco coils placed proximal to the aneurysm was successful.

Abdominal aortic aneurysm surgery, Part II: Major complications and nursing implications.

This article reviews the most immediate postoperative complications after abdominal aortic aneurysm surgery. Acute limb ischemia, thromboembolism and pulmonary embolism, postoperative bleeding, and compartment syndrome are described with the associated nursing implications. Prosthetic graft problems are discussed and suggestions for prevention are offered.

Abdominal aortic aneurysm surgery, Part I: An overview and discussion of immediate perioperative complications.

An overview of abdominal aortic aneurysm surgery and the immediate perioperative problems are described. Cardiovascular complications are discussed, with the underlying theme being one of prevention. Clinical nursing algorithms are presented and the salient points of nursing care are summarized.

A technical-skills course for 1st-year residents in general surgery: a descriptive study.

The proper teaching of operative skills to surgical residents is increasingly constrained by operative time, complex procedures and medicolegal concerns. A technical-skills program was developed and introduced over a 3-year period to 28 1st-year residents in general surgery. To introduce the residents to the principles of surgical techniques in a simulated environment outside the operating room, the program consisted of a combination of two didactic sessions and six "wet labs" taking 3 to 4 hours per week for 8 weeks between January and March each year. The didactic sessions included instruction on suture material and the use of stapling devices; the "wet lab" used a "hands-on" approach. Educational objectives in the "wet lab" included instruction on preparation of the patient and draping, aseptic technique, principles of bowel anastomosis, incisions, instrument use and handling, principles of hemostasis, intraoperative surgical emergencies, surgical assisting and overall conduct in the operating room. The residents' surgical technique and skills improved over the course period. The overall value, teaching and understanding of surgical principles were rated highly. Problems cited during resident feedback were the use of live animals and insufficient time to practise. The efficacy of a surgical-skills program has been demonstrated, but its effectiveness requires further evaluation.