Ruptured abdominal aortic aneurysm.

A total of 131 surgically treated ruptured abdominal aortic aneurysms have been reviewed. Factors affecting morbidity and mortality rates have been analyzed. In our experience very little improvement has occurred in the last 10 years and the question is raised whether a plateau has been reached in the management of this catastrophic disease. Patient selection is not considered to be the key to better results, since some operated patients inevitably die. Improved technique with better, more rapid control of blood loss, especially from venous tears, will continue to yield better results. Eighty-six nonoperative cases have been studied. Diagnostic accuracy is lower than it should be, often leading to delayed surgery or death.

Initial experience with the polytetrafluoroethylene graft for limb salvage. A report on twenty patients.

The early results of the bypass procedures for limb salvage using the new polytetrafluoroethylene (PTFE) graft are analyzed. Of twenty patients presenting with either severe rest pain or gangrene, patency has been maintained in fourteen for a mean period of thirteen months to date. Particularly satisfying results have been achieved when bypassing into single dominant arteries below the knee where limb salvage and graft patency was obtained in all cases.

Revascularization of the leg using polytetrafluoroethylene: cumulative patency in patients with claudication and limb salvage.

Of 196 polytetrafluoroethylene bypass grafts in the leg, 113 were placed in the femoropopliteal and 83 in the femorotibial or femoroperoneal position. Claudication was the indication for 31 percent of the grafts, and 67 percent were done for limb salvage. Cumulative patency rates calculated by the life-table method for the femoropopliteal grafts were 66 percent at 1 year, 53 percent at 2 years, and 49 percent at 3 years. Corresponding patency rates for the femorotibial or peroneal grafts were 48, 44, and 36 percent, respectively. An analysis of factors influencing graft patency indicated that the best results were obtained with femoropopliteal grafts done for claudication in the presence of good distal runoff and grafts placed in limbs without previously failed grafts. Graft occlusion was most likely in distal bypasses for limb salvage and limbs with previously failed grafts. It is concluded that alternatives to PTFE bypass should be considered in those patients at greatest risk for graft occlusion. In patients who lack a satisfactory saphenous vein but who must have a bypass graft, polytetrafluoroethylene is an acceptable arterial substitute; however, thrombectomy or revision will be required to maintain patency in a high proportion of cases.

The talent endoluminal AAA stent-graft system. Report of the phase I USA trial, and summary of worldwide experience.

In the United States, the Phase I Feasibility Study under IDE G970065 was approved by the Food and Drug Administration on 04/11/97. The approved protocol called for implantation of the bifurcated Talent spring stent-graft system on patients who are high-risk candidates for conventional surgery because of cardio-respiratory, medical, general, or local anatomical reasons which would likely complicate the technical execution of the operation or be accompanied by a high expected mortality rate. Patient enrollment was complete with 16 cases as of September 26, 1997. This was a multicenter experience involving five different sites. This is an ongoing study and patients, of course, will continue to be followed longitudinally. Phase II will likely be approved by the FDA for initiation in January or February of 1998. Standard-risk AAA patients will be entered into the study at this time; comparison with concurrent controls will be used for comparison with conventional surgery.

Fracture associated sarcoma in the cat.

A nine-year-old neutered male cat developed an osteosarcoma 15 months after the surgical repair of the proximal femur using an intramedullary pin at the fracture site. The repair had been effective with good healing of the fracture and restoration of normal activity.

The current and future role of the nurse in phlebology: the Canadian experience.

Sclerotherapy treatment of varicose and telangiectatic leg veins is becoming a popular treatment in North America. Since the tools for performing this treatment are inexpensive and readily available, many health care practitioners are performing this technique with variable states of expertise and outcome. Understanding the professional and ethical issues facing phlebology nurses in Canada can enhance the care of phlebology patients in the United States.

Colonic ischemia after aortic reconstruction.

Colonic ischemia after aortic reconstruction is rare, but when it occurs in its worst form it carries a 50% death rate. The etiology and pathogenesis of this condition demonstrate that in many instances it may be prevented. Early recognition, particularly of the transmural ischemic injury, is essential. Numerous techniques used during surgery for assessing the adequacy of colonic perfusion have been evaluated and found to be cumbersome and inaccurate in terms of predicting colonic ischemia. Recent experience with the use of the pulse oximeter appears promising in identifying patients with inadequate colonic perfusion who may then be candidates for reimplantation of the inferior mesenteric artery.

Presidential address, 1989. The future of vascular surgery in Canada.

There has been an explosion of technology in the field of vascular surgery in the latter half of the 1980s. Laser procedures, atherectomy catheterization, intra-arterial stenting and balloon angioplasty have all been demonstrated, with varied degrees of success, to play a role in the management of the patient with vascular disease. Vascular surgeons must be wary of unproven devices that come complete with extravagant claims of success. But, they should also show an interest in new technology as it comes along and should be prepared to become involved in its scientific evaluation. Some of these techniques, perhaps in a more refined state, will play an important role in patient care in the future. Vascular surgeons in Canada must also develop their interests and knowledge of circulatory hemodynamics by committing themselves to using duplex scanning equipment in their diagnostic vascular laboratories. Such laboratories must be staffed by thoroughly trained directors and technologists, and to do this, we must look to making vascular laboratory training part of the requirements for fellowship in the Royal College of Physicians and Surgeons of Canada.

Current surgical approach to toxic megacolon.

Presented evidence illustrates that proctocolectomy performed as an emergency procedure is frequently less than adequate in salvaging patients with toxic megacolon, and a current mortality of 27 per cent is recorded. The mortality and morbidity of this disease are directly related to the delay in recognition and treatment of this complication and to iatrogenic perforation of the colon during colectomy, which results in fecal peritonitis. This is particularly evident when definitive operation is postponed for more than five days after the initial diagnosis of toxic megacolon. The rationale of current adherence to proctocolectomy for this complication is questioned, and a plea is made for the recognition of the life-saving potential for ileostomy-colostomy for selected patients and also for closer and earlier collaboration between surgeon and internist during the management of these patients.