ABSTRACT
From April 1987 to March 1990, we performed open heart surgery using extracorporeal circulation in 90 patients (average age, 51.8 years old) and vascular surgery (graft replacement of abdominal aortic aneurysm and surgery for ASO) in 29 patients (average age, 58.1 years old). Among there, 8 patients with open heart surgery (EEC group) and 9 patients with vascular surgery (vascular group) had suffered from renal insufficiency preoperatively. In the two groups, we compared operative mortality, complications and postoperative severity of renal failure. Preoperative renal insufficiency was defined as a serum creatinine level of more than 1.4mg/dl and postoperative renal failure was defined as 2.0mg/dl. There was no significant difference in operative mortality, in postoperative creatinine, Ccr, BUN and serum potassium and in effectiveness of hemodialysis in the two groups. In conclusion, it seems that we should not hesitate to perform cardiovascular surgery with extracorporeal circulation for patients with renal insufficiency or in hemodialized patients.
ABSTRACT
In a consecutive series of abdominal aortic aneurysm repairs, a non-washing autotransfusion unit system was used in 47 patients, and was not used in 25. In the 47 patients treated with the autotransfusion unit, the average amount of autotransfused blood was 1, 109±131ml in elective cases. The amount of banked blood transfusion was significantly smaller in autotransfused patients (mean; 712ml), compared to non-autotransfused patients (mean; 1, 405ml). Postoperative levels of serum bilirubin were higher in patients with greater autotransfused blood volumes than those with smaller volumes. The combination of preoperative autologous blood donation (2-3 units) and intraoperative autotransfusion is necessary to perform abdominal aortic aneurysm repair without homologous blood transfusion.
ABSTRACT
Surgical interventions for aorto-iliac obstructive diseases were studied through the operative results. Eighteen patients underwent aorto-femeral bypass (AOF) and 23 who were over 70 years of age or who had serious preoperative complications had axillofemoral bypass (AXF). No perioperative death occurred in AOF patients, while the mortality rate of AXF patients was 8%. Postoperative ankle pressure indexes were significantly higher in AOF patients than in AXF patients. Follow-up graft patency rate was 100% in AOF patients at 54 months (mean), and 85% in AXF patients at 44 months respectively. AOF should be the first choice for patients with aorto-iliac obstructive disease, and AXF is suitable only for high-risk patients.
ABSTRACT
This is a case report of a 40-year-old man with leiomyosarcoma of the inferior vena cava. He had suffered from shortness of breath and edema on lower limbs over several months. Clinical examinations including UCG, CT and MRI revealed the mass in the right atrium. The stalk of mass was located near junction of the right atrium and inferior vena cava by cavography. He was operated upon using extracorporeal circulation. The tumor originated from inferior vena cava, measuring 8.5×5.5×4.8cm in size, 130g in weight, was successfully removed. Partial defect of anterior wall on the inferior vena cava was reconstructed using Gore-Tex patch. Histologically, the tumor was composed of the spindled cells with arranged bundles. Immunohistochemically, they were positive for Dessmin and Vimentin. Seven months after the surgery, he has been followed at OPD. In review of the Japanese literature to our knowledge, only 14 cases were reported including this case.