ABSTRACT
The ideal operative approach for infrainguinal in situ bypass grafting would render the saphenous vein (SV) valves incompetent while occluding venous tributaries from within the SV: an endovascular in situ SV bypass. Forty-six femoropopliteal-tibial in situ bypasses were performed in part by the endovascular occlusion technique. Valvulotomy was accomplished with a retrograde "cutter" valvulotome, and endoluminal cannulation of 84 SV tributaries was performed with a shape memory metal alloy (nickle-titanium), electronically steerable catheter under angioscopic surveillance. Sixty-nine SV tributaries (82%) were totally occluded and 15 (18%) were partially occluded with platinum occlusion coils. Twelve coils that "recoiled" into the SV lumen were retrieved uneventfully. The valvulotomes caused six SV perforations that were repaired without consequence. Intraoperative fluoroscopy confirmed coil placement and verified venous tributary occlusion, as well as SV graft patency. During short-term follow-up (mean 9.2 months; range 1 to 15 months), all patients have undergone ultrasonography of the in situ bypasses. All 69 of the SV tributaries that occluded initially have remained occluded and 84% (39/46) of the in situ bypasses have remained patent. This study demonstrates that an electronically steerable nitinol catheter can be used safely to occlude venous tributaries from within the SV. Endovascular occlusion of SV tributaries may ultimately obviate the need for long incisions the length of the leg, thus reducing wound-related problems and shortening recuperation.
Subject(s)
Embolization, Therapeutic/instrumentation , Peripheral Vascular Diseases/therapy , Saphenous Vein , Aged , Alloys , Arteriovenous Shunt, Surgical/methods , Catheterization , Catheterization, Peripheral/instrumentation , Embolization, Therapeutic/methods , Female , Femoral Vein , Humans , Male , Popliteal Vein , Vascular Patency/physiologyABSTRACT
A case is described in which, at semilunar valve level, the aorta and pulmonary artery arose from inappropriate ventricles. Despite this, the outflow tracts to both vessels originated from the left ventricle. Embryologically, it is speculated that this anomaly is the result of normal rotation of the proximal conus, without concomitant truncal inversion, and excessive leftward shift of the proximal conus and conal septum or anterior and rightward deviation of the anterior segment of the ventricular septum. Surgical repair using a double conduit between the right ventricle and pulmonary artery and left ventricle and aorta, respectively, was unsuccessful.
Subject(s)
Heart Ventricles/abnormalities , Transposition of Great Vessels/complications , Child, Preschool , Heart Septal Defects, Ventricular/complications , Heart Septal Defects, Ventricular/pathology , Heart Ventricles/pathology , Humans , Male , Transposition of Great Vessels/pathologyABSTRACT
A technique for closure of the complicated ductus arteriosus is described which has proved both simple and safe. The technique embodies the use of profound hypothermia, low flow, and direct suture of the pulmonary end of the ductus arteriosus through a pulmonary arteriotomy. No operative deaths have occurred among 4 patients so treated, and no complications from air embolism or hemorrhage have been encountered.
Subject(s)
Ductus Arteriosus, Patent/surgery , Blood Flow Velocity , Cardiac Catheterization , Cardiopulmonary Bypass , Female , Humans , Hypothermia, Induced , Middle Aged , Pulmonary Artery/surgery , SuturesABSTRACT
A case of gastrobronchial fistula complicating thoraco-abdominal trauma is presented. Possible pathogenesis is discussed and a further cause for failure of a fistula to close is suggested.
Subject(s)
Bronchial Fistula/etiology , Gastric Fistula/etiology , Wounds, Gunshot/complications , Abdominal Injuries/complications , Adult , Bronchial Fistula/diagnostic imaging , Bronchial Fistula/surgery , Gastric Fistula/diagnostic imaging , Gastric Fistula/surgery , Humans , Male , Radiography , Thoracic Injuries/complications , Thoracic Surgery , Thorax/surgery , Time FactorsABSTRACT
Experience in the use of intra-aortic balloon pumping for moribund cardiac surgical patients over a 10-month period is presented. Of the 11 patients reported, 5 survived and have left hospital. The mechanism of diastolic augmentation of the circulation is discussed and the details of its clinical use are outlined.