Assuntos
Prótese Vascular/efeitos adversos , Controle de Infecções/métodos , Cuidados Pós-Operatórios/métodos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/terapia , Antibioticoprofilaxia/métodos , Humanos , Controle de Infecções/tendências , Seleção de Pacientes , Cuidados Pós-Operatórios/tendências , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/epidemiologia , Irrigação Terapêutica/métodos , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodosRESUMO
Pseudoaneurysm formation and infection at the site of iliac artery stenting are uncommon complications that occur soon after stent placement. We describe a case in which an infected pseudoaneurysm developed 22 months following stent implantation. Stent infection, although rare, has potentially disastrous implications, as made evident by a review of the literature. Prophylactic antibiotic therapy at the time of stent placement is recommended.
Assuntos
Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Artéria Ilíaca , Stents/efeitos adversos , Falso Aneurisma/diagnóstico , Falso Aneurisma/terapia , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/prevenção & controle , Aneurisma Infectado/terapia , Antibioticoprofilaxia , Constrição Patológica , Embolização Terapêutica , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Fatores de TempoRESUMO
OBJECTIVE: To compare carotid endarterectomy (CEA) based solely on Duplex ultrasonography (DU) with CEA based on DU and arteriography. DESIGN AND SETTING: Retrospective case series analysis in a regional tertiary care center. PATIENTS: Consecutive sample of 194 patients undergoing 218 CEAs from January 1, 1993, through June 30, 1995, with either preoperative DU plus arteriography (165 CEAs) or DU only (53 CEAs). MAIN OUTCOME MEASURES: Concordance of the 2 diagnostic imaging techniques and influence of these on the conduct of surgery, surgical outcome, and resource cost. RESULTS: There was agreement (kappa = 0.85) between DU and arteriography in the detection of a carotid occlusion or a stenosis greater than 45%. Arteriography demonstrated 26 aortic arch branch lesions (15.8%), 22 intracranial abnormalities (13.3%), and 6 type C ulcers (3.6%), in addition to 1 nonoccluded internal carotid artery (ICA) (0.61%) and 1 contralateral severe ICA stenosis (0.61%) inaccurately estimated by Duplex. These findings prompted 3 changes (1.8%) in surgical therapy, including 2 decisions in favor of CEA and 1 subclavian-carotid bypass added to CEA. There was no difference in the stroke and death rate for CEA based solely on DU compared with CEA based on DU and arteriography (P = .43). The mean total hospital cost was $5,534 for DU only CEA vs $7,608 for DU plus arteriogram CEA (mean difference = $2,074, P < .01). CONCLUSIONS: The addition of carotid arteriography to a diagnostic Duplex ultrasound study that already suggested the need for CEA did not change the operative plan in 98% (162/165) of the cases. Carotid endarterectomy based solely on DU is appropriate and cost-effective.
Assuntos
Angiografia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/economia , Ultrassonografia Doppler Dupla , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/diagnóstico , Análise Custo-Benefício , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos RetrospectivosRESUMO
A comprehensive review of vascular access procedures at one institution over a 10-year period was performed to assess primary hemodialysis (HD) access patency. A total of 427 operations were performed between January 1983 and January 1993. There were 147 Brescia-Cimino fistulae (B-C fistula), 111 perforating antecubital vein (PAV) fistulae, and 28 synthetic graft fistulae. There were 134 patients who were not considered candidates for arteriovenous fistula (AVF) formation and received only central venous HD access. Seven external fistulae in burn patients were deleted from the study. No patient in this study had undergone prior HD access. Primary failure was defined as fistula thrombosis, inadequate flow for hemodialysis, or a complication requiring ligation. Kaplan-Meyer life table analysis was used to determine primary fistula patency. The results were as follows: PAV fistulae had a primary patency rate of 80% at a median follow up of 36 months (1-124 months); the B-C fistula was 66% at a median 27 months (1-120 months), and the synthetic graft fistula was 64% at median 7 months (1-40 months). The primary patency rate of the PAV fistula was significantly better than the B-C fistula (p = 0.0015) or the synthetic graft fistula (p = < 0.0001). In conclusion, the PAV fistula has an excellent patency rate and appears to be a viable option for AV access after a failed B-C fistula or when a B-C fistula is not technically feasible.
Assuntos
Braço/irrigação sanguínea , Derivação Arteriovenosa Cirúrgica , Diálise Renal , Grau de Desobstrução Vascular , Adolescente , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Cateteres de Demora , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
PURPOSE: This study was performed to determine the primary patency, foot salvage, and complication rates associated with iliac artery stent deployment. METHODS: From March 1992 to May 1995, 147 iliac artery stents were deployed in 98 limbs of 72 patients for disabling claudication or limb-threatening ischemia. Procedure-related and late (> 30 days) complications, as well as adjunctive maneuvers required to correct a complication, were tabulated. Stented iliac artery cumulative primary patency and foot salvage rates were calculated with life-table analysis. Factors that impacted early complications, late complications, foot salvage rates, and stented iliac artery primary patency rates were identified with stepwise logistic regression analysis. RESULTS: A procedure-related complication occurred in 19 (19.4%) limbs. Initial technical success, however, was achieved in all but three of 98 limbs (96.9%). Stented iliac artery cumulative primary patency rates were 87.6%, 61.9%, 55.3%, and foot salvage rates were 97.7%, 85.1%, 76.1%, at 12, 18, and 24 months, respectively. External iliac artery stent deployment, superficial femoral artery occlusion before treatment, and single-vessel tibial runoff before treatment negatively affected stented iliac artery cumulative primary patency rates. Stented iliac artery primary patency rates were not significantly affected by age, smoking, coronary artery disease, diabetes, hypercholesterolemia, hypertension, presenting symptom, early complication, number of stents deployed, type of stent deployed, or stent deployment for stenosis versus occlusion. CONCLUSIONS: Limb-threatening and life-threatening complications can be associated with iliac artery stent deployment. Stented iliac artery primary patency rates are affected by distal atherosclerotic occlusive disease and the position of the deployed stent within the iliac system. Stent reconstruction of severe iliac artery occlusive disease is feasible but should be thoughtfully selected.
Assuntos
Arteriopatias Oclusivas/cirurgia , Artéria Ilíaca/cirurgia , Stents/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/fisiopatologia , Humanos , Claudicação Intermitente/fisiopatologia , Claudicação Intermitente/cirurgia , Isquemia/fisiopatologia , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Tábuas de Vida , Modelos Logísticos , Pessoa de Meia-Idade , Grau de Desobstrução VascularRESUMO
The purpose of this study was to analyze outcomes of two different treatment strategies in patients treated for renal artery (RA) stenosis and a coincidental abdominal aortic aneurysm (AAA). A total of 50 patients were encountered who required treatment for concomitant RA stenosis and an AAA from 1980 to 1994. Simultaneous operative aortic and RA reconstruction was done in 32 patients, whereas 18 patients where treated with preoperative percutaneous transluminal renal artery angioplasty (PTRA). The two groups were well matched with respect to age, AAA size, incidence of hypertension, preoperative creatinine level, and creatinine clearance (all p values > 0.07). Aortorenal bypass (18 RAs), reimplantation (18 RAs), or endarterectomy (2 RAs) was performed to correct a mean RA stenosis of 88%, whereas 23 RAs (91% mean stenosis) were treated with preoperative PTRA. PTRA failed in four patients with RA stenosis, and they were successfully treated with surgery (3 bypasses and 1 reimplantation). Statistical analysis did not demonstrate a significant difference between these four failed PTRA patients, the 14 successful PTRA patients, and the 32 RA reconstruction patients in terms of operating time (p = 0.15), operative blood loss (p = 0.20), intensive care unit days (p = 0.71), or total hospital days (p = 0.94). Among the 40 patients available for follow-up, hypertension was cured in seven, improved in 10, unchanged in 15, and worse in eight with no difference demonstrated between the groups (p = 0.73). These data suggest that preoperative PTRA has no specific advantage over surgical RA reconstruction in patients with concomitant RA stenosis and AAA. Failed PTRA did not preclude or complicate subsequent operative RA revascularization.
Assuntos
Aneurisma da Aorta Abdominal/complicações , Obstrução da Artéria Renal/complicações , Fatores Etários , Idoso , Anastomose Cirúrgica , Angioplastia com Balão , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/cirurgia , Perda Sanguínea Cirúrgica , Creatinina/sangue , Creatinina/urina , Cuidados Críticos , Endarterectomia , Feminino , Seguimentos , Hospitalização , Humanos , Hipertensão/complicações , Hipertensão/prevenção & controle , Tempo de Internação , Masculino , Cuidados Pré-Operatórios , Artéria Renal/cirurgia , Obstrução da Artéria Renal/cirurgia , Obstrução da Artéria Renal/terapia , Reimplante , Estudos Retrospectivos , Fatores de Tempo , Falha de Tratamento , Resultado do TratamentoRESUMO
One hundred forty-seven consecutive patients with limb-threatening acute diabetic pedal sepsis and/or chronic ischemia (Fontaine III/IV) were prospectively studied. Forty-four with palpable pulses underwent successful surgery (major or minor amputation, incision, and drainage) without further evaluation; 103 with decreased or absent pulses had baseline TcPO2 measurements. Fourteen patients with values > or = 30 mm Hg underwent major or minor amputation with 91% (13 of 14) healing success. Ninety patients with values < 30 mm Hg underwent arteriography with 98% (87 of 89) showing significant disease. Of these, 22 did not undergo revascularization and only 50% (11 of 22) showed primary healing following minor amputation or debridement. Sixty-seven patients underwent 74 revascularization procedures; 95% (64 of 67) showed improvement of TcPO2 > 30 mm Hg and of these, 91% (58 of 64) had healing of minor amputation or debridement sites (p < 0.05). TcPO2 measurements may be used to direct therapy because they have been shown to accurately predict the presence of significant vascular disease, its appropriate correction by means of revascularization, and the success of major or minor amputations with or without revascularization.
Assuntos
Monitorização Transcutânea dos Gases Sanguíneos , Pé Diabético/sangue , Doenças Vasculares Periféricas/sangue , Algoritmos , Amputação Cirúrgica , Derivação Arteriovenosa Cirúrgica , Pé Diabético/cirurgia , Humanos , Doenças Vasculares Periféricas/cirurgia , Estudos Prospectivos , CicatrizaçãoRESUMO
PURPOSE: To test the hypothesis that lower extremity transcutaneous oxygen (TcPO2) measurements can accurately predict severity of foot ischemia and can be used to select appropriate treatment (conservative versus operative) for patients with diabetes and tissue necrosis or ischemic rest pain. METHODS: Fifty-five patients with 66 limbs were prospectively treated from June 1993 to July 1994. Noninvasive hemodynamic arterial assessment and TcPO2 mapping of the involved limb were obtained before treatment was selected. If the transmetatarsal TcPO2 level was 30 mm Hg or greater, the patient's foot problem was managed conservatively with local wound care, debridement, or a minor foot amputation. If the transmetatarsal TcPO2 level was less than 30 mm Hg, arteriography was performed with the anticipated need for vascular reconstruction. The endpoints for determining treatment success or failure were complete wound healing or relief of ischemic rest pain. RESULTS: Thirty-one of 36 (86%) limbs with an initial transmetatarsal TcPO2 level of 30 mm Hg or greater were treated successfully with conservative care, including 73% (11 of 15 feet) of limbs without a palpable pedal pulse. After either bypass or angioplasty, 20 of 24 (83%) limbs achieved a transmetatarsal TcPO2 level greater than 30 mm Hg and had complete resolution of their presenting foot problem. An initial or postintervention transmetatarsal TcPO2 level of 30 mm Hg or greater was more accurate (90%, p = 0.001) than a palpable pedal pulse (65%, p = 0.009), in predicting ultimate wound healing or resolution of rest pain. CONCLUSIONS: TcPO2 mapping is a useful noninvasive modality that can prospectively determine severity of foot ischemia, aid in selecting appropriate treatment for patients with diabetes and foot salvage problems, and decrease the total cost of such care.
Assuntos
Monitorização Transcutânea dos Gases Sanguíneos , Pé Diabético/sangue , Pé/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Monitorização Transcutânea dos Gases Sanguíneos/economia , Protocolos Clínicos , Custos e Análise de Custo , Pé Diabético/economia , Pé Diabético/terapia , Feminino , Custos de Cuidados de Saúde , Humanos , Isquemia/sangue , Isquemia/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: The purpose of this review was to ascertain the cumulative primary and secondary graft patency rates, the cumulative limb salvage rate, and the frequency of atherosclerotic disease progression proximal to the graft origin, in patients with autologous saphenous vein popliteal-tibial artery bypass grafts whose operative indication was limb-threatening ischemia. PATIENTS AND METHODS: Forty-three short autologous saphenous vein grafts originating from the popliteal artery were retrospectively reviewed. The life-table method was used to determine primary and secondary graft patency and limb salvage rates. Atherosclerotic disease progression proximal to the graft origin was assessed via follow-up arteriography, segmental limb pressures, or pulse-volume recordings. All other data were compared by chi-square analysis. RESULTS: The cumulative primary graft patency rate at 1, 3, and 5 years (86%, 66%, 58%) was similar to the cumulative secondary patency rate (90%, 70%, 62%) and the cumulative limb salvage rate (80%, 55%, 55%). No patient developed hemo-dynamically significant atherosclerotic disease proximal to the graft origin during the follow-up period. CONCLUSIONS: The similarity of the life-table data suggests graft-dependent, poorly collateralized limbs; it is therefore not uncommon for these patients to require major amputations shortly after bypass failure. There was no evidence of critical proximal disease progression that might warrant a more proximal graft origin. Poplitealtibial artery bypass grafts are durable, with acceptable graft patency and limb salvage rates.
Assuntos
Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Artéria Poplítea/cirurgia , Veia Safena/transplante , Artérias da Tíbia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriosclerose/patologia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Autólogo , Grau de Desobstrução VascularAssuntos
Amputação Cirúrgica , Doenças Vasculares Periféricas/cirurgia , Reperfusão , Idoso , Amputação Cirúrgica/economia , Amputação Cirúrgica/mortalidade , Análise Custo-Benefício , Tomada de Decisões , Humanos , Avaliação em Enfermagem , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/enfermagem , Reperfusão/economia , Reperfusão/mortalidadeRESUMO
An aggressive posture toward limb salvage in the elderly was assessed by retrospective review of a 5 year experience. A total of 302 primary lower extremity revascularizations and 465 primary major amputations were performed; of these, 62 per cent (472/767) were performed in patients 70 years or older (range 70-104, mean 78). Psychosocial status was utilized to indicate primary amputation; revascularization was attempted in all patients capable of ambulation or transfer. Revascularization was performed in 119 patients > 70 years old (44 femoropopliteal, femorotibial, or sequential, 24 extra-anatomic, and 11 miscellaneous) with a 30-day mortality of 8 per cent, thrombosis 12 per cent, and early amputation 7 per cent. There were five additional mortalities and three amputations, for a 77 per cent life and limb salvage at one year. This contrasted with a 2.2 per cent mortality (P < 0.05), 5.4 per cent thrombosis, and 3.3 per cent amputation rate in 183 revascularizations in < 70 year old patients. Primary amputation was performed with an 8 per cent (23/253) mortality in 253 patients > 70 years old undergoing 192 above and 61 below-knee procedures. There were two mortalities in 154 elective cases, but a 22 per cent rate in urgent situations (P < 0.01) ranging from 66 per cent (12/18) for emergency and 25 per cent (3/12) guillotine to 8 per cent (6/69) for physiologic amputation (P < 0.001). Fifty per cent of all amputation survivors died within 1 year. The comparative mortality for 212 amputations in < 70 year old patients was 1.5 per cent (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Amputação Cirúrgica/estatística & dados numéricos , Perna (Membro)/cirurgia , Reperfusão/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Amputação Cirúrgica/mortalidade , Arizona/epidemiologia , Emergências , Artéria Femoral/cirurgia , Seguimentos , Humanos , Perna (Membro)/irrigação sanguínea , Artéria Poplítea/cirurgia , Reperfusão/mortalidade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Artérias da Tíbia/cirurgiaRESUMO
Fifty-five vascular graft infections were personally managed by the author over an 8-year period. For 22 patients with aortic graft infection, Staphylococcus epidermidis was the most common pathogen (18 of 22 patients), presenting as limb thrombosis in nine and pseudoaneurysm in five. All patients underwent staged extra-anatomic reconstruction and graft resection 4-5 days later. For 33 patients with peripheral infection, S. aureus was the most common pathogen (29 of 33 patients), presenting as clinical graft sepsis usually within months of initial operation. Local therapy was successful in seven of nine patients, whereas graft resection with autologous reconstruction achieved limb salvage in all 11 patients involved. Overall, the mortality rate was 9.1% for 22 aortic and zero for 33 peripheral infections; amputation rates were 14 and 12%, respectively.
Assuntos
Aneurisma Aórtico/cirurgia , Doenças da Aorta/cirurgia , Prótese Vascular , Complicações Pós-Operatórias/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Infecções Estafilocócicas/cirurgia , Amputação Cirúrgica , Falso Aneurisma/etiologia , Falso Aneurisma/mortalidade , Falso Aneurisma/cirurgia , Aneurisma Aórtico/mortalidade , Doenças da Aorta/mortalidade , Desbridamento , Seguimentos , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/mortalidade , Oclusão de Enxerto Vascular/cirurgia , Humanos , Isquemia/etiologia , Isquemia/mortalidade , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Politetrafluoretileno , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/mortalidade , Reoperação , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/mortalidade , Staphylococcus aureus , Staphylococcus epidermidis , Taxa de SobrevidaRESUMO
The strength of various anastomotic techniques was examined in a canine model utilizing a strain gauge to determine the force required to disrupt single/double/multiple sutures placed at 1,2, and 3 mm depth of bite. Pull-out strength was found to be primarily a factor of the plane of preliminary arterial dissection, reflected as the amount of adventitia included in each bite; the depth of the suture was a lesser contributory factor. Pull-out strengths of complete vascular anastomoses were no stronger than their constituent single stitches. An optimal vascular anastomotic technique is therefore advocated.
Assuntos
Aorta/cirurgia , Artéria Ilíaca/cirurgia , Técnicas de Sutura , Suturas , Anastomose Cirúrgica , Animais , Cães , Modelos BiológicosRESUMO
OBJECTIVE: To assess the efficacy of topically applied CT-102 APST for treating diabetic neurotrophic foot ulcers. RESEARCH DESIGN AND METHODS: Thirteen patients entered a randomized, double-blind trial of topically applied CT-102 APST vs. placebo (normal saline) gauze dressings for the treatment of nonhealing diabetic neurotrophic foot ulcers. CT-102 APST (Curative Technologies, Setauket, NY) was prepared from homologous platelets and contained multiple growth factors including PDGF, PDAF, EGF, PF-4, TGF-beta, aFGF, and bFGF. Inclusion criteria for subjects included diabetes, ulcer of > 8 wk duration, peri-wound transcutaneous oxygen tension > 30 mmHg, platelet count > 100,000/mm3, and no wound infection. Wounds were excised before entry and were > 700 mm3 but < 50,000 mm3 in volume, < 100 cm2 in area, and involved subcutaneous tissue. RESULTS: In the CT-102 group, 5 of 7 ulcers were healed (100% epithelialized) by 15 wk, but only 1 of 6 ulcers was healed by 20 wk with placebo (P < 0.05). Average percent reduction in ulcer area at 20 wk was 94% for CT-102 vs. 73% for placebo. Daily reduction in ulcer volume was 73.8 +/- 42.4 mm3/day (mean +/- SE) for CT-102 vs. 21.8 +/- 8.1 mm3/day for placebo (P < 0.05). Daily reduction in ulcer area was 6.2 +/- 1.8 mm2/day for CT-102 vs. 1.8 +/- 0.4 mm2/day for placebo (P < 0.05). CONCLUSIONS: CT-102 significantly accelerated wound closure in diabetic leg ulcers when administered as part of a comprehensive program for the healing of chronic ulcers.
Assuntos
Misturas Complexas , Diabetes Mellitus/fisiopatologia , Úlcera do Pé/tratamento farmacológico , Substâncias de Crescimento/uso terapêutico , Cicatrização , Doença Crônica , Complicações do Diabetes , Método Duplo-Cego , Feminino , Úlcera do Pé/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Ativação Plaquetária , Estudos Prospectivos , Fatores de TempoRESUMO
This 11-year retrospective study reviewed 99 arterial injuries distal to the brachial bifurcation or popliteal trifurcation in 89 extremities in 88 patients. Associated injuries occurred in 78 of 88 (89%) patients, including 10 fractures or dislocations, 66 nerve injuries, and 59 single or multiple tendon injuries. Fasciotomy was performed in 9 upper extremities and 11 lower extremities (23% of patients). The selection of operative treatment by arterial repair or ligation was by surgeon choice (52% repair and 48% ligation). Postoperative patency was found in 45 of 47 (96%) repaired arteries. In cases of isolated single arterial injuries (10), there were excellent results, and there was no difference in the results between repair and ligation. In cases of nonisolated single arterial injuries (69), there were 46% and 36% nonvascular complications in the repaired and ligated groups, respectively. In 10 patients with nonisolated multiple arterial injuries in the same extremity, the results of repair of one artery with ligation of the other artery versus repair of both arteries were identical, and there were no vascular complications. Operative exploration was the key to complete evaluation of vascular and neuro/musculoskeletal injuries. The data suggest that one functional artery distal to the elbow or knee is sufficient for limb viability and vascular function (follow-up range: 0 to 110 months; mean: 12 months). Nerve injury was the single most important factor of extremity injury in terms of the degree of functional loss.
Assuntos
Artéria Radial/lesões , Artéria Radial/cirurgia , Artérias da Tíbia/lesões , Artérias da Tíbia/cirurgia , Artéria Ulnar/lesões , Artéria Ulnar/cirurgia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica , Criança , Feminino , Seguimentos , Humanos , Ligadura , Masculino , Microcirurgia , Pessoa de Meia-Idade , Traumatismo Múltiplo/cirurgia , Parestesia/etiologia , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Angioaccess procedures at one institution over a 4-year period were retrospectively reviewed to ascertain the frequency of major limb- or life-threatening complications. A total of 435 angioaccess procedures were performed, including 81 Cimino-Brescia fistulas, 166 polytetrafluoroethylene grafts, and 111 thrombectomy/revisions. There were 77 operations for major complications in 53 patients. In addition, five patients required major vascular repair or emergency thoracotomy for complications of central hemodialysis line placement. A significant portion (18% of this series) of the total angioaccess caseload of a vascular surgeon will be utilized in the repair of major complications. The in-hospital (6 patients, or 11%) and long-term (12 patients, or 23%) mortality rates are significant. Although most complications can be repaired without limb loss and with shunt salvage, a small percentage (in our study three patients, or 4%) will have debilitating long-term symptoms.