Coronary steal syndrome.

A patient who suffered recurrent myocardial ischaemia and cerebrovascular symptoms 56 months after a quadruple coronary bypass is reported. Three coronary arteries had been bypassed using reversed saphenous vein and the other using the left internal mammary artery (IMA). Coronary angiography demonstrated patency of al bypasses but the presence of an obstruction of the left subclavian artery proximal to the origin of the left IMA, with angiographic criteria of the steal syndrome. The patient's symptoms were relieved by bypass from the left common carotid artery to the distal left subclavian artery. The pathophysiology, diagnosis, prevention and treatment of coronary steal syndrome are discussed.

Intraoperative assessment of carotid endarterectomy.

In our experience intraoperative arteriography in carotid endarterectomy is very effective in detecting residual small lesions after surgery. There were no neurosurgical complications due to arteriography. The interpretation of the surgical results is objective since the criteria are the same as those used to assess preoperative arteriography. Different intraoperative assessment methods to control carotid endarterectomy are also analysed.

Iliac arteriovenous fistula as a complication of lumbar disc surgery. Report of two cases and review of literature.

Vascular lesions following surgery of the lumbar disc are very infrequent, and exceptionally an arteriovenous fistula can developed. An important proportion of the reported cases were previously diagnosed as deep venous thrombosis, because this kind of pathology was not suspected. Postsurgical arteriovenous fistula produces severe haemodynamic disturbances, and congestive heart failure will develop if they are left to their natural course without intervention. Arteriovenous fistula should be suspected in the post-operative period of the lumbar disc surgery if congestive heart failure appears, accompanied by swelling of one or both lower limbs. Early surgery is the treatment of choice in order to prevent the congestive heart failure, and to preserve the normal function of the lower extremities. The technical choice seems to be the closure of the orifice of the fistula through the arterial lumen, together with appropriate arterial reconstruction.

Abdominal aortic aneurysms. Results of surgical treatment.

One hundred and twenty-one aneurysms of the abdominal aorta were operated on during a ten year period (1971-1981). Elective surgery was carried out in 89 patients (73.5%). Thirty-two patients were operated on for impending or frank rupture. Most of the patients treated electively had no symptoms on admission. The mortality of this group of patients was 6.7% (6 patients). All the patients treated as emergencies had acute abdominal or back pain. Six cases presented with shock and acute renal failure. The hospital mortality was high in this group of 11 patients (34.3%). Nine of them were operated on because of suspected rupture but this was not confirmed at operation. Only one patient in this group died after the operation (11.1%). The hospital mortality of the 23 patients with ruptured aneurysms was 43.4% (10 patients). Six of them died in the operating room. While elective surgery carries an acceptable mortality, the emergency procedure involves a high risk. All the aneurysms must be resected electively in spite of the absence of symptoms.

Assessment of transcutaneous oxygen tension in ischaemic legs by means of using an electric blanket and 40% O2.

This work was done to evaluate the transcutaneous oxygen tension (TcPO2) in ischaemic legs introducing two variables: O2 breathed at 40% and heating with an electric blanket (HEB). Forty nine legs were studied and divided into three different groups: Normal (N) 19 legs, Intermittent Claudication (IC) 12, and Rest Pain (RP) 13. The transcutaneous sensor was placed on the Anterior Chest Wall (AChW), High thigh (HT), Anterior Tibial Compartment (ATC) and Dorsum of the Foot (DF). Measurements were done at each area with and without 40% O2 and with and without HEB. The TcPO2 readings increased significantly (P less than 0.05) in the three groups (N, IC, RP) at all leg levels (HT, ATC, DF) when the patient breathed 40% O2 with and without HEB. In the N group no significant differences were noted between the three leg levels whether the 40% O2 or the HEB was used or not (P less than 0.05). In the RP group significant differences were obtained when the HEB was used whether the patient was breathing ambient O2 or at 40%. On the contrary, when the HEB was not used, the differences between HT and ATC disappeared but persisted at the DF (P less than 0.05). There was a good correlation at the DF and at the AChW (DF/AChW) (r: 0.8012; P less than 0.001). From these results, we conclude that the TcPO2 is a good method of differentiating different degrees of leg ischemia in vascular patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical treatment of the thoraco-abdominal aneurysms.

Three thoraco-abdominal aneurysms treated surgically are presented. They were operated between July 1975 and February 1978. The different surgical-techniques are emphasized, which in turn allow us to comment on the complications that these types of patients may have. All our three patients were operated following the "Retrograde Revascularization Technique" proposed by Dubost. We think that the ischemic time of the visceral arteries is less than following the more simplified, less time consuming and perhaps less traumatic "Graft Inclusion and Direct Vessel Reattachment Crawford-Technique". The incidence of paraplegia can be reduced by maintaining normal blood pressure and reattaching intercostal and lumbar arteries to the graft. Two of our patients survived without presenting any complication in the last four years. The third died in the immediate postoperative period, due to insoluble coagulation problems after massive blood transfusion during surgery.