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1.
JNMA J Nepal Med Assoc ; 53(199): 156-61, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-27549496

RESUMO

INTRODUCTION: Lower-extremity ulcers represent the largest group of ulcers presenting to an outpatient department. It is a cumbersome, difficult to treat disease, which causes high morbidity and huge cost for the patient and healthcare system. Current standard treatment includes compression therapy.  However, majority of patients need long term treatment with minimal efficacy. Aim of our study is to evaluate efficacy of four layers compressive bandages for the management of chronic venous ulcers. METHODS: In Group A, we have prospectively included 20 patients with chronic venous ulcers on lower limbs for four layers hosiery bandage using Velfour bandage. Other 15 patients, Group B, were treated with conventional wound dressing. Velfour and crepe bandage were done once weekly for three weeks. RESULTS: DVT was cause of chronic venous ulcer in 70% patient in group A and in 73.3% in Group B. Majority of patients were having left sided chronic venous ulcers. The mean duration of the ulcers was 15.6 vs 10.86 months (group A vs. group B). At the end of 3rd week, in 55% wounds in Group A were healed except few big and deep wounds remained. Most of these wounds also became smaller with minimal discharge. Size of wounds significantly decreased in Group A vs. Group B patients (0.7±0.81 cm vs. 1.73±0.77 cm, p<0.00031). However, cost of treatment in group A remained higher than group B. CONCLUSIONS: Our study has shown that four layer compressive bandage using Velfour is an easy, effective, and reproducible method of treatment for the chronic venous ulcer.


Assuntos
Bandagens Compressivas , Úlcera Varicosa/terapia , Cicatrização , Adulto , Idoso , Bandagens/economia , Doença Crônica , Bandagens Compressivas/economia , Pé Diabético/complicações , Feminino , Custos de Cuidados de Saúde , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Úlcera Varicosa/etiologia , Trombose Venosa/complicações
2.
Eur J Vasc Endovasc Surg ; 42(5): 658-66, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21865062

RESUMO

OBJECTIVES: The aim of the study is to study contemporary presentation patterns and clinical results in patients undergoing aortofemoral bypass (AFB) surgery. DESIGN: This was a retrospective comparative study. MATERIAL AND METHODS: During a 14-year period, 269 consecutive patients (mean age 65 years) underwent AFB. Indications included occlusive disease with severe intermittent claudication (IC) (n = 86), critical limb ischaemia (CLI, n = 97) and aneurysmo-occlusive disease (n = 86). RESULTS: From 2000-07 on, AFB was performed more frequently for occlusive disease with CLI than for other indications (48% vs. 31% before 2000, P = 0.009) and also in women (51% vs. 32% before 2000, P = 0.003), compared to the period before 2000. Thirty-day mortality was reduced during 2000-2007 to 2.4%, compared with 4.3% during 1993-1999, although this difference was not statistically significant (P = 0.73). Morbidity did not change substantially over the study period. Predictors of 30-day mortality included indication (CLI = 4.1% vs. claudication = 1.2% (P = 0.37)) and chronic kidney disease (CKD, serum creatinine > 1.5 mg dl⁻¹) (11.1% vs. 2.9% in normal renal function, P = 0.07), the latter being the single predictor on multivariate analysis (hazard risk 4.2, P = 0.047). Overall 5 and 10-year assisted primary and secondary patency was 95% and 88%, and 99% and 95%, respectively. Survival at 5 and 10 years was 69% and 48%, respectively. Patient age (hazard risk 1.05, P < 0.001), CKD (hazard risk 1.79, P = 0.018) and diabetes (hazard risk 1.56, P = 0.022) were independent predictors of worse long-term survival. Long-term outcome did not change over the course of the study. CONCLUSIONS: In the contemporary era, AFB is more likely to be performed for CLI and in women than in the past. Despite these changes, perioperative mortality and morbidity remain low and long-term outcome excellent.


Assuntos
Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Artéria Femoral , Artéria Ilíaca , Enxerto Vascular , Idoso , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular
3.
Int Angiol ; 30(2): 115-22, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21427647

RESUMO

AIM: The aim of this paper was to perform a systemic review and meta-analysis of the efficacy of combined modalities (intermittent pneumatic leg compression and pharmacological prophylaxis, treatment group) against single modalities alone (control group) in preventing pulmonary embolism (PE), including fatal PE and deep-vein thrombosis (DVT) in high-risk patients. METHODS: Databases searched included the Cochrane Central Register of Controlled Trials, the Specialized Register of the Peripheral Vascular Diseases Group, MEDLINE and EMBASE. RESULTS: Seventeen studies, six of them randomized controlled trials (RCTs), which enrolled a total of 9998 patients in a variety of specialties were identified. Sixteen of the included studies evaluated the role of combined modalities on the incidence of symptomatic PE. These showed a reduction in symptomatic PE from 2.83% (122/4313) in the control group to 0.86% (33/3838) in the treatment group. Odds ratio was 0.34, 95% Confidence interval (CI) 0.23 to 0.50. Fatal PE was reduced from 0.56% (11/1972) in the control group to 0.07% (1/1377) in the treatment group (results were available in 10 studies). Odds ratio was 0.37 (95% CI; 0.09 to 1.48). Fourteen studies investigated the role of combined modalities on the incidence of DVT. These showed a reduction in DVT from 6.18% (200/3238) in the control group to 2.05% (63/3074) in the treatment group. Odds ratio was 0.31, 95% CI 0.23 to 0.43. CONCLUSION: Combined prophylactic modalities decrease significantly the incidence of PE and DVT, compared to single modalities, but the reduction seen in fatal PE did not reach statistical significance. Further research on the role of combined modalities in reducing DVT and PE is necessary.


Assuntos
Anticoagulantes/uso terapêutico , Fibrinolíticos/uso terapêutico , Dispositivos de Compressão Pneumática Intermitente , Tromboembolia Venosa/prevenção & controle , Terapia Combinada , Medicina Baseada em Evidências , Humanos , Incidência , Razão de Chances , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/mortalidade
4.
Eur J Vasc Endovasc Surg ; 37(3): 364-5, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19162515

RESUMO

BACKGROUND: It has been suggested that combined modalities (methods of treatment) are more effective than single modalities in preventing venous thrombo-embolism (defined as deep vein thrombosis and pulmonary embolism, or both) in high-risk patients. OBJECTIVES: To assess the efficacy of intermittent pneumatic leg compression combined with pharmacological prophylaxis versus single modalities in preventing venous thrombo-embolism in high-risk patients. SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases (PVD) Group searched the reference lists of their Specialised Register (last searched 17 July 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched The Cochrane Library 2008, issue 3) for relevant articles to identify additional trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) of combined intermittent pneumatic leg compression and pharmacological interventions used to prevent venous thrombo-embolism in high-risk patients. DATA COLLECTION AND ANALYSIS: Data extraction was undertaken independently by two review authors using data extraction sheets.


Assuntos
Aspirina/uso terapêutico , Fibrinolíticos/uso terapêutico , Dispositivos de Compressão Pneumática Intermitente , Embolia Pulmonar/prevenção & controle , Trombose Venosa/prevenção & controle , Ensaios Clínicos como Assunto , Humanos
5.
Ann Vasc Surg ; 15(5): 511-9, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11665433

RESUMO

Sixty-five consecutive patients undergoing nonemergent repair of an abdominal aortic aneurysm (AAA) originating above the visceral and/or renal arteries were studied to determine operative results and identify factors influencing outcome of proximal AAA repair. Factors associated with postoperative morbidity were analyzed using multivariate analysis. There were no postoperative deaths, paraplegia/paraparesis, or symptomatic visceral ischemia. Proximal AAA repair can be accomplished with acceptable mortality. If renal artery bypass or reimplantation is anticipated, cold renal perfusion may protect against renal dysfunction. Postoperative pulmonary dysfunction can be reduced by avoiding radial division of the diaphragm.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
J Vasc Surg ; 32(4): 722-30, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11013036

RESUMO

OBJECTIVE: Erosion of pancreatic pseudocysts into adjacent vessels is a rare but highly lethal cause of intra-abdominal hemorrhage. Percutaneous angiographic embolization (PAE) of the bleeding artery has recently been advocated as the preferred therapy. This study was undertaken to survey the outcome after treatment of this complication and to make recommendations for its management. METHODS: An 11-year retrospective analysis was performed of all patients treated at a large tertiary care referral center for visceral artery pseudoaneurysms associated with pancreatic pseudocysts. RESULTS: From 1988 to 1998, 256 patients were admitted for complications of pancreatic pseudocysts. Sixteen patients (11 men and 5 women) were identified in whom a pseudocyst had eroded into a major blood vessel with hemorrhage or development of a false aneurysm. The mean age was 45 years (range, 23-67 years). Active bleeding was present in 13 patients, whereas three had evidence of recent hemorrhage. Ten of 16 patients initially underwent operative therapy, four elective and six emergency, whereas six stable patients were initially treated with PAE. Technical failures of the initial treatment or secondary complications required both therapeutic modalities in six patients, which resulted in 13 total surgical interventions and 10 PAEs. The surgical morbidity rate was 62% (8 of 13), whereas that of PAE was 50% (5 of 10). Three deaths occurred after emergency operations, two of which failed to stop the bleeding, accounting for all of the deaths in the series (3 [19%] of 16). A trend was noted toward increased death with necrotizing pancreatitis (P =.07) and emergency surgery (P =.06). Ranson's criteria were not found to be predictive of death in this series. Surgical drainage procedures were required in seven (44%) of 16 patients for infections (n = 3) or mass effect of the pseudoaneurysm (n = 3). The mean size of pseudoaneurysms that required operative intervention for secondary complications was 13.9 cm, compared with 7.7 cm for all others in the series (P =.046). Long-term follow-up was available in all 13 survivors at a mean of 44 months (range, 1-108 months). CONCLUSIONS: The management of pancreatic pseudocyst-associated pseudoaneurysms remains a challenging problem with high morbidity and death rates. Operation and PAE play complementary management roles. PAE is recommended as the initial therapy for hemodynamically stable patients. Surgery should be reserved for actively bleeding, hemodynamically unstable patients; for failed embolization; and for other secondary complications such as infection or extrinsic compression.


Assuntos
Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Embolização Terapêutica , Pseudocisto Pancreático/complicações , Pancreatite/complicações , Adulto , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
8.
Semin Vasc Surg ; 13(1): 49-52, 2000 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10743890

RESUMO

The obturator bypass is a useful method for revascularizing the lower extremity in the presence of a hazardous groin dissection. The most common indication for employing this method of reestablishing arterial continuity is in circumventing infected vascular prostheses. One- and 5-year patency rates of 72.7% and 56.9% have been described. This article reviews the indications for obturator bypass and discusses technical considerations regarding the procedure.


Assuntos
Anastomose Cirúrgica/métodos , Perna (Membro)/irrigação sanguínea , Humanos , Procedimentos Cirúrgicos Vasculares/métodos
9.
J Vasc Surg ; 27(2): 374-7, 1998 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9510295

RESUMO

OBJECTIVE: We analyzed the data from our vascular registry to determine the cause, clinical features, and cost-effective management of this uncommon pathologic entity. DESIGN: Patients referred to the vascular surgery outpatient clinic of a tertiary referral center during the past 18 years were evaluated. SUBJECTS: The subjects were six male patients (14 to 32 years) referred for evaluation of a unilateral pulsatile mass over the temporal region of the head. INTERVENTION: Diagnosis of superficial temporal artery aneurysm was verified by loss of the aneurysm's pulse with compression of the ipsilateral proximal superficial temporal artery. All treated aneurysms were electively ligated and excised as an ambulatory procedure. RESULTS: The symptoms were resolved. No recurrences or other complications were seen. CONCLUSIONS: Although rare, a superficial temporal artery aneurysm should be considered when a temporal head mass is evaluated. This condition is almost always a result of blunt or penetrating head trauma. Clinical examination is sufficient to confirm the diagnosis. Simple elective ligation and excision of the aneurysm is curative.


Assuntos
Aneurisma Intracraniano , Artérias Temporais , Adolescente , Adulto , Traumatismos Craniocerebrais/complicações , Traumatismos Cranianos Fechados/complicações , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/cirurgia , Masculino , Sistema de Registros , Artérias Temporais/lesões , Ferimentos não Penetrantes/complicações
10.
J Vasc Surg ; 26(1): 144-9, 1997 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9240335

RESUMO

Secondary aortoesophageal fistula is the rarest type of aortopeptic fistula, characterized by communication between the reconstructed aorta and the esophagus. This condition has been reported to be uniformly fatal, even after prompt diagnosis and treatment. We report what may be the first case of a successfully managed secondary aortoesophageal fistula that occurred 14 months after repair of a Crawford type II thoracoabdominal aortic aneurysm. The entity was diagnosed with a combination of esophagogastroduodenoscopy and aortography. At exploration, a communication between the proximal anastomosis and the esophagus with otherwise minimal mediastinal contamination was encountered. The anastomosis was replaced with an interposition polytetrafluoroethylene graft, and the esophageal defect was debrided, primarily closed, and reinforced with adjacent old aneurysm wall. There were no postoperative complications, and the patient remains well 18 months after fistula repair.


Assuntos
Doenças da Aorta/cirurgia , Fístula Esofágica/cirurgia , Fístula/cirurgia , Idoso , Anastomose Cirúrgica , Aneurisma Aórtico/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etiologia , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Fístula/diagnóstico por imagem , Fístula/etiologia , Humanos , Masculino , Complicações Pós-Operatórias , Radiografia
11.
Arch Surg ; 132(6): 633-9; discussion 639-40, 1997 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-9197856

RESUMO

OBJECTIVE: To test the hypothesis that systemic hypothermia (SH) to 30 degrees C in combination with partial left heart bypass (PLHB) at either a high or low distal arterial perfusion pressure (DAPP) following 45 minutes of cross-clamp (XC) occlusion of the thoracic aorta will protect against clinical and histological spinal cord ischemia in the dog. DESIGN: A blinded, prospective, randomized, and controlled experimental trial. SETTING: Tertiary care center animal laboratory. PARTICIPANTS: Seventeen adult mongrel dogs. INTERVENTIONS: The animals were randomized into 5 groups: control group 1: XC plus no protection (n = 3); control group 2; XC plus systemic normothermia plus PLHB, with a DAPP less than 20 mm Hg (n = 3); treatment group 1: XC plus systemic normothermia plus PLHB, with a DAPP greater than 20 mm Hg (n = 3); treatment group 2: XC plus SH plus PLHB, with a DAPP greater than 20 mm Hg (n = 3); treatment group 3: XC plus SH plus PLHB, with a DAPP less than 20 mm Hg (n = 5). MAIN OUTCOME MEASURES: Clinical and histological neurological injury evaluation by separate blinded observers. RESULTS: Control animals were neurologically and histologically ischemic. Treatment animals were neurologically and histologically normal. Partial left heart bypass with a DAPP greater than 20 mm Hg prevented paraplegia, with either systemic normothermia or SH. Systemic hypothermia plus PLHB, even with a DAPP less than 20 mm Hg, protected against spinal cord ischemia during thoracic aortic occlusion. CONCLUSION: Systemic hypothermia to 30 degrees C combined with PLHB at either a high or low DAPP prevented spinal cord ischemia following thoracic aortic XC occlusion in our canine model and merits clinical trial in patients.


Assuntos
Derivação Cardíaca Esquerda , Hipotermia Induzida , Isquemia/prevenção & controle , Medula Espinal/irrigação sanguínea , Animais , Cães , Isquemia/patologia , Distribuição Aleatória , Medula Espinal/patologia , Medula Espinal/fisiopatologia
12.
J Vasc Surg ; 23(5): 844-9; discussion 849-50, 1996 May.
Artigo em Inglês | MEDLINE | ID: mdl-8667506

RESUMO

PURPOSE: The purpose of this study was to review the complications of transaxillary arteriography (TRAX), determine clinical factors associated with their occurrence, and define optimal treatment methods. METHODS: A retrospective review of 842 consecutive TRAX studies performed in a large, urban, tertiary care, academic medical center was undertaken. Patients with complications were compared with a concurrent randomized control group without complications with the use of a multivariate analysis model. Results of operative therapy for nerve injury were compared with those of nonoperative therapy. RESULTS: Nineteen (2.3%) complications were identified including 14 nerve injuries, four expanding hematomas/pseudoaneurysms without neurologic deficit, and one puncture site thrombosis. Several statistically significant or suggestive findings associated with the occurrence of complications were identified: female sex (odds ratio [OR] = 4.7), systolic blood pressure > or = 150 mm Hg at the conclusion of TRAX (OR = 9.5), periprocedural systemic heparin anticoagulation (OR = 7.9), concomitant use of intraarterial thrombolysis or percutaneous angioplasty (OR = 12.0), and duration of procedure > or = 90 minutes (OR = 4.0). Patients who underwent prompt exploration (< or = 4 hours from symptom onset) for nerve injuries were more likely to have complete resolution of their neurologic deficits (five of six patients) than those who were observed or underwent delayed operation (three of eight patients) (OR = 8.3). CONCLUSIONS: Aggressive treatment of post-TRAX hypertension, limitation of TRAX duration, delay of postprocedure anticoagulation, and use of alternative sites for arterial puncture in female patients or patients undergoing catheter-based intervention may reduce the incidence of TRAX-related complications. In patients who have neurologic deficits prompt surgical exploration of the puncture site with decompression of the involved nerve(s) may reduce the incidence of prolonged deficits.


Assuntos
Falso Aneurisma/etiologia , Angiografia/efeitos adversos , Cateterismo Periférico/efeitos adversos , Hematoma/etiologia , Traumatismos dos Nervos Periféricos , Falso Aneurisma/epidemiologia , Falso Aneurisma/cirurgia , Axila , Artéria Braquial , Estudos de Casos e Controles , Feminino , Hematoma/epidemiologia , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/cirurgia , Punções/efeitos adversos , Estudos Retrospectivos , Fatores de Risco
13.
Ann Vasc Surg ; 9(4): 357-60, 1995 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8527336

RESUMO

The utility of transserosal photoplethysmographic pulse oximetry (PO) to assess intestinal viability intraoperatively was evaluated using an experimental canine model. Comparisons of PO were made with continuous-wave Doppler ultrasound (CWDU) and fluorescein (FL) using histopathologic examination for control. Clinical examination estimates were included for reference. Four 20 cm portions of small bowel from each of four dogs were made ischemic by mesenteric ligation. Thus 320 individual 1 cm bowel segments were studied by means of PO, CWDU, FL, and control histologic grading for ischemia. Statistical analysis revealed no significant differences, with PO matching CWDU and FL in intraoperative assessment of small bowel viability. PO, which is readily available in most operating rooms, is a simpler method than CWDU or FL for assessing intestinal viability. This technique is operator independent, easy to interpret and repeat, and is well tolerated. PO is the preferred alternative for objective intraoperative assessment of intestinal viability.


Assuntos
Intestinos/irrigação sanguínea , Isquemia/diagnóstico , Oximetria , Animais , Cães , Intestinos/diagnóstico por imagem , Período Intraoperatório , Isquemia/diagnóstico por imagem , Fotopletismografia , Sensibilidade e Especificidade , Ultrassonografia Doppler
15.
J Vasc Surg ; 20(1): 14-9, 1994 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8028083

RESUMO

PURPOSE: The purpose of this study was to determine the impact of end-stage renal disease (ESRD) on the outcome of patients undergoing lower extremity (LE) amputation. METHODS: Hospital charts and vascular surgery registry data were reviewed for all patients who underwent LE amputation over a consecutive 56-month period. The results of 84 patients with ESRD (137 amputations) were compared with 375 patients (442 amputations) without ESRD. RESULTS: Hospital mortality rate was significantly greater in patients with ESRD than patients without ESRD, 24% versus 7% (p = 0.001). Patients with ESRD undergoing minor amputations had mortality rates three times greater than patients without ESRD undergoing major LE amputations. In patients with ESRD requiring bilateral or unilateral above-knee amputation hospital mortality rates were 43% and 38%, respectively. In addition, patients with ESRD were seven times more likely to undergo bilateral amputation than patients without ESRD over a mean follow-up period of 17 months. No kidney transplant patients died after amputation. CONCLUSION: ESRD has a profound negative impact on morbidity, mortality, and survival rates after LE amputation. Attempts at prevention of amputation with aggressive foot care and patient education in this high-risk group should be the focus of therapy.


Assuntos
Amputação , Arteriopatias Oclusivas/cirurgia , Isquemia/cirurgia , Falência Renal Crônica/complicações , Perna (Membro)/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Feminino , Mortalidade Hospitalar , Humanos , Isquemia/complicações , Falência Renal Crônica/terapia , Transplante de Rim , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Diálise Renal , Estudos Retrospectivos
16.
Arch Surg ; 129(6): 603-7; discussion 607-8, 1994 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8204034

RESUMO

OBJECTIVE: To review a large experience with acute aortic occlusion (AAO) to better define the cause, clinical presentation, treatment, prognostic variables, and outcome. DESIGN: Retrospective review of 46 consecutive patients with AAO during a 40-year period. SETTING: A large urban tertiary care referral center in Detroit, Mich. PATIENTS: Adult patients with arteriographic and/or operative confirmation of acute occlusion of the abdominal aorta plus signs and symptoms of acute ischemia. INTERVENTION: Operative and nonoperative treatment of AAO. MAIN OUTCOME MEASURES: Mortality, morbidity, and long-term survival. Other variables measured included cause, risk factors, and effects of duration and severity of ischemia and treatment methods on outcome. RESULTS: Two primary causes were identified--embolism (65%) and thrombosis (35%). Heart disease and female gender were risk factors for embolism, while smoking and diabetes were risk factors for thrombosis. Severity of ischemia on presentation correlated better with outcome than duration of ischemia. The hospital mortality rate was 35% and morbidity, 74%, with no difference between the two groups. Recurrent arterial embolism occurred in 43% of patients with embolic AAO. Seventy-two percent of AAO survivors were alive 5 years after therapy. CONCLUSIONS: Acute aortic occlusion remains a serious vascular surgical emergency with significant morbidity and mortality, even when recognized promptly and treated appropriately. Nevertheless, survivors have a reasonable long-term outcome. Permanent anticoagulation is suggested in patients with embolic AAO to minimize a high incidence of recurrent arterial embolism.


Assuntos
Doenças da Aorta/epidemiologia , Doenças da Aorta/terapia , Arteriopatias Oclusivas/epidemiologia , Arteriopatias Oclusivas/terapia , Doença Aguda , Adulto , Idoso , Aorta Abdominal , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etiologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Doença das Coronárias/complicações , Doença das Coronárias/epidemiologia , Complicações do Diabetes , Diabetes Mellitus/epidemiologia , Embolia/complicações , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiografia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fumar/efeitos adversos , Fumar/epidemiologia , Taxa de Sobrevida , Trombose/complicações , Fatores de Tempo , Resultado do Tratamento
17.
J Vasc Surg ; 19(5): 858-63; discussion 863-4, 1994 May.
Artigo em Inglês | MEDLINE | ID: mdl-8170040

RESUMO

PURPOSE: The purpose of this study was to better define the associated risks and optimal management of groin lymphatic complications (GLC) after femoral artery reconstructive operations. METHODS: Retrospective review of a vascular surgery registry for the last 15 years identified 2679 arterial operations requiring a groin incision. Forty-one GLC were recognized, 28 lymphocutaneous fistulas (LF) and 13 lymphoceles. RESULTS: The incidence of GLC was 1.5% per patient or 1.2% per incision. The highest incidence of GLC was in patients having an aortobifemoral bypass for aneurysmal disease in a previously operated groin (8.1% per patient) and in those undergoing an isolated femoral procedure in a previously operated groin (5.3%). The lowest frequency of GLC was after femoropopliteal/tibial bypasses (0.5%). Twenty-nine patients (71%) were treated without operation with bedrest, intravenous antibiotics, and aggressive local wound care. Operative therapy with wound reexploration attempted identification and control of the leak site, and meticulous wound closure was used in 12 patients (29%). Lymph fistulas in patients undergoing reoperation (10/28) resolved sooner than in patients treated without operation (18/28) (9 +/- 3 days vs 24 +/- 3 days). Infectious wound complications with one resultant graft infection developed in five of 18 patients with LF who did not undergo reoperation. There were no wound or graft infections in the patients in the LF group treated with operation. Operative exploration of lymphoceles did not reduce hospital stay or infectious wound complications. Repetitive lymphocele aspiration did not affect rapidity of resolution or increase the infectious complications. CONCLUSION: GLC remain a troublesome complication of femoral arterial reconstruction. Early reoperation should be performed once a LF is diagnosed. Treatment for lymphoceles should be individualized, with neither operative nor nonoperative management showing clear superiority.


Assuntos
Artéria Femoral/cirurgia , Fístula/epidemiologia , Doenças Linfáticas/epidemiologia , Linfocele/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Dermatopatias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fístula/diagnóstico , Fístula/terapia , Virilha , Humanos , Incidência , Doenças Linfáticas/diagnóstico , Doenças Linfáticas/terapia , Linfocele/diagnóstico , Linfocele/terapia , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Dermatopatias/diagnóstico , Dermatopatias/terapia
18.
Arch Surg ; 128(7): 803-11; discussion 811-3, 1993 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8317963

RESUMO

OBJECTIVE: To analyze different operative approaches for repair of pararenal abdominal aortic aneurysm, to define factors associated with perioperative morbidity, particularly renal insufficiency, and to compare the results of pararenal abdominal aortic aneurysm repair with standard infrarenal repair. DESIGN: Case series review of all patients undergoing repair of nonruptured pararenal abdominal aortic aneurysms over 7 consecutive years at a tertiary care teaching hospital. PATIENTS: Fifty-three consecutive patients with nonruptured atherosclerotic pararenal abdominal aortic aneurysms undergoing operative repair. A comparison group of 65 patients randomly selected from a pool of 384 patients undergoing concurrent infrarenal abdominal aortic aneurysm repair. MAIN OUTCOME MEASURES: Operative morbidity and mortality, postoperative renal insufficiency, estimated blood loss, perioperative blood and fluid requirements, and length of hospital stay. RESULTS: Postoperative renal insufficiency was more likely when concomitant renal revascularization was performed (P = .007) or when any major intraoperative complication occurred (P = .008). Retroperitoneal abdominal aortic aneurysm repair was associated with lower estimated blood loss (P = .05) and less fluid requirement within the first 24 hours following operation than transperitoneal repair (P = .03). No differences in outcome measures were identified with regard to site of proximal aortic clamping (supraceliac vs suprarenal). Pararenal abdominal aortic aneurysms were larger and their repair was associated with greater estimated blood loss (P = .007), intraoperative blood replacement (P < .001), and a longer hospital stay (P = .02) than infrarenal abdominal aortic aneurysms. CONCLUSIONS: Pararenal abdominal aortic aneurysm repair is a technically challenging operation associated with significant morbidity. A retroperitoneal approach facilitates repair. The site of proximal aortic cross-clamping should be dictated by technical factors and not by any perceived outcome advantages.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Lesão Renal Aguda/etiologia , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Prótese Vascular , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Artéria Renal/cirurgia , Reoperação , Taxa de Sobrevida , Resultado do Tratamento
19.
J Vasc Surg ; 17(5): 868-75; discussion 875-6, 1993 May.
Artigo em Inglês | MEDLINE | ID: mdl-8487355

RESUMO

PURPOSE: A 7-year experience in which 43 patients underwent supraceliac aortic cross-clamping (SC-AXC) during elective abdominal aortic reconstruction was reviewed. METHODS: Operation was performed for abdominal aortic aneurysm (AAA) in 29 (68%) patients, aortoiliac occlusive disease in seven (16%), proximal anastomotic AAA in three (7%), "shaggy" aorta syndrome in three (7%), and in situ grafting of a previously ligated aorta in one (2%) patient. The indications for supraceliac control included pararenal AAA origin (25), pararenal aortic atherosclerosis (18), inflammatory AAA (2), and a short infrarenal aortic stump (1). Vital organ ischemic complications (VOICs) were defined as any major ischemic complication involving the liver, kidneys, bowel, or spinal cord. RESULTS: The incidence of VOICs was significantly increased when concomitant renal or visceral revascularization (CRVR) was required (p = 0.002) and correlated with an increasing SC-AXC time (p = 0.015). In patients undergoing CRVR (n = 16) the perioperative mortality rate was 25%; VOICs developed in six patients and included renal failure (3), mesenteric/colonic ischemia (3), hepatic ischemia with coagulopathy (2), and spinal cord ischemia (1). In contrast, in those not requiring CRVR (n = 27), SC-AXC was well tolerated. There were no VOICs and no deaths; morbidity rate was 33%. CONCLUSIONS: The incidence of VOICs associated with the use of SC-AXC is primarily related to the level of preoperative renal or mesenteric insufficiency, the severity of pararenal aortic atherosclerosis, the extent of the operative procedure, and the duration of proximal aortic cross-clamping. In complex abdominal aortic reconstruction in which infrarenal aortic control is either not possible or deemed hazardous, SC-AXC is a safe and valuable technique for achieving proximal control.


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Doenças da Aorta/cirurgia , Prótese Vascular , Isquemia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Artéria Celíaca , Constrição , Feminino , Humanos , Incidência , Intestinos/irrigação sanguínea , Rim/irrigação sanguínea , Fígado/irrigação sanguínea , Masculino , Fatores de Risco , Medula Espinal/irrigação sanguínea , Resultado do Tratamento
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