Vascular surgery最新文献

The normal arterial blood pressure at the ankle, (AP), right brachial arterial pressure (RBP) and pressure index (PI) were investigated in 50 healthy young volunteers under basal conditions and during certain positions of the legs, utilizing Doppler ultrasound flow determination and standard size blood pressure cuff. The mean AP was 10 mm Hg higher than the mean RBP in 76 instances but AP was smaller than RBP in 24 out of 100 investigated lower extremities. Mean PI was 1.069+/-0.158. There was no statistically significant difference between PI of heavier and leaner patients although increased weight was associated with a significantly higher brachial and ankle arterial pressure. Departure of the lower extremity from the horizontal position resulted in AP changes explained by gravitational effects. If the new posture was maintained, the new AP persisted, thus indicating an absence of significant corrective circulatory adaptation to the posture changes. Extreme flexion of hip and knee joints resulted in a marked decrease of AP and PI, suggesting arterial kinking. This change was not affected by the weight:height ratio of the subject. It is concluded, therefore, that the presence of a greater amount of periarterial soft tissues does not significantly prevent arterial kinking. These tensional shifts indicate changes of flow pattern occurring in normal subjects during extreme flexion. Even more marked shifts can be anticipated in arteriosclerotic patients under similar circumstances.

The basic considerations in the use of an arterio-venous fistula for revascularization of the ischemic extremity have been summarized. Retrograde flow of arterial blood entering the venous system by way of an arteriovenous fistula has been demonstrated in acute and chronic animal experiments. While evidence of significant reversed flow in humans has been shown in a few small series, its occurrence is still controversial. The significance of venous valves in impending retrograde flow is not yet adequately investigated. Since a peripheral arteriovenous fistula is one of the most potent stimuli to arterial vessel formation in the extremity, its application may be worthy of consideration in certain selected patients with advanced and otherwise "inoperable" arterial occlusive disease.

Postoperative deep vein thrombosis has been demonstrated in four out of seven (57%) unselected patients undergoing homograft cadaveric renal transplantation, with pulmonary embolism in one. The diagnosis being made by using the combined 125I-fibrinogen and Doppler ultrasound techniques. The late onset of the deep vein thrombosis may be due to the heparin given interoperatively and postoperatively which acted as a prophylactic agent.

Among the several various surgical approaches to the cervico-dorsal sympathetic system, the axillary approach seems to us the operation of choice. The operation is simple, gives excellent access to the required sympathetic ganglions, including the lower part of the stellate ganglion, down to the fifth thoracic ganglion. In all cases the sympathectomy was clinically complete. The postoperative course was mostly smooth, and the few cases of transient Horner's Syndrome, pneumothorax and hemothorax could have been avoided.

The injury was severe in wounded limb patients of this series who suffered from an associated major peripheral vein trauma. The presence of such an injury weighed heavily on the prognosis. Thirty eight patients with major peripheral veins injuries are reviewed. The injury had resulted from war wounds, work or road accidents. The superficial femoral vein was the most frequently injured vein. Associated injuries were frequently noted: soft tissues injuries in 35 patients, fractures in 33, arterial injuries in 32 and peripheral nerve injuries in 22 patients. Shock was more often present and more severe in patients who suffered also from a vein injury than in patients with an arterial injury only. The lacerated femoral vein was ligated in the majority of patients. Attempts were made to repair the lacerated popliteal veins. Repair of the vein was usually done by anastomosis of debrided ends. When an arterial injury was also present, it was repaired first. The postoperative complications were frequent and included infections, thrombophlebitis and pulmonary embolisations. Twenty four patients were discharged with a viable limb. Complete function was recovered in seven patients only. Partial neurological deficit remained in twelve patients and complete paralysis in five. Twelve patients underwent subsequent amputation of the injured limb. Indications for amputation were ischemia in eight, infection or extensive destruction of tissues in four. Two patients died.

The use of the Bovine artegraft for creation of arteriovenous fistulas in the hemodialysis patients was first carried out in the midsummer of 1971. Since that time, there has been considerable material reported in the use of this substitute as an access for hemodialysis. In this article information gained from an ongoing study of the first 100 patients in chronic hemodialysis who had Bovine artegraft arteriovenous fistulas was reviewed. The indications for operation, the standard technique, the results, the complications, and the future plans for study of the physiology and hemodynamics of this type of fistula are described. The Bovine artegraft, AV fistula can be created successfully in a high percentage of patients, offers ease of needle placement, and effective dialysis with very little complication.

The Fogarty arterial embolectomy catheter, while indispensible in the armamentarium of the vascular surgeon, is not entirely benign instrument. A case is desribed in which the balloon was lost in its entirety from the catheter and immediately retrieved using a second identical instrument. A comprehensive survey of the literature reveals that a variety of arterial injuries have occurred during the use of the Fogarty catheter. Each of the major ones is discussed in depth. Amongst the most serious are arterial perforation and rupture occasionally followed by loss of the involved extremity. All previously reported complications following use of the Fogarty catheter are tabulated and reviewed. Additionally, a formal classification of these complications is proposed. Since the time of its introduction in 1963 the Fogarty ballon-tipped catheter has become an indispensible tool in the armamentarium of the vascular surgeon. Its use for arterial embolectomy has been responsible for the salvage of many thousands of limbs. Over the course of the past decade, however, a number of complications referable to this instrument have appeared in the literature. These include perforation of vessels, intimal disruption and foreign body embolization amongst others. To our knowledge, however, there has been only one reported case of a balloon having been lost intra-arterially in toto without obvious cause. It is the purpose of this paper to present the second such case where the balloon, which had separated entirely from the catheter during the course of an arterial embolectomy, was later retrieved by passage of a second Fogarty catheter. In addition, a comprehensive review of the literature is undertaken, and all arterial complications reported to date summarized and tabulated.