Pub Date : 1994-06-01DOI: 10.1016/S0950-821X(05)80974-0
H.-B. Ris, P. Reber
Successful preservation of the first ray was achieved in a diabetic patient with a penetrating ulcer with underlying osteomyelitis of the first metacarpophalangeal joint and arterial insufficiency. Resection of the joint followed by stabilisation using an external fixator for four weeks resulted in permanent control of infection and preservation of the toe without recurrence of osteomyelitis or ulceration. Since preservation and correct alignment of the first ray is essential for foot stability, this technique may be beneficial in young and active diabetic patients suffering from this difficult complication of their disease.
{"title":"Preservation of the first ray in a diabetic patient with a penetrating ulcer and arterial insufficiency by use of debridement and external fixation","authors":"H.-B. Ris, P. Reber","doi":"10.1016/S0950-821X(05)80974-0","DOIUrl":"10.1016/S0950-821X(05)80974-0","url":null,"abstract":"<div><p>Successful preservation of the first ray was achieved in a diabetic patient with a penetrating ulcer with underlying osteomyelitis of the first metacarpophalangeal joint and arterial insufficiency. Resection of the joint followed by stabilisation using an external fixator for four weeks resulted in permanent control of infection and preservation of the toe without recurrence of osteomyelitis or ulceration. Since preservation and correct alignment of the first ray is essential for foot stability, this technique may be beneficial in young and active diabetic patients suffering from this difficult complication of their disease.</p></div>","PeriodicalId":77123,"journal":{"name":"European journal of vascular surgery","volume":"8 4","pages":"Pages 514-516"},"PeriodicalIF":0.0,"publicationDate":"1994-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-821X(05)80974-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19081672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1994-06-01DOI: 10.1016/S0950-821X(05)80964-8
Mark G. Davies , Lizzie Barber , Helge Dalen , Einar Svendsen , Per-Otto Hagen
Following angioplasty and vein bypass grafting, there is endothelial cell injury, infiltration of leukocytes and smooth muscle cell (SMC) proliferation leading to intimal hyperplasia which may result in stenosis and can lead to eventual occlusion. This study examines the effect of the 21-aminosteroid U74389G (Upjohn Company), on the formation of vein graft intimal hyperplasia in vivo and on SMC DNA synthesis and proliferation in vitro. Twenty New Zealand White rabbits had a right carotid interposition bypass graft using the ipsilateral external jugular vein. Ten animals received chronic oral therapy with U74389G (25 mg/kg/day; begun 5 days before surgery and continued until harvest) and 10 control animals received vehicle only. All animals were sacrificed on the 28th postoperative day. Vein grafts were harvested either for histology/videomorphometry (n = 6 per group) or for in vitro isometric tension studies (n = 4; four 5mm rings per graft). The incorporation of [3H]thymidine into the cellular DNA of serum-stimulated rabbit aortic SMC (passage 6th to 12th) was assessed in the presence of increasing concentrations of U74389G (10−9 to 10−4M). The effect of U74389G on in vitro cell proliferation was also assessed. Treatment with U74389G produced a 44% decrease in overall mean intimal thickness from 82 ± 1 μM (mean ± s.e.m.) in the controls to 57 ± 10 μM in the U74389G treated vein grafts (p = 0.003). Furthermore, there was a 40% increase in overall luminal areas of the treated vein grafts compared to controls (19.4 ± 2.9 vs. 13.9 ± 2.0 mm2; p = 0.13; mean ± s.e.m.) while there was no statistical differences in the medial thicknesses of the control and treated vein grafts. The vasomotor function of the vein grafts was not altered by U74389G. Incubation with U74389G inhibited in vitro [3H]thymidine incorporation of serum-stimulated rabbit SMC with an IC50 of 6.9 μM (4.9 μg/ml) and a maximal inhibition of 67 ± 3% (mean ± s.e.m.) at 10μM. In addition, the presence of U74389G produced a concentration dependent inhibition of in vitro cell proliferation. This study shows that a 21-aminosteroid, U74389G, significantly reduced intimal hyperplasia in experimental vein grafts, but did not modulate the increased vasoconstrictive properties of the grafts. In addition, U74389G inhibited SMC DNA synthesis in vitro. The in vivo reduction in intimal hyperplasia together with an increased luminal area would mitigate against the development of vein graft stenosis. However, the absence of vasomotor changes suggests that the tendency towards vasospasm remains in the treated grafts. Furthermore, the inhibition of SMC proliferation by U74389G suggests that it may have properties unrelated to its antioxidant activity an
{"title":"Control of the structural and functional consequences of vein graft intimal hyperplasia with a 21-aminosteroid—U74389G","authors":"Mark G. Davies , Lizzie Barber , Helge Dalen , Einar Svendsen , Per-Otto Hagen","doi":"10.1016/S0950-821X(05)80964-8","DOIUrl":"10.1016/S0950-821X(05)80964-8","url":null,"abstract":"<div><p>Following angioplasty and vein bypass grafting, there is endothelial cell injury, infiltration of leukocytes and smooth muscle cell (SMC) proliferation leading to intimal hyperplasia which may result in stenosis and can lead to eventual occlusion. This study examines the effect of the 21-aminosteroid U74389G (Upjohn Company), on the formation of vein graft intimal hyperplasia <em>in vivo</em> and on SMC DNA synthesis and proliferation <em>in vitro</em>. Twenty New Zealand White rabbits had a right carotid interposition bypass graft using the ipsilateral external jugular vein. Ten animals received chronic oral therapy with U74389G (25 mg/kg/day; begun 5 days before surgery and continued until harvest) and 10 control animals received vehicle only. All animals were sacrificed on the 28th postoperative day. Vein grafts were harvested either for histology/videomorphometry (<em>n</em> = 6 per group) or for <em>in vitro</em> isometric tension studies (<em>n</em> = 4; four 5mm rings per graft). The incorporation of [<sup>3</sup>H]thymidine into the cellular DNA of serum-stimulated rabbit aortic SMC (passage 6th to 12th) was assessed in the presence of increasing concentrations of U74389G (10<sup>−9</sup> to 10<sup>−4</sup>M). The effect of U74389G on <em>in vitro</em> cell proliferation was also assessed. Treatment with U74389G produced a 44% decrease in overall mean intimal thickness from 82 ± 1 μM (mean ± <em><span>s.e.m.</span></em>) in the controls to 57 ± 10 μM in the U74389G treated vein grafts (<em>p</em> = 0.003). Furthermore, there was a 40% increase in overall luminal areas of the treated vein grafts compared to controls (19.4 ± 2.9 <em>vs</em>. 13.9 ± 2.0 mm<sup>2</sup>; <em>p</em> = 0.13; mean ± <em><span>s.e.m.</span></em>) while there was no statistical differences in the medial thicknesses of the control and treated vein grafts. The vasomotor function of the vein grafts was not altered by U74389G. Incubation with U74389G inhibited <em>in vitro</em> [<sup>3</sup>H]thymidine incorporation of serum-stimulated rabbit SMC with an IC<sub>50</sub> of 6.9 μM (4.9 μg/ml) and a maximal inhibition of 67 ± 3% (mean ± <em><span>s.e.m.</span></em>) at 10μM. In addition, the presence of U74389G produced a concentration dependent inhibition of <em>in vitro</em> cell proliferation. This study shows that a 21-aminosteroid, U74389G, significantly reduced intimal hyperplasia in experimental vein grafts, but did not modulate the increased vasoconstrictive properties of the grafts. In addition, U74389G inhibited SMC DNA synthesis <em>in vitro</em>. The <em>in vivo</em> reduction in intimal hyperplasia together with an increased luminal area would mitigate against the development of vein graft stenosis. However, the absence of vasomotor changes suggests that the tendency towards vasospasm remains in the treated grafts. Furthermore, the inhibition of SMC proliferation by U74389G suggests that it may have properties unrelated to its antioxidant activity an","PeriodicalId":77123,"journal":{"name":"European journal of vascular surgery","volume":"8 4","pages":"Pages 448-456"},"PeriodicalIF":0.0,"publicationDate":"1994-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-821X(05)80964-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19081837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1994-06-01DOI: 10.1016/S0950-821X(05)80955-7
A.H. Davies, T.R. Magee, E. Sheffield, R.N. Baird, M. Horrocks
The aetiology of vein graft stenosis is poorly understood. In a cohort of 88 patients, the mean internal diameter of the vein grafts that developed a stenosis was 3.7 (3.1–4.2) mm compared to 4.7 (4.4–5.0) mm in those that did not (p = 0.006). The mean lowest compliance value in the 11 patients who developed a stenosis was 0.1 (0.07–0.13) % per mmHg compared to 0.21 (0.19-0.23) % per mmHg in the rest (p < 0.001). The presence of vein incompetence, site of tributaries or valves and the degree of endothelial cell loss were not related to the development of vein graft stenoses. The presence of a macrophage infiltrate (p < 0.001), lymphocyte infiltrate (p < 0.025) and subendothelial smooth muscle cells (p < 0.05) were all significantly more common in those grafts that developed a stenosis. Vein quality is an important factor in the development of graft stenoses.
{"title":"The aetiology of vein graft stenoses","authors":"A.H. Davies, T.R. Magee, E. Sheffield, R.N. Baird, M. Horrocks","doi":"10.1016/S0950-821X(05)80955-7","DOIUrl":"10.1016/S0950-821X(05)80955-7","url":null,"abstract":"<div><p>The aetiology of vein graft stenosis is poorly understood. In a cohort of 88 patients, the mean internal diameter of the vein grafts that developed a stenosis was 3.7 (3.1–4.2) mm compared to 4.7 (4.4–5.0) mm in those that did not (<em>p</em> = 0.006). The mean lowest compliance value in the 11 patients who developed a stenosis was 0.1 (0.07–0.13) % per mmHg compared to 0.21 (0.19-0.23) % per mmHg in the rest (<em>p</em> < 0.001). The presence of vein incompetence, site of tributaries or valves and the degree of endothelial cell loss were not related to the development of vein graft stenoses. The presence of a macrophage infiltrate (<em>p</em> < 0.001), lymphocyte infiltrate (<em>p</em> < 0.025) and subendothelial smooth muscle cells (<em>p</em> < 0.05) were all significantly more common in those grafts that developed a stenosis. Vein quality is an important factor in the development of graft stenoses.</p></div>","PeriodicalId":77123,"journal":{"name":"European journal of vascular surgery","volume":"8 4","pages":"Pages 389-394"},"PeriodicalIF":0.0,"publicationDate":"1994-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-821X(05)80955-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19081878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The ability of vein to dilate may allow smaller veins to be used for bypass if this change could be predicted. Sixty patients undergoing femorodistal popliteal or infrapopliteal bypass have had their long saphenous vein studied. Diameter measurements of the long saphenous vein have been performed using an ATL Duplex scanner at the groin, mid-thigh and knee. Measurements were performed preoperatively both at rest and with a venous occlusion cuff to dilate the vein and subsequently at 7 days and 3, 6, 9, 12 months after implantation. The mean diameter of the vein at the mid thigh was 4.2mm non dilated, 5.1mm with occlusion, 5.4mm 7 days postoperatively and 5.5mm at 12 months (p < 0.01 ANOVA). The mean diameter of the vein at the knee was 3.8 mm non-dilated, 4.8mm with occlusion, 4.8 mm at 7 days and 5.0mm at 12 months after operation (p < 0.01 ANOVA). If the minimum resting internal diameter of vein regarded as being suitable for bypass was 3mm, this technique would have increased the vein utilisation rate by 22%. These results show that by using a technique of venous occlusion at the time of preoperative vein mapping the adaptive response of the vein can be predicted and this can result in an increased rate of vein utilisation.
{"title":"Prediction of long saphenous vein graft adaptation","authors":"A.H. Davies , T.R. Magee, J.K. Hayward, R.N. Baird, M. Horrocks","doi":"10.1016/S0950-821X(05)80968-5","DOIUrl":"10.1016/S0950-821X(05)80968-5","url":null,"abstract":"<div><p>The ability of vein to dilate may allow smaller veins to be used for bypass if this change could be predicted. Sixty patients undergoing femorodistal popliteal or infrapopliteal bypass have had their long saphenous vein studied. Diameter measurements of the long saphenous vein have been performed using an ATL Duplex scanner at the groin, mid-thigh and knee. Measurements were performed preoperatively both at rest and with a venous occlusion cuff to dilate the vein and subsequently at 7 days and 3, 6, 9, 12 months after implantation. The mean diameter of the vein at the mid thigh was 4.2mm non dilated, 5.1mm with occlusion, 5.4mm 7 days postoperatively and 5.5mm at 12 months (<em>p</em> < 0.01 ANOVA). The mean diameter of the vein at the knee was 3.8 mm non-dilated, 4.8mm with occlusion, 4.8 mm at 7 days and 5.0mm at 12 months after operation (<em>p</em> < 0.01 ANOVA). If the minimum resting internal diameter of vein regarded as being suitable for bypass was 3mm, this technique would have increased the vein utilisation rate by 22%. These results show that by using a technique of venous occlusion at the time of preoperative vein mapping the adaptive response of the vein can be predicted and this can result in an increased rate of vein utilisation.</p></div>","PeriodicalId":77123,"journal":{"name":"European journal of vascular surgery","volume":"8 4","pages":"Pages 478-481"},"PeriodicalIF":0.0,"publicationDate":"1994-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-821X(05)80968-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19081736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1994-06-01DOI: 10.1016/S0950-821X(05)80963-6
Christiaan Hoff, Peter de Gier, Jaap Buth
Objectives:
Intraoperative Duplex examination can be used to identify technical imperfections during carotid endarterectomy. The objectives of this study were: (1) to evaluate the technical feasibility of intraoperative Duplex; (2) to compare Duplex findings with contrast arteriography; (3) to correlate intraoperative Duplex findings with postoperative complications and with Duplex data obtained during follow-up.
Design:
Prospective clinical study.
Setting:
Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Materials:
44 patients underwent Duplex scanning at the completion of carotid endarterectomy. In addition intraoperative arteriography was performed in the first 16 consecutive patients. Follow-up included a Duplex examination at three monthly intervals during the first postoperative year.
Outcome measures:
Technical defects and flow disturbance at the time of surgery, and postoperative restenosis.
Results:
At contrast arteriography a distal intimal ridge with 15–20% diameter reduction was observed in two, an occlusion of the external carotid artery in three and moderate kinking in one patient. All abnormalities were identified at Duplex imaging. In none of the cases were the Duplex findings considered an indication to re-explore the endarterectomised internal carotid artery. Postoperative complications occurred in six patients: three strokes, two transient ischaemic attacks and two internal carotid occlusions (in one patient combined with a stroke). Severe spectral broadening (spectral class D) correlated significantly with early postoperative complications (p = 0.027). In contrast, moderate defects on Duplex imaging did not correlate significantly with early complications. Duplex examination during the first year of follow-up demonstrated recurrent stenosis in four patients. Intraoperative spectral broadening did not correlate significantly with the development of common or internal carotid restenosis. However, external carotid recurrent stenosis was positively related to intraoperative flow disturbance (p = 0.0003).
Conclusion:
Duplex scanning is easy to use after completion of carotid endarterectomy. There is good agreement between intraoperative Duplex scanning and contrast arteriography. Extensive spectral broadening of the Doppler velocity signal is associated with an increased prevalence of early postoperative complications. Restenosis at follow-up appears to be related to severe flow disturbance as was demonstrated for the external carotid artery.
{"title":"Intraoperative Duplex monitoring of the carotid bifurcation for the detection of technical defects","authors":"Christiaan Hoff, Peter de Gier, Jaap Buth","doi":"10.1016/S0950-821X(05)80963-6","DOIUrl":"10.1016/S0950-821X(05)80963-6","url":null,"abstract":"<div><h3>Objectives:</h3><p>Intraoperative Duplex examination can be used to identify technical imperfections during carotid endarterectomy. The objectives of this study were: (1) to evaluate the technical feasibility of intraoperative Duplex; (2) to compare Duplex findings with contrast arteriography; (3) to correlate intraoperative Duplex findings with postoperative complications and with Duplex data obtained during follow-up.</p></div><div><h3>Design:</h3><p>Prospective clinical study.</p></div><div><h3>Setting:</h3><p>Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.</p></div><div><h3>Materials:</h3><p>44 patients underwent Duplex scanning at the completion of carotid endarterectomy. In addition intraoperative arteriography was performed in the first 16 consecutive patients. Follow-up included a Duplex examination at three monthly intervals during the first postoperative year.</p></div><div><h3>Outcome measures:</h3><p>Technical defects and flow disturbance at the time of surgery, and postoperative restenosis.</p></div><div><h3>Results:</h3><p>At contrast arteriography a distal intimal ridge with 15–20% diameter reduction was observed in two, an occlusion of the external carotid artery in three and moderate kinking in one patient. All abnormalities were identified at Duplex imaging. In none of the cases were the Duplex findings considered an indication to re-explore the endarterectomised internal carotid artery. Postoperative complications occurred in six patients: three strokes, two transient ischaemic attacks and two internal carotid occlusions (in one patient combined with a stroke). Severe spectral broadening (spectral class D) correlated significantly with early postoperative complications (<em>p</em> = 0.027). In contrast, moderate defects on Duplex imaging did not correlate significantly with early complications. Duplex examination during the first year of follow-up demonstrated recurrent stenosis in four patients. Intraoperative spectral broadening did not correlate significantly with the development of common or internal carotid restenosis. However, external carotid recurrent stenosis was positively related to intraoperative flow disturbance (<em>p</em> = 0.0003).</p></div><div><h3>Conclusion:</h3><p>Duplex scanning is easy to use after completion of carotid endarterectomy. There is good agreement between intraoperative Duplex scanning and contrast arteriography. Extensive spectral broadening of the Doppler velocity signal is associated with an increased prevalence of early postoperative complications. Restenosis at follow-up appears to be related to severe flow disturbance as was demonstrated for the external carotid artery.</p></div>","PeriodicalId":77123,"journal":{"name":"European journal of vascular surgery","volume":"8 4","pages":"Pages 441-447"},"PeriodicalIF":0.0,"publicationDate":"1994-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-821X(05)80963-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19081836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1994-05-01DOI: 10.1016/S0950-821X(05)80145-8
Max Greve Christensen, Jorgen Ewald Lorentzen, Torben Veith Schroeder
Materials: 54 women and 36 men, aged 56 (median; range: 34–78 years) underwent 109 consecutive mesenteric reconstructions. The indication in 90 primary procedures was acute mesenteric ischaemia of non-embolic origin in 25 patients, chronic ischaemia in 53 and prophylactic reconstruction in connection with aortic surgery in 12 patients. The superior mesenteric artery (SMA) was revascularised in 87 patients and the coeliac axis or common hepatic artery in six. Thus, only three patients had both territories revascularised. Thromboendarterectomy was performed in 15 patients, transposition of the SMA directly into the infrarenal aorta in 30 and bypass in 48 patients. Chief outcome measures: Cumulative symptom-free and survival rates. Main results: The overall perioperative (30 days) mortality rate was 13%, mainly caused by the high mortality rate of 44% (11 patients) in the acutely operated, as the mortality was 0% in patients operated on electively and only one out of 12 patients (8%) died after a prophylactic operation. Nine of the twelve deaths were due to progressive mesenteric infarction. Cumulated survival rates were 81, 60 and 35% after 5, 10 and 20 years, respectively which indicated a mortality rate three times that of an age- and sex-matched Danish population. During follow-up symptoms recurred in 30 patients, more often following emergency surgery and SMA transposition. Conclusions: Mesenteric revascularisation may yield long lasting results. However, surgery for acute ischaemia carries a high mortality rate, emphasising the importance of early surgery.
{"title":"Revascularisation of atherosclerotic mesenteric arteries: Experience in 90 consecutive patients","authors":"Max Greve Christensen, Jorgen Ewald Lorentzen, Torben Veith Schroeder","doi":"10.1016/S0950-821X(05)80145-8","DOIUrl":"10.1016/S0950-821X(05)80145-8","url":null,"abstract":"<div><p>Materials: 54 women and 36 men, aged 56 (median; range: 34–78 years) underwent 109 consecutive mesenteric reconstructions. The indication in 90 primary procedures was acute mesenteric ischaemia of non-embolic origin in 25 patients, chronic ischaemia in 53 and prophylactic reconstruction in connection with aortic surgery in 12 patients. The superior mesenteric artery (SMA) was revascularised in 87 patients and the coeliac axis or common hepatic artery in six. Thus, only three patients had both territories revascularised. Thromboendarterectomy was performed in 15 patients, transposition of the SMA directly into the infrarenal aorta in 30 and bypass in 48 patients. Chief outcome measures: Cumulative symptom-free and survival rates. Main results: The overall perioperative (30 days) mortality rate was 13%, mainly caused by the high mortality rate of 44% (11 patients) in the acutely operated, as the mortality was 0% in patients operated on electively and only one out of 12 patients (8%) died after a prophylactic operation. Nine of the twelve deaths were due to progressive mesenteric infarction. Cumulated survival rates were 81, 60 and 35% after 5, 10 and 20 years, respectively which indicated a mortality rate three times that of an age- and sex-matched Danish population. During follow-up symptoms recurred in 30 patients, more often following emergency surgery and SMA transposition. Conclusions: Mesenteric revascularisation may yield long lasting results. However, surgery for acute ischaemia carries a high mortality rate, emphasising the importance of early surgery.</p></div>","PeriodicalId":77123,"journal":{"name":"European journal of vascular surgery","volume":"8 3","pages":"Pages 297-302"},"PeriodicalIF":0.0,"publicationDate":"1994-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-821X(05)80145-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19008211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1994-05-01DOI: 10.1016/S0950-821X(05)80153-7
F.C.W. Slootmans, J.A. van der Vliet, H.H.M. Reinaerts, S.F.S. van Roye, F.G.M. Buskens
The outcome of ruptured abdominal aortic aneurysm repair was reviewed in 83 consecutive patients with special emphasis on the influence of subsequent laparotomy. The overall 30-day mortality was 47%. Causes of death were exsanguination in six, cardiac failure in 15, uncontrolled hypotension in six, multiple organ failure (MOF) in nine, adult respiratory distress syndrome in one and sepsis in two patients. Thirty-three relaparotomies were performed in 21 patients after a mean interval of 10 days. Suspected intraabdominal haemorrhage was the indication in 15 and sepsis in 18 cases. The preoperative diagnosis proved to be correct in 12/15 (80%) and 11/18 (61%) instances, respectively. Negative explorations were mainly performed in patients with an established MOF syndrome. Relaparotomies were associated with a significantly (p < 0.05) increased mortality of 76%. The complications that give rise to the need for surgical reintervention are usually accompanied by a clinical deterioration of the patient and inevitably reduce the chances of survival. However, until a reliable predictor of mortality is developed, treatment should not be denied in individual cases.
{"title":"Relaparotomies after ruptured abdominal aortic aneurysm repair","authors":"F.C.W. Slootmans, J.A. van der Vliet, H.H.M. Reinaerts, S.F.S. van Roye, F.G.M. Buskens","doi":"10.1016/S0950-821X(05)80153-7","DOIUrl":"10.1016/S0950-821X(05)80153-7","url":null,"abstract":"<div><p>The outcome of ruptured abdominal aortic aneurysm repair was reviewed in 83 consecutive patients with special emphasis on the influence of subsequent laparotomy. The overall 30-day mortality was 47%. Causes of death were exsanguination in six, cardiac failure in 15, uncontrolled hypotension in six, multiple organ failure (MOF) in nine, adult respiratory distress syndrome in one and sepsis in two patients. Thirty-three relaparotomies were performed in 21 patients after a mean interval of 10 days. Suspected intraabdominal haemorrhage was the indication in 15 and sepsis in 18 cases. The preoperative diagnosis proved to be correct in 12/15 (80%) and 11/18 (61%) instances, respectively. Negative explorations were mainly performed in patients with an established MOF syndrome. Relaparotomies were associated with a significantly (<em>p</em> < 0.05) increased mortality of 76%. The complications that give rise to the need for surgical reintervention are usually accompanied by a clinical deterioration of the patient and inevitably reduce the chances of survival. However, until a reliable predictor of mortality is developed, treatment should not be denied in individual cases.</p></div>","PeriodicalId":77123,"journal":{"name":"European journal of vascular surgery","volume":"8 3","pages":"Pages 342-345"},"PeriodicalIF":0.0,"publicationDate":"1994-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-821X(05)80153-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19008175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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