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Biomedical subjects

A J Roon

Publications and source records attributed to A J Roon.

13 recordsLinked to original sources
PubMed1992

Intraoperative arteriography and carotid surgery.

To minimize morbidity in carotid surgery we have adopted the practice of routine operative arteriography. In our total experience of 692 carotid artery reconstructions done since 1979 no arteriography was used for the first 157 procedures. The combined morbidity and mortality rate in this group was 4.5% (4 strokes and 3 deaths as a result of stroke). After 157 carotid operations we used intraoperative arteriography on all cases, and the neurologic morbidity and mortality rate for this part of the series was 1.3% (6 strokes and 1 fatal cerebral hemorrhage). One death was due to myocardial infarction. The difference in ischemic neurologic sequellae between these two groups was statistically significant by chi-square analysis (p less than 0.01). Although the difference in these two cohorts could be related to the "learning curve" effect, it is unlikely that this is the only reason for the difference. Intraoperative arteriography has demonstrated unsuspected stenoses, occlusions, flaps, and kinks. There was also a statistically significant difference (p less than 0.01) in the number of reoperations for recurrent stenosis: 3.8% in the first group and 0.8% in the second group. No complications were thought to be directly associated with the arteriogram. Since the development of better digital imaging systems for the operating suite, this technique is much more easily used than when it was first described.

Carotid Stenosis↗
PubMed1983

Blue toe syndrome--a warning sign of unsuspected vascular injury.

A case report is presented of a young patient involved in a motor vehicle accident, who initially demonstrated no physical or radiologic evidence of thoracic injury. Six weeks later the patient was noted to have two blue toes. Arteriography done at that time demonstrated a previously unsuspected false aneurysm of the descending thoracic aorta. An embolic event in a patient with a history of major trauma should be considered a strong indication for arteriographic evaluation of the proximal arterial system.

Adult↗
PubMed1980

Management of acute cervicothoracic vascular injuries.

One hundred eighty-one patients with 218 acute cervicothoracic vascular injuries underwent operations for diagnosis, resuscitation, and control of hemorrhage. The patients were divided into three clinical groups depending on their clinical status. Group I consisted of 105 patients who were hemodynamically stable and able to undergo diagnostic measures: Group II consisted of 41 patients who remained unstable and required immediate operation; Group III consisted of 35 patients who were moribund and underwent emergency room thoracotomy. The mortality rates were 4% for Group I, 15% for Group II, and 80% for Group III with an overall mortality rate of 21%. Angiography was performed in 53% of the stable Group I patients. This allowed specific identification of lesions such as arteriovenous fistula in eight patients and aortic disruption in 12 patients. Thirty-five Group III patients had thoracotomy performed in the emergency room and seven survived (20%). A vigorous clinical approach is recommended to minimize morbidity. A different approach is described for each of the three clinical groups of patients.

Adolescent↗
PubMed1979

Evaluation and treatment of penetrating cervical injuries.

Because the serious nature of penetrating cervical injuries may not be readily apparent on initial evaluation, and since delay in treatment can result in serious complications, a systematic method of evaluation and routine exploration has been employed in treating these injuries. One hundred eighty-nine patients, 49 with gunshot wounds and 140 with stab wounds, were treated in this series. Arteriography was performed in 62 patients (33%) to detect vascular injuries and to aid in the planning of the operative approach in patients with high or low neck wounds. Arteriography was 98% accurate and changed the operative approach in 29% of the positive studies. Of the 154 explorations 72 were positive (47%). There were no deaths and only four complications in the group with negative explorations. The mortality rate for the series was 2.6%. We believe that angiography in selected patients and routine exploration of wounds penetrating the platysma can minimize morbidity and mortality in these injuries.

Adolescent↗
PubMed1978

Natural history of nonstenotic, asymptomatic ulcerative lesions of the carotid artery.

To define the natural history of the asymptomatic, nonstenotic, ulcerative lesion involving the carotid artery bifurcation, the arteriograms and clinical course of 67 patients with 72 asymptomatic ulcerative lesions of the carotid artery were reviewed. The angiographic appearance of ulceration was classified into three groups: minimal (group A), large (group B), and compound (group C). Using life-table methods, the clinical course of these patients was compared between groups and was also compared to a nonrandomized surgically treated group of patients with nonstenotic ulcerative lesions in whom operation was performed for hemispheric or monocular symptoms. There were no significant (P greater than .1) differences in mortality, but the differences in stroke incidence was highly significant (P less than .001). The annual stroke rate, averaged over seven years, was 0.4% per year for group A, 1.47% per year for the surgically treated group, and 12.5% per year for groups B and C. The data indicate that group A ulcers have a benign prognosis, in noticeable contrast to group B and C ulcers which incur a high risk for subsequent stroke.

Adult↗
PubMed1978

Maintenance of viable arterial allografts by cryopreservation.

An experimental study, designed to investigate the feasibility of maintaining fresh, viable arterial allografts by cryopreservation, is presented. Cryopreserved femoral arterial allografts were shown to be equal in patency rate when compared with fresh controls. The cryopreserved allografts were shown to be superior to fresh allografts in the parameters of intimal integrity, absence of host rejection, and reduced surface thrombogenicity. This experimental study supports the thesis that cryopreservation in liquid nitrogen, utilizing 15% dimethyl sulfoxide (DMSO) and methylprednisolone as a cryoprotectant solution, is an excellent method of preserving and storing fresh allograft arteries for use as a small vessel replacement.

Animals↗
PubMed1978

Role of angiography in cervicothoracic trauma.

The role of angiography in cervicothoracic trauma is controversial. Since 1967 the policy at San Francisco General Hospital has been to use liberal indications for angiography in hemodynamically stable patients with either penetrating or blunt cervicothoracic trauma. The 304 patients in Group 1 had emergency angiographic evaluation: 102 had penetrating cervical wounds: 202 had thoracic injuries-71 penetrating and 131 blunt trauma. During the same time period, 72 patients (Group II) had cervical or thoracic vascular injuries and underwent operative treatment without preoperative angiography. Sixty-six patients in Group 1 had significant vascular injury. Thirty patients with penetrating cervical injury had 38 vascular lesions. Thirty-six patients with gunshot or blunt chest trauma had 43 vascular lesions. Group II patients had two main indications for operation: exanguinating hemorrhage (45 patients) or suspected vascular injury, usually associated with hemorrhage (27 patients). Angiographic results were useful whether abnormal or normal. In cases with adnormal findings operative treatment was specific and improper incisions were avoided. In cases with normal angiographic results, clarification of the vascular status avoided unnecessary operations and permitted concentration of therapeutic effort upon the main clinical problems of the patients.

Adolescent↗
PubMed1977

Below-knee amputation: a modern approach.

Immediate and long-term results of 113 below-knee amputations in 103 patients are presented to justify a comprehensive program of management that includes an objective method for determining amputation level with xenon 133 clearance, precise surgical technic, immediate postoperative prosthesis, and an aggressive program of rehabilitaion. Prediction of healing of the last 30 below-knee amputations was 100% successful, showing the value of 133Xe clearance for determination of amputation level. Zero per cent thirty-day mortality and 100% prosthetic rehabilitation of patients on below-knee prostheses justifies the use of immediate postoperative prosthesis. Long-term follow-up of our patients demonstrates that the five year survival rate of diabetic patients is poor (39%) compared with the nondiabetic amputee (75%) who approached the survival of the normal, age-adjusted male population (85%). The fact that 75% of patients were alive after five years and were still independently ambulatory on their prostheses is final testimony to the value of the program.

Adult↗