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Biomedical subjects

B Sussman

Publications and source records attributed to B Sussman.

36 records · Page 2Linked to original sources
PubMed1985

Omental protection of autogenous arterial reconstruction following femoral prosthetic graft infection.

Vascular graft infections in the femoral region that require synchronous revascularization are generally reconstructed with prosthetic grafts via extra-anatomic routes. If in situ revascularization is required, then autologous tissue provides optimal results. A particular challenge in this circumstance is achieving soft tissue coverage of the reconstruction where wide and radical débridement has removed the tissues ordinarily used for this purpose. If muscle flaps are not available or possible, the use of omentum is advocated. The omentum can be easily reached from behind the inguinal ligament and transposed on its bipedicled vascular base for coverage of vital structures in the femoral triangle, thereby obliterating dead space and providing a surface for both temporary and permanent skin coverage. The procedure is quite simple, can be performed rapidly, and should be considered for use in the dire situation that requires soft tissue coverage of exposed vessels in extraperitoneal locations.

Blood Vessel Prosthesis↗
PubMed1985

Adventitial cystic disease of the popliteal artery: failure of percutaneous transluminal angioplasty as a therapeutic modality.

Adventitial cystic disease of the popliteal artery is an important cause of peripheral vascular insufficiency in the young and middle-aged man. The pathologic feature is a mucinous cyst located within the adventitia of the artery that expands and secondarily compromises the vessel lumen. Although physiologically quite different, this process is easily mistaken for arteriosclerosis. The clinical history of sudden claudication in a young nonsmoking man, combined with characteristic angiographic features, are important clues to the correct underlying pathology. Treatment generally consists of cyst evacuation or local bypass. This article was prompted by the failure of percutaneous transluminal angioplasty to achieve durable success in controlling this unique type of arterial disease. Subsequent surgical intervention proved satisfactory, lending support to this modality as the treatment of choice.

Angioplasty, Balloon↗
PubMed1984

Improved patient selection for enzymatic lysis of peripheral arterial and graft occlusions.

Intraarterial thrombolysis by remote intravenous or direct intraarterial infusion of streptokinase is possible. The latter may be more effective with a lesser potential for systemic hemorrhagic complications because of the smaller dose administered directly in the area. Fifty patients with prosthetic graft, embolic, and renal artery occlusions were evaluated. Embolic occlusion responded dramatically, particularly since lytic therapy was initiated at an early stage. Patients with severe ischemia or those with simple localized occlusion were best treated by surgical means. Successful thrombolysis was also obtained with renal artery occlusions combined with percutaneous transluminal angioplasty. The management of patients with prosthetic graft occlusion by lytic therapy is complex. Optimal results can be obtained in patients presenting with occluded grafts after the immediate postoperative period and in those in whom previous satisfactory runoff has been demonstrated. Failure of lysis in this group is associated with a high incidence of limb loss due to unreconstructable obliterative disease. Successful lysis of occluded prosthetic grafts will often require corrective angioplasty or surgical revision.

Adult↗
PubMed1984

Biodegradation and aneurysm formation in umbilical vein grafts. Observations and a realistic strategy.

In a series of 756 glutaraldehyde-stabilized umbilical vein grafts implanted over a 7 1/2-year period, aneurysms were identified in seven cases. The earliest aneurysm was seen at 31 months after implantation and the remainder between 43 and 79 months after surgery. Corrective surgery was performed in five cases and succeeded in four. Although definite mechanisms have not been identified, mechanical fatigue, reversal of aldehyde crosslinks, and immunologic factors may be operative. The pathologic changes include: (1) actual dilation of both graft and mesh with or without intraluminal thrombus and, (2) maintenance of graft diameter with erosion of the umbilical vein and polyester mesh rupture leading to perigraft hematoma and false aneurysm formation. Microscopic examination and infrared spectral analysis confirmed the presence of host-contributed lipid in some specimens. Although this is a low incidence of aneurysm formation, umbilical vein grafts should be selected primarily for patients with limited life expectancy or for whom alternative materials with comparable or superior patency rates are not available or acceptable. Periodic angiography, particularly after 3 or 4 years, is recommended as a routine part of follow-up examinations. Improved graft materials and control of host environmental factors are potential means to reduce the noted degradation.

Aneurysm↗
PubMed1983

Distal arteriovenous fistula as an adjunct to maintaining arterial and graft patency for limb salvage.

Sixty-one distal arteriovenous fistulas (dAVFs) were constructed as adjuncts to tibial and peroneal vascular reconstructive procedures in 58 patients threatened with imminent limb loss. Specific indications for dAVF construction were absent or deficient pedal arches, usually associated with small, calcareous crural vessels. Conventional bypasses had been previously performed in 35 patients. Cumulative graft patency rates were 56%, 39%, and 18% at 6, 12, and 24 months, respectively. For the same intervals, the figures were 56%, 52%, and 52% (P less than 0.001 at 24 months) for nonAVF reconstructions (n = 49). The corresponding cumulative limb salvage rates were 62%, 52%, and 40% for the dAVF group and 78%, 72%, and 72% for the nonAVF group (P less than 0.05 at 24 months). The perioperative mortality rate was 7% (four of 61). Twenty-four amputations were required, of which 16 were below the knee and six despite patent grafts. There was no significant morbidity attributable directly to the dAVF. Cardiac output showed no deviations from normal values. Primary causes of early failure were infection (n = 4), absence of satisfactory veins (n = 6), and inappropriate case selection (n = 7). Intimal hyperplasia led to dAVF closure and graft failure in 13 patients. This study shows that dAVFs can maintain graft patency by diversion of the overload on a high-resistance vascular bed and, secondarily, by augmentation of inflow. Immediate survival of the limb still depends on the arterial runoff, as retrograde venous flow caused by venous valvular incompetence is a delayed development. Adjunctive dAVF is justified in selected cases where conventional bypass failure has occurred or is predictable by increased pedal vascular resistance.

Adult↗
PubMed1982

Influence of failed vascular bypass procedures on conversion of below-knee to above-knee amputation levels.

From 1975 to 1980, 79 major limb amputations were performed from a group of 552 lower extremity vascular reconstructions with glutaraldehyde-stabilized umbilical vein grafts. All amputations were performed in instances in which limb salvage had been the indication for the attempted bypass (n = 520)--an incidence of 15.2%. Twelve of 51 below-knee (BK) amputations were converted to above-knee (AK) levels (crude failure rate, 23.5%). The highest crude failure rate occurred after failed bypass to the popliteal artery (33.3%); the lowest occurred after failed tibial bypass (16.7%), and the peroneal arteries were intermediate (22.2%). In addition to these 12, 28 primary AK amputations were performed. Excluding nine cases judged to require AK amputations before the attempted vascular reconstruction, success/failure rates for the entire series and each of the reconstruction types were calculated. Success, defined as a healed BK stump, occurred least after failed popliteal bypass, 44.5%, compared to 71.4% and 53.8% for the tibial and peroneal groups, respectively. Thus, failure of a popliteal bypass was more apt to lead to an AK amputation (56.5%) than failure of a distal bypass. In fact, tibial bypass failure leading to an AK stump occurred at a frequency (28.6%) almost similar to that obtained by other investigators when no previous bypass had been performed. Comparative cumulative graft patency and limb salvage rate data confirm the value of reconstructive vascular surgery, particularly in the peroneal group where negativism with regard to its clinical usefulness persists. With improved case selectivity and surgical expertise, increasing limb salvage rates can be secured while minimizing the definite morbidity of conversion of BK to AK amputation with failed vascular bypass.

Aged↗
PubMed1981

Morphologic structure of the pedal arch and its relationship to patency of crural vascular reconstruction.

Pedal arch integrity can be determined morphologically and functionally. The former is accessible by contrast studies and intraoperative catheterization, the latter, by flow studies and observation of graft patency. The roengten image of an intact pedal arch corresponds to the anatomic plantar arch. Sixty-four arch studies obtained by adequate intraoperative arteriography were categorized as intact, deficient or inadequate or absent. Patency of crural reconstructions was obtained in 18 of 24 patients with intact arches as compared with 15 of 32, p<0.06, when the arch was deficient. Crural reconstruction in the face of an inadequate or absent arch resulted in predictable graft closure. Qualitative factors, that is, size, calcium and stenotic lesions, are integrally related to over-all graft performance even with intact arches. The deficient arch for tibial and peroneal reconstruction continues as a challenge to the vascular surgeon.

Angiography↗
PubMed1981

Tibial arteriovenous fistula: successful use for limb salvage.

Embolization of atheromatous material from abdominal aortic aneurysms to the distal arterial circuit is a well-recognized clinical entity causing the "blue toe syndrome." A case is presented in which this phenomenon resulted in obliteration of the pedal arch and thrombosis of the tibial arteries. As a result, forefoot gangrene, severe leg ischemia and anterior and posterior compartment syndromes occurred. Salvage of the extremity required an extraordinary approach with the construction of an arteriovenous fistula between the posterior tibial vessels. The literature on the use of therapeutic and adjunctive arteriovenous fistulas and their physiology is discussed.

Aortic Aneurysm↗
PubMed1980

Adjunctive arteriovenous fistula with tibial and peroneal reconstruction for limb salvage.

Arteriovenous fistulas were constructed as an adjunct to femoral peroneal and tibial bypasses in 13 patients threatened by imminent limb amputation. Previous attempts at conventional vascular reconstructive procedures had failed in nine patients. Deficient or absent pedal arches were noted in all patients, as were poor quality or small crural arteries. Graft patency was achieved in 11 cases and limb salvage in 10. There was no mortality. A steal phenomenon occurred in one patient and was successfully treated by secondary popliteal vein ligation. These preliminary results clearly indicate that an adjunctive arteriovenous fistula can maintain patency in a femoral tibial or peroneal bypass graft while preserving flow into the markedly diseased distal circulation.

Aged↗
PubMed1979

Synchronous aortofemoral or iliofemoral bypass with revascularization of the lower extremity.

Bypassing aortoiliac stenosing lesions to the profunda femoria alone, even with extensive end-arterectomy and angioplasty of the latter, will not provide predictable excellent results in the presence of gangrene and occlusion in the femoral popliteal system. With severe pregangrene and rest pain, residual ischemic complaints are also common, and if lesions are present, healing is incomplete or, at best, delayed. Alternatively, femoropopliteal or tibial bypass, in the presence of even moderately diminished inflow, is subject to either early or delayed closure, unless proximal repair is also performed in appropriately selected patients. Synchronous correction of tandem lesions involving the aortoiliac and femoropopliteal segments should, therefore, be considered for limb salvage only and particularly in the presence of focal gangrene, excision or debridement of which can be anticipated to heal after successful bypass. Major diminution in femoral inflow usually indicates the need for proximal repair only, even in the presence of distal lesions. Noninvasive studies and intraoperative flow determinations are not uniformly helpful in patient selection. Synchronous aortofemoral or iliofemoral and femoropopliteal or tibial reconstructions were performed upon 38 patients, 15 of whom had no prior vascular operation and 23 of whom had previously undergone either aortofemoral or femoropopliteal bypasses that had failed. Graft patency for all patients was 76 per cent, and although it was better for the patients in group 1 than for those in group 2, no statistical significance existed between the two groups. Improved patient selection and criteria for performing synchronous reconstructions might originally have been of benefit for the patients in group 2, avoiding more difficult secondary repairs. It must be emphasized, however, that synchronous reconstructions should not be done routinely in the presence of multilevel disease. Rather, specific indications do exist and should be considered on an individual basis.

Aged↗
PubMed1978

The stapled gastrointestinal tract anastomosis: incidence of postoperative complications compared with the sutured anastomosis.

Performance of gastrointestinal anastomosis by means of surgical stapling devices has achieved popularity in the last decade even though no detailed study has been reported comparing complications following the stapled anastomosis with those following hand sutured procedures performed by the same surgeons. We have reviewed 812 operative procedures on the gastrointestinal tract performed in one hospital over a four year period. Stapled anastomoses were performed in 472 with 13 (2.8%) complications related to the anastomosis; in 296 sutured anastomoses there were nine (3.0%) related complications. Comparison did not disclose any significant difference in the number of complications in these two groups. In 44 instances wherein the anastomosis contained both staples and sutures, there were no related complications. Further analysis of the patients in each group disclosed that stapling procedures were utilized in a much higher percentage of those operations which were performed under emergency conditions or in the presence of intra-abdominal sepsis, intestinal obstruction, and carcinomatosis. If the technical details of surgical stapling are mastered, this technique appears to be as safe as suturing in the performance of anastomoses in the gastrointestinal tract.

Colectomy↗
PubMedDate not supplied

Endovascular treatment of mycotic hepatic artery aneurysm in the hostile abdomen--a case report.

Mycotic hepatic artery aneurysms are rare. This report documents a case in which a mycotic hepatic artery aneurysm was associated with Crohn's disease, renal adenocarcinoma, and a urinary tract infection. Endovascular management of this mycotic hepatic artery aneurysm was successful in the setting of a hostile abdomen based on multiple previous operations, a stoma, and a scarred abdomen.

Adult↗
PubMedDate not supplied

Dual function of the distal arteriovenous fistula for maintenance of arterial and venous prosthetic graft patency in the lower extremity.

Venous hypertension, severe swelling, and tissue necrosis occurred in a limb previously subjected to distal arterial bypass plus adjunctive arteriovenous fistula. Occlusion of the popliteal vein had not been recognized during the early treatment period. Subsequent to identification of this mechanism, limb salvage was achieved with an interposition graft of the popliteal vein using externally supported PTFE. The prereconstruction venous pressure gradient of 29 cm H2O was virtually abolished immediately after reestablishing venous outflow. The distal arteriovenous fistula, initially established to maintain prosthetic arterial graft patency, now serves, in this case, a dual function by additionally maintaining prosthetic venous graft patency. An intact deep venous system is critical for achieving successful arterial reconstruction and to avoid the complications associated with an occluded outflow tract in the face of augmented inflow.

Aged↗