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C S Hoar

Publications and source records attributed to C S Hoar.

11 recordsLinked to original sources
PubMed1985

Improved results with diabetic below-knee amputations.

This study of 100 consecutive below-knee amputations in 98 diabetic patients was undertaken to review our results and to compare them with a similar report of 20 years ago. Ninety-three limbs were ischemic, and 79% of the patients had significant infection. This finding was similar to that in our previous study group. Twenty-one percent of the patients had previous arterial reconstruction, 11% had had a toe or metatarsal amputation, and 17% required a guillotine (open) amputation to control sepsis. The below- to above-knee amputation ratio was 2.3/1. The selection of level was made on clinical grounds. None of the 100 amputations required revision to above-knee amputation. The mortality rate was 3% and the wound complication rate was 18%. Eighty-three percent of the patients were ambulatory at the time of discharge, which occurred at an average of 35 days. There has been a significant improvement in the number of successful below-knee amputations performed since our previous study. We attribute these results to aggressive surgical control of infection and to close follow-up with early recognition and treatment of healing problems.

Adult↗
PubMed1984

Carotid artery surgery in diabetic patients.

We present a retrospective study of 191 carotid artery operations in which a large population of diabetic patients is compared with a smaller nondiabetic group of patients. Of the patients who were studied, 62.3% were diabetic and 37.6% were nondiabetic. The patients with a juvenile-onset diabetes fared poorly, with few of them living long enough to develop carotid artery disease. The patients with adult-onset diabetes differed from the nondiabetic patients only in the increased incidence of associated peripheral vascular disease. The incidence of symptomatic heart disease preoperatively, and the perioperative morbidity from heart disease was the same for both groups. The perioperative stroke rate was 2.6% and 0%, respectively, for asymptomatic patients. Long-term follow-up demonstrated the effectiveness of the procedure, with only two of the patients with transient ischemic attacks developing strokes later. There was, however, a highly significant increased death rate from myocardial infarction among the diabetic patients (55%), compared with the nondiabetic patients (25%).

Carotid Artery Diseases↗
PubMed1979

Predicting success of forefoot amputations in diabetics by noninvasive testing.

Sixty-six diabetic patients underwent needed forefoot amputations when clinical assessment indicated a reasonable chance of healing. All patients underwent noninvasive testing consisting of segmental systolic pressure measurements and pulse volume recordings (PVRs) taken at the thigh, calf, ankle, and forefoot levels. Segmental systolic pressures were falsely high (greater than 200 mm Hg) and therefore not useful in 56%. Ankle systolic pressures predicted failure in 36% of patients who healed and success in 64% who failed to heal. Segmental PVRs were sequentially predictive in only 50%. Forefoot PVR traces predicted failure in 50% of patients whose amputations healed. No patient should be denied a forefoot amputation solely on the basis of unfavorable results of noninvasive tests. Favorable clinical signs and a strongly positive forefoot PVR trace are the best predictors of successful forefoot amputations in diabetic patients.

Amputation, Surgical↗
PubMed1979

Noninvasive prediction of amputation level in diabetic patients.

Noninvasive laboratory testing was used to predict successful amputation levels in 150 diabetic patients. The cases of 100 patients undergoing forefoot amputation and 50 patients undergoing below-knee amputation were evaluated using segmental systolic pressures and pulse volume recordings (PVRs). The decision for and the level of amputation were based solely on clinical judgment. In patients undergoing forefoot amputation, segmental systolic pressures were falsely high or predicted incorrectly in over half the cases. Segment PVRs were correctly predictive in only half of the cases. In patients undergoing below-knee amputation, segment systolic pressures were falsely high or predicted incorrectly in over one third of cases. Segmental PVRs were correctly predictive in less than one third of the cases. In the diabetic patient, clinical judgment continues to provide the most accurate and reliable information by which the type of amputation and likelihood of its success can be judged.

Adult↗
PubMed1979

The use of arm veins in femoral-popliteal bypass grafts.

In view of the increasing debate as to the best alternative to saphenous vein for femoral popliteal bypass grafts, we present our experience with the use of arm vein grafts. Though there are many anecdotal reports, only one series has been previously published. Arm veins were used when saphenous vein was unavailable in 18 femoral popliteal or femoral tibial bypass grafts. Eighty-three per cent of the patients were diabetic. Ninety-four per cent of the patients were operated on for limb salvage, and in 67% the arteriograms showed only fair to poor run-off. Despite this, the one year patency rate was 82%, which is significantly better than the sixty-nine per cent one year patency rate reported by the senior author in an earlier series using cloth grafts. In view of these good results, we believe that autogenous vein remains the material of choice in femoral popliteal bypass grafts. We do not feel that expanded polytetrafluoroethylene grafts or umbilical vein grafts have yet been shown to be superior. We emphasize also the special techniques that are required when using arm veins.

Aged↗