Biomedical subjects

E E Rigdon

Publications and source records attributed to E E Rigdon.

12 recordsLinked to original sources

PubMed2000

Endovascular-assisted versus conventional in situ saphenous vein bypass grafting: cumulative patency, limb salvage, and cost results in a 39-month multicenter study.

OBJECTIVE: In this retrospective multicenter study, the results of a minimally invasive method of endovascular-assisted in situ bypass grafting (EISB) versus "open" conventional in situ bypass grafting (CISB) were evaluated with a comparison of primary and secondary patency, limb salvage, and cost. METHODS: Enrolled in this study were 273 patients: 117 underwent CISB (42 femoropopliteal, 75 femorocrural) and 156 underwent EISB (41 femoropopliteal, 115 femorocrural). EISB was performed with an angioscopic Side Branch Occlusion system and an angioscopically guided valvulotome. All the patients underwent follow-up examination with serial color-flow ultrasound scanning. RESULTS: Both groups had similar comorbid risk factors for diabetes mellitus, coronary artery heart disease, hypertension, and cigarette smoking. The primary patency rates (CISB, 78.2% +/- 5% [SE]; EISB, 70.5% +/- 5%; P =.156), the secondary patency rates (CISB, 84.1% +/- 4%; EISB, 82.9% +/- 5%; P =.26), and the limb salvage rates (CISB, 85.8%; EISB, 88.4%; P =.127) were statistically similar, with a follow-up period that extended to 39 months (mean, 16.6 months; range, 1 to 40 months). In veins that were less than 2.5 to 3.0 mm in diameter, the EISB grafts fared poorly, with an increased incidence of early (12-month) graft thromboses (CISB, 10 grafts, 8.5%; EISB, 24 grafts, 15.3%). However, wound complications (CISB, 23%; EISB, 4%; P =.003), mean hospital length of stay (CISB, 6.5 days +/- 4.83; EISB, 3.2 days +/- 3.19; P =.001), and mean hospital charges (CISB, $25,349 +/- $19,476; EISB, $18,096 +/- $14,573; P =.001) were all significantly reduced in the EISB group. CONCLUSION: The CISB and EISB midterm primary and secondary patency and limb salvage rates were statistically similar. In smaller veins (< 2.5 to 3.0 mm in diameter), however, EISB is not appropriate because overly aggressive instrumentation may cause intimal trauma, with resultant early graft failure. With the avoidance of a long leg incision in the EISB group, wound complications and hospital length of stay were significantly reduced, which lowered hospital charges and justified the additional cost of the endovascular instruments. When in situ bypass grafting is contemplated, EISB in appropriate patients is a safe, minimally invasive, and cost-effective alternative to CISB.

Aged↗

PubMed2000

Trousseau's syndrome and acute arterial thrombosis.

This report describes three patients treated for acute arterial thrombosis due to malignancy-related hypercoagulability (Trousseau's syndrome). The average age was 59yr. There were two women and one man. The cancers were breast, lung, and pancreas. Atherosclerosis or nonneoplastic hypercoagulable states did not appear to be a factor in any patient. One patient who presented with irreversible arm ischemia and Stage IV breast cancer underwent primary amputation. The other two patients underwent immediate surgical thrombectomy and thrombolytic therapy, and malignancy was discovered during postoperative workup for hypercoagulable states. Both ultimately required amputation. All three patients died due to cancer less than one year after presentation. When a hypercoagulable state is suspected as the cause of acute arterial thrombosis, an evaluation for occult malignancy is indicated. Although aggressive revascularization attempts may be appropriate, the prognosis for limb salvage and long-term survival is poor.

Adenocarcinoma↗

PubMed1998

Racial and gender differences in outcome after carotid endarterectomy.

Women and minorities were underrepresented in trials demonstrating carotid endarterectomy (CEA) is superior to medical treatment for significant carotid stenosis. These trials also revealed that the benefit of CEA is largely determined by the incidence of operative complications. Our series of 429 CEAs reflects a more diverse population (41% women, 24% blacks). We questioned if outcome was related to race, gender or other factors. Stroke occurred after 4.9 per cent of operations, cardiac events after 3 per cent, and death after 2 per cent. No factors correlated with cardiac events. Diabetes, smoking, neurologic symptoms, shunting, and patch closure did not correlate with complications. Chronic renal insufficiency (CRI), emergent operation, and operation by neurosurgeons correlated with stroke. Black females (BF) had significantly more strokes than did others (16% versus 3%). More BF had CRI, but their higher complication rate persisted when CRI patients were excluded. More BF were hypertensive (98% versus 74%), but hypertension did not correlate with complications. However, severe acute perioperative hypertension was common in BF experiencing complications and may be related to the differences observed. These findings highlight the need for better understanding of racial and gender outcome differences after CEA in order to improve risks and allow modification of selection criteria for high risk groups.

Adult↗

PubMed1997

Criteria for selective utilization of the intensive care unit following carotid endarterectomy.

The common practice of admitting all patients to an intensive care unit (ICU) following carotid endarterectomy (CEA) is based upon concern for adverse events that may be properly cared for only in the ICU. We developed restrictive criteria for postoperative nursing unit admission based on analysis of adverse outcomes and risk factors. 365 CEAs over 15 years were reviewed. In the first 24 hours after CEA, 38 patients experienced 46 events that may have been best managed in an ICU. Preoperative factors associated with significant risk for complications were indications of cardiac disease within 6 months (n = 62, p < 0.05), emergent CEA (n = 2, p = 0.01), and need for postoperative anticoagulation (n = 2, p = 0.01). Only 56 (15%) of patients had indications for ICU admission, 57 (16%) would have been admitted to an EKG-monitored nursing unit, and 252 (69%) would have been admitted to a standard nursing unit. Immediate admission to the ICU after CEA is indicated for patients undergoing emergent CEA, those requiring anticoagulation postoperatively, those with intraoperative stroke or major cardiac complication, and possibly those with chronic renal failure. All other patients should be admitted to the RR. Patients experiencing stroke, major cardiac events, significant wound hemorrhage, or reintubation in the RR, and those requiring vasoactive medication more than 3 hours after surgery should be transferred to the ICU. Patients with indications of cardiac disease within 6 months prior to CEA but no indications for ICU admission may be discharged from the RR to an EKG monitored unit. All others may be discharged to a standard nursing unit.

Endarterectomy, Carotid↗

PubMed1997

Is carotid endarterectomy justified in patients with severe chronic renal insufficiency?

We evaluated the effect of chronic renal insufficiency (CRI) and commonly associated co-morbid conditions on the risk of adverse events (stroke, cardiac events, and death) within 30 days after carotid endarterectomy (CEA). Renal function of patients undergoing CEA from 1980 to 1994 was categorized as normal (creatinine < 1.5 mg/dl), mild CRI (creatinine 1.5-2.9 mg/dl), or severe CRI (creatinine > 2.9 mg/dl). Renal function, age, gender, indications for surgery, cardiac disease, chronic preoperative hypertension, diabetes mellitus, smoking history, severe perioperative hypertension or hypotension, intraoperative shunting, and patch closure of the carotid artery were evaluated for their influence on the incidence of adverse events within 30 days after surgery. The timing of postoperative stroke and mechanism of stroke was determined when possible. A total of 237 patients underwent 285 CEAs. No significant differences were found in demographic or clinical characteristics between patients with normal or abnormal renal function. Postoperative stroke and death occurred following three (43%) of seven CEAs in six patients with severe CRI, significantly greater than the 6% incidence of stroke and 1% mortality following 264 CEAs in 221 patients with normal renal function (p < 0.001 and p < 0.001, respectively). Of three patients with severe CRI suffering postoperative stroke, two had severe, difficult to control perioperative hypertension. Two patients with severe CRI who survived 30 days after operation suffered strokes 3 and 4 months postoperatively with one stroke-related death and another death not directly related to the stroke. One patient with severe CRI who survived CEA without stroke was alive 6 months after surgery. The 0% incidence of stroke and death following 14 CEAs in 10 patients with mild CRI was not significantly different from that in patients with normal renal function. Postoperative stroke was not associated with age, gender, history of cardiac disease, chronic preoperative hypertension, diabetes, smoking, or use of intraoperative shunts or patch closure. All three cardiac events occurred in diabetic patients, although they constituted only 26% of operations (p = 0.003). Other clinical characteristics were not associated with the occurrence of cardiac events. Patients with severe CRI are at significantly greater risk than others for postoperative stroke and death following CEA, possibly related to difficulty controlling severe perioperative hypertension. Age, gender, smoking, preoperative hypertension, diabetes, and known cardiac disease are not associated with an increased risk of postoperative stroke in any patient group. CEA can be justified only for carefully selected patients with severe CRI who have symptomatic carotid disease, acceptable operative risk factors, and a good long-term life expectancy. CEA in patients with mild CRI is associated with low risk, and these patients may be treated with the same consideration as patients with normal renal function.

Adult↗

PubMed1993

Persistent sciatic artery: embryology, pathology, and treatment.

PURPOSE: The purpose of this article is to describe the embryologic development and anomalous persistence of the sciatic artery, pathologic changes that may occur in the persistent sciatic artery, and management of complications related to these pathologic changes. METHODS: Two patients with persistence of the sciatic artery treated in the authors' experience are reported. In addition, the computerized data base of the University of Mississippi Medical Center was searched for patients with other lower extremity arterial aneurysms, and their records were reviewed for possible aneurysm of a persistent sciatic artery. A review of the literature was undertaken to determine the embryologic development of the persistent sciatic artery, the pathologic changes that have been observed in the sciatic artery, clinical findings associated with these pathologic changes, and methods of treatment. RESULTS: Two patients with persistence of the sciatic artery were treated by the authors. No other cases were identified in 43 patients with 66 lower extremity aneurysms treated at our institution. The first patient presented with acute lower extremity ischemia caused by thrombosis of a sciatic artery aneurysm and was treated successfully with intraarterial thrombolytic therapy followed by interposition graft repair. In the second case an incidental unilateral persistent sciatic artery was identified in a patient with bilateral Buerger's disease presenting with digital gangrene of the contralateral extremity in whom below-knee amputation was eventually required. Bilateral tibial artery occlusion was observed on arteriography. Histologic examination of the amputated limb confirmed findings typical of Buerger's disease, and no microemboli were seen. DISCUSSION: The sciatic artery is a continuation of the internal iliac artery and is the primary blood supply to the lower limb bud during early fetal development. The sciatic artery normally involutes during fetal development, but remnants persist as the popliteal and peroneal arteries after the superficial femoral artery develops and establishes continuity with the popliteal artery. Persistence of the sciatic artery as the major blood supply to the lower extremity in adults is a rare vascular anomaly that may be of surgical significance. Failure to appreciate the persistent sciatic artery as the major inflow into the lower extremity may lead to inappropriate bypass of apparent occlusive disease of the superficial femoral artery. The persistent sciatic artery is also frequently aneurysmal, which may cause critical limb ischemia resulting from thrombosis or embolization of aneurysm thrombus. Options for vascular reconstruction include interposition graft replacement and standard femoropopliteal bypass grafting if the common femoral artery is sufficiently developed to provide adequate inflow. As with other peripheral arterial aneurysms resulting in thrombosis and extensive distal arterial embolization and thrombosis, intraarterial thrombolytic therapy may be useful in selected cases before definitive surgical revascularization.

Adult↗

PubMed1992

Outpatient vascular access surgery: impact of a dialysis unit-based surgical facility.

The present report describes a novel approach to vascular access surgery based on the philosophy that a readily available operating room, staffed by nurses familiar with the unique problems of dialysis patients and their therapy, would reduce dialysis delays and maintain the quality of surgical care. Based on a 28-month experience with more than 1,000 access cases, we conclude that a traditional surgical setting is not necessary for either quality access graft placement or the management of access complications.

Age Factors↗

PubMed1992

Aneurysms of the superficial femoral artery: a report of two cases and review of the literature.

True "arteriosclerotic" aneurysms of the superficial femoral artery, not associated with generalized dilatation of the common femoral or popliteal artery, are relatively rare. We report our experience with two isolated superficial femoral artery aneurysms and review the previous literature. An 88-year-old woman was first seen with thrombosis of a superficial femoral aneurysm and limb-threatening ischemia and had eventual limb loss as a result of occlusion of distal run-off vessels despite surgical revascularization. A 93-year-old man came to us with rupture and was treated with an interposition graft, which resulted in limb salvage. Review of 17 "arteriosclerotic" superficial femoral artery aneurysms in 14 patients whose cases were reported in the literature revealed a complication at presentation in 65%, rupture in 35%, thrombosis in 18%, and distal emboli in 12%. However, limb salvage was 94% and there were no perioperative deaths. Abdominal aortic aneurysms were discovered in 40%. Males (75%) were more common than females, and the average age was 77 years (range 61 to 93). Isolated superficial femoral artery aneurysms are rare and occur at an older average age than do other peripheral aneurysms, but their incidence is anticipated to increase with this growing segment of our population. In the absence of evidence of syphilitic, other infectious, immunologic, inflammatory, or connective-tissue disorders, these and other aneurysms are considered arteriosclerotic in origin, despite the absence of diffuse arteriosclerosis in many cases and controversy regarding the role of arteriosclerosis in their cause.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1991

Hepatorenal and splenorenal artery bypass for salvage of renal function.

Hepatic and splenic arteries have been used increasingly as inflow sources to avoid aortorenal bypass in patients whose cardiac dysfunction may be exacerbated by aortic clamping and in patients with previous aortic grafting in whom periaortic dissection is more hazardous than incising undisturbed tissue planes. During an 18-month period, eight patients with atherosclerotic renal artery stenosis and azotemia were treated with six hepatorenal and five splenorenal artery bypasses. Serum creatinine improved initially in all patients. Severe hypertension, present in five patients, improved significantly in four (80%). In one-half the gastroduodenal branch of the hepatic artery was suitable for end-to-end anastomosis to the renal artery, obviating the need for an interposition graft. Hepatorenal bypass is a safe, simple procedure that has been associated with few complications, although occasional transient subclinical evidence of hepatic dysfunction has been reported. Splenorenal bypass requires a relatively more hazardous exposure and is associated with a low risk of splenic and pancreatic injury, especially when the spleen and splenic flexure of the colon are mobilized to expose the splenic artery. The risk of splenic injury is substantially reduced when the splenic artery is approached through the retroperitoneum at the base of the transverse mesocolon as described.

Anastomosis, Surgical↗

PubMed1991

Retrieval of renal function by revascularization of renovascular disease.

Renal dysfunction due to renal artery occlusive disease is potentially reversible and this diagnosis should be considered in all patients with renal failure, especially in patients with other manifestations of occlusive peripheral vascular disease, those with severe hypertension, and those over 45 or under 20 years of age at the onset of hypertension (i.e., older or younger than the usual age for onset of "essential" hypertension). Renovascular disease should also be suspected in hypertensive patients with mild to modest impairment of renal function who demonstrate a sudden worsening of renal function following administration of an angiotensin-converting enzyme inhibitor. Effective and safe techniques for renal revascularization are available in almost all cases to achieve greater longevity and improved quality of life, as well as to reduce the economic impact of chronic renal failure and renovascular hypertension.

Humans↗

PubMed1983

Management of leakage from gastrostomy sites.

Enlargement of a gastrostomal orifice with leakage of gastric content is a bothersome complication of a tube gastrostomy resulting in skin excoriation, fluid loss, and loss of access for enteral nutrition. Thirteen patients with this complication of a Stamm gastrostomy have been treated successfully by replacing a large gastrostomy tube with small silastic tubes for gastric aspiration and decompression and in some cases a small silastic enteral feeding catheter guided endoscopically into the duodenum through the gastric stoma. Karaya pad placement about the stoma to seal the gastric fluids from skin contact was helpful in seven patients. Stomal closure occurred in all 13 patients until a tight cutaneous closure about a 20-24 F catheter was achieved.

Catheterization↗

PubMed1982

Immunoregulation by antigenic stimulation via the anterior chamber of the eye.

The presentation of alloantigen to the host via the anterior chamber of the eye can alter the host's immune response. Spleen cells from Lewis rats bearing Brown Norway skin implants in the anterior chamber demonstrated a mildly depressed in vitro blastogenic response to MLC and to PHA stimulation 7-28 days after implantation, a normal response by 35 days, and a slightly greater than normal response by 42 days after implantation. In addition, serum from rats bearing implants for 7-24 days demonstrated a significant depressant effect on the blastogenic response of normal spleen cells to MLC and to PHA stimulation, but the "blocking" effect was absent by 42 days postimplantation. These results indicate that antigen presentation via the anterior chamber of the eye can produce a state of active immunosuppression within the host which could contribute to the privileged nature of the anterior chamber of the eye.

Animals↗