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Biomedical subjects

E Prombonas

Publications and source records attributed to E Prombonas.

10 recordsLinked to original sources
PubMed1990

The mid-aortic dysplastic syndrome. Surgical considerations with a 2 to 18 year follow-up and selective histopathological study.

Mild-aortic dysplastic syndrome is usually presented with advanced hypertension in young individuals in association with either weak or absent femoral pulses, due to diffuse narrowing of the aorta in its mid thoraco-abdominal course. There is frequent involvement of visceral arterial branches such as renal and superior mesenteric arteries. Although the disease has been popularised by the appealing name of "abdominal coarctation", the term mid-aortic dysplastic syndrome is more appropriate. In spite of the fact that the syndrome was described almost three decades ago, its exact aetiology remains obscure and pathogenesis speculative. Surgical revascularisation remains the only therapeutic remedy, in dealing with this particular group of young hypertensive patients. The clinical presentation, angiographic assessment and long-term outcome, following reconstruction in 11 patients (mean age 24.4 years) with mid-aortic dysplastic syndrome were evaluated, in an effort to determine the effectiveness of surgery. Late follow-up, slightly exceeding 16 years (mean 5.6 years) has shown normal and relief from hypertension in practically all individuals. Furthermore, in order to elucidate at least some aspects of histopathology, studies were undertaken upon specimens from the aortic wall and the renal, carotid, lumbar and brachial arteries. The results suggested predominantly dysplastic features in the media, intima and particularly along the course of internal lamina. Aortography, using different projections, revealed variable patterns of high mid-aortic stenosis with or without associated renal artery disease. All patients were hypertensive (mean blood pressure 170 mmHg) and co-exist renal artery disease, unilateral in three and bilateral in three cases, was detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Aorto-femoral bypass and determinants of early success and late favourable outcome. Experience with 1000 consecutive cases.

Experience with 1000 cases of aorto-(bi)femoral bypass is presented evaluating factors influencing the overall patency rate and late survival, over a period of 25 years. There were 820 cases with bilateral and 180 with a unilateral bypass. Mortality was 3.3% and death rate 39.4%. Re-do procedures have been excluded. Operative indications were for stage I disease (moderate claudication) (17.6%), stage II (advanced claudication) (53.2%), stage III (rest pain and/or pregangrenous changes) (22.7%) and stage IV (gangrenous tissue loss (6.5%). Myocardial infarction was the predominant cause of late death in 192 cases (48.7%), followed by cancer in 48 (13%), cerebrovascular disease in 43 (11%), chronic lung disease with cor pulmonale in 15 (3.8%) and miscellaneous causes in 52 (13.2%) of patients. The cause of death was unknown in 31 (7.8%) cases. Co-existent peripheral arteriopathy (PAD) noted in 377 (37.7%) patients, was found to be a major determinant of late graft patency. Carotid artery disease and renovascular hypertension were corrected surgically, prior to aorto-femoral bypass in the 5.6% and concomitantly in 4.2%. Coronary artery disease in 273 (27.3%) patients and hypertension in 269 (26.9%), had a great influence on late survival as did age and smoking habits. Endarterectomy together with profundaplasty was carried out in 162 (16.2%) instances. It was our policy to extend the graft limb over the profunda femoris and in cases with co-existent superficial femoral artery disease 208 (20.8%). In 630 (63%) instances, the distal anastomosis was performed at the level of common femoral artery. Immediate graft patency was obtained in 99.3% of the cases. Late patency rate for stages I and II at 5, 10 and 15 years was 82%, 76% and 72% respectively. Following secondary operation for graft occlusion, the 15 year patency was increased to 71%. Co-existent superficial femoral disease can be alleviated by appropriate concomitant profundaplasty. Amputation rates were 0.8% for stage II, 1.5% for stage III and 2.4% for stage IV disease. Twenty year life table analysis showed a reduced survival (54%), in comparison with normal population (77%).

Adult↗
PubMedDate not supplied

Juxtarenal abdominal aneurysmectomy.

The term juxtarenal abdominal aneurysm is used to describe an aneurysm whose neck is level or adjacent to the origin of one or both renal arteries. Misinterpretation of these appearances could result in the operation being abandoned with the erroneous diagnosis of suprarenal aneurysm. We report 38 patients with a median age of 66 who underwent juxtarenal aneurysm repair, 18 of whom had been diagnosed as having an abdominal aneurysm extending above the renal arteries. Computed tomography, duplex scanning and selective aortography in 7 cases, failed to reveal the true nature of the aneurysm owing to the upper part of the sac lying over the origin of the renal arteries, resulting in aortic tortuosity at this point. The true extent of the aneurysm was best demonstrated by aortography performed in the lateral position. The operations were undertaken through a long midline incision. The aorta is cross-clamped at the supra-renal level and the proximal anastomosis is performed from inside the aneurysm at the level of the renal arteries. The occluding clamp is subsequently re-positioned over the graft ensuring restoration of renal flow and the distal anastomosis is completed in a routine manner. Associated renal artery disease in three hypertensive patients was simultaneously reconstructed. Unfavourable anatomical conditions led to re-implantation of the renal artery in one case and transection with interposition of a vein graft in another. 95% of the patients survived to leave hospital.

Adult↗
PubMedDate not supplied

Surgical treatment of renovascular hypertension and respective late results. A twenty years experience.

This paper presents the long term results following operative reconstruction for renovascular hypertension in 115 patients operated upon over a period of 20 years. There were 71 (61.7%) males and 44 (38.3%) females with a median age of 46 years (range 16-67). Renal revascularization was unilateral in 96 (83.4%) cases and bilateral in 19 (16.6%). Dacron knitted bypass grafts, were used in 51 and PTFE in 33 instances. Saphenous vein grafts were used in 11 patients. In 15 cases treatment was by local endarterectomy with concomitant angioplasty (12 unilateral and 3 bilateral). Simultaneous aortorenal reconstruction was undertaken in 38 (33%) patients. There were no deaths in the group with isolated renal artery reconstruction. In the group of aortorenal reconstructions, two deaths were encountered (5.7%). Postoperatively, blood pressure was either normal or improved in 83 (72%) patients at a mean follow-up period of 48.3 months (range 1-195 months). The best results were obtained in younger individuals with segmental renal artery lesions. Linear progression analysis, showed age to be a major determinant in the postoperative response to hypertension. There was a greater degree of long term success in patients with fibromuscular dysplasia, as compared to individuals with atherosclerosis. Crude survival probabilities, were 78% and 61% at 5 and 10 years respectively. Late deaths encountered in the present series, were mostly attributable to myocardial infarction (7.8%). In this series, the best results were obtained in individuals younger than 50 years of age, with segmental renal artery lesions.

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Twenty years experience with abdominal aneurysmectomy. Surgical considerations and analysis of late results.

This report is concerned with presentation of overall experience with abdominal aneurysmectomy, carried out upon 500 consecutive cases during the last 20 years. Emphasis is placed upon substantially improved results of the last decade in terms of survival and late mortality thus, leading to an increased spectrum of operative indications together with justified surgical aggression in the overall management of abdominal aneurysm. Elective surgery was applied upon 385 cases whereas in the remaining 115, emergency undertaking was necessary. Mortality in elective surgery was 3%. From the group of 115 emergency operations, 70 represent formal rupture with a mortality of 32% and 35 exhibited symptomatology compatible with threatening rupture. Mortality in this particular group was 8%. There was an age ranging from 38 to 87 years, with a mean age of 62.2. A definite preponderance of the disease was noted in patients between 60 and 70 years of age (17%-29%). Risk factors including heart disease, hypertension and advanced age, were responsible for the majority of deaths occurred within 30 days. Subsequent decrease of mortality should be attributed to improvements of anesthesia, monitor equipments and other supportive measures during and immediately following the operation within modern intensive care unit. Cardiac cases were the predominant cause of late death (24%) with following cerebrovascular insufficiency (8.1%), cancer (5%) and chronic pulmonary disease (6%). No particular difference in mortality was noted among the three group of patients classified according to the 60, 70 and 80 decade of their age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Simultaneous aorto-renal reconstruction and consideration to the value of combined approach. A 2-16 years follow-up study, with review of the literature.

Thirty five patients who underwent simultaneous aortic and renal artery reconstruction are reviewed, to determine the value of the combined approach. The risk factors determining operative morbidity and mortality are discussed, on the basis of a long term follow-up of more than sixteen years. All patients had a significant renal artery stenosis, in addition to either severe aorto-iliac occlusive disease or an abdominal aortic aneurysm. Twenty seven patients were hypertensive, and eight patients normotensive. Combined aorto-renal reconstruction was carried out prophylactically in eight instances. There were two operative deaths (5.7%). Factors found to be associated with an increased operative risk were advanced age (over 65 years), heart disease with ECG changes, severe hypertension and diabetes. Renal insufficiency with azothaemia and high levels of creatinine, represented a major risk factor. Post operatively, six individuals (24%) were classified as "cured" and thirteen (523) were "improved". Patients with bilateral renal artery stenosis, mild azothemia and moderately elevated creatinine, were found to improve significantly their renal function post operatively. No patient required hemodialysis. Simultaneous aorto-renal reconstruction may be performed with a low mortality and gratifying improvement in hypertensive patients, without evidence of adverse features.

Adult↗
PubMedDate not supplied

Extracranial angiopathology, within the scope of justified surgical aggression and particular emphasis upon "impending stroke". Surgical considerations with 1-10 years follow-up report of 300 operated cases.

Overall surgical experience in dealing with extracranial angiopathology on the basis of 300 cases submitted to surgical reconstitution is hereby presented, together with long term observations covering a period of 1-10 years. Particular emphasis is given to the concept of prophylaxis which has to be considered as the major goal of contemporary operative approach, by means of "preventing" ischemic episode rather than "reducing" an already established infarct. Spectrum of surgical indications covers mainly transient attacks of brain ischemia with attention focused upon the selective group of patients with "impending stroke" semiology, who although considered asymptomatic, are by no means as such if carefully investigated. "Avant garde" philosophy of operative approach as instituted is fully outlined, with all merits of a fully justified surgical aggression, accordingly discussed.

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