Biomedical subjects

F B Pomposelli

Publications and source records attributed to F B Pomposelli.

44 records · Page 3Linked to original sources

PubMed1991

Popliteal-to-distal bypass grafts for limb salvage in diabetics.

Between January 1984 and August 1989, 117 diabetic patients with a palpable popliteal pulse but distal limb threatening ischaemia underwent 124 popliteal artery (or below) to distal bypass grafts. All grafts were intra-operatively monitored. The operative mortality was 0.8% and the 30 day primary patency 93%. Primary patencies at 1 and 3 years were 88.6 and 85.2%, respectively. The results of using the popliteal artery as the proximal graft inflow site in diabetes are comparable to other patient groups and to alternative more proximal inflow sites, but require a shorter length of vein graft with a shorter vein harvesting incision, avoid groin disection and result in a more peripheral operation.

Adult↗

PubMed1991

Continued experience with intraoperative angioscopy for monitoring infrainguinal bypass grafting.

Intraoperative angioscopy provides direct, in vivo, three-dimensional visualization of the interior of the blood vessels and grafts. We have shown previously that with the application of the basic principles of irrigation and with a dedicated irrigation pump that routine intraoperative angioscopy can be performed with consistent high quality results during lower extremity revascularization. In our total experience with angioscopy as a monitoring procedure during infrainguinal bypass grafting, 259 intraoperative angioscopies, during 63 femoropopliteal and 196 distal bypass grafts, were performed from May 1, 1987, to October 31, 1989. Mean total irrigation fluid used in the study was 448 ml (range, 0 to 1400 ml) with good visual quality in more than 80% of the studies. The overall failure rate was 1.5%. No complications were directly attributable to the insertion of the angioscope or the use of the pump. Based on the angioscopic findings, 124 clinical or surgical decisions were made in 259 of the angioscopies. The incidence of graft failure in this study was 8.1% (less than 30 days) and 4.8% (greater than 30 days) with a mean follow-up of 272 days. Direct inspection of the interior of the graft and native vessels at the time of surgery has resulted in the recognition of previously unsuspected vein-graft pathology. Angioscopy as the sole monitoring procedure for infrainguinal bypass grafting is safe, effective, and reliable and may not only improve the durability of these grafts but may improve our understanding of the pathogenesis of graft failure and of the progression of the underlying atherosclerotic disease.

Adult↗

PubMed1991

Angioscopically directed valvulotomy: a new valvulotome and technique.

Despite a large experience with "blind" retrograde valvulotomy in in situ vein bypass grafting, the incidence of residual competent valves remains high, and valvulotome-induced injury is common. In this study we describe a new valvulotome and technique of angioscopically directed valvulotomy and review the video tape recordings of 85 completion angioscopies of in situ femorodistal bypasses. Fifty-three vein grafts were prepared with the blind retrograde valvulotomy technique and 32 vein grafts with the new valvulotome and angioscopy. The use of the new valvulotome and technique is compared with that of the standard blind retrograde valvulotomy technique, and the normal endoluminal anatomy and incidence of primary disease in saphenous vein grafts was noted. The incidence of valvulotome-induced injury was 5/32 (15.6%) and 45/53 (85%) in vein grafts prepared with angioscopically directed valvulotomy and blind retrograde valvulotomy, respectively. Residual competent valves were found in 10/53 (18.9%) in blind retrograde valvulotomy and 0/25 of angioscopically directed valvulotomy vein grafts (p = 0.0114). In 22/53 vein grafts unsuspected primary disease was detected. Angioscopically directed valvulotomy with the new valvulotome and technique is feasible, reliable, and safe. It avoids residual competent valves, minimizes valvulotome-induced injury, and allows the detection and correction of unappreciated primary vein graft abnormalities. The new valvulotome and technique is a first step in the complete endoluminal preparation of the in situ vein graft.

Aged↗

PubMed1990

New angioscopic findings in graft failure after infrainguinal bypass.

We have previously shown that intraoperative angioscopy is a safe, useful, and effective method for monitoring infrainguinal bypass grafts. The videotaped recordings of the intraoperative angioscopy studies of 25 failed infrainguinal bypass grafts inserted between May 1987 and July 1989 and 3 failing grafts that were angioscoped during the subsequent graft salvage procedure were reviewed in a systematic fashion according to a fixed protocol, to identify any endovascular findings either initially missed or in which the relevance to graft failure had been unappreciated at the time of bypass grafting. We were able to identify new venous pathologic characteristics and highlight endoluminal features, of both a technical and nontechnical nature, which have a probable causal relationship to graft failure. However, the significance of some of the endovascular findings that were seen during infrainguinal bypass grafting has yet to be fully defined.

Adult↗

PubMed1990

Efficacy of the dorsal pedal bypass for limb salvage in diabetic patients: short-term observations.

Limbs of diabetic patients with distal tibial disease are frequently considered unreconstructible; however, when studied with intraarterial digital subtraction angiography, the dorsal pedal artery is frequently found to be patent. We have reviewed our recent experience with 96 patients, 94% of whom had diabetes and had 97 bypasses placed to the dorsal pedal artery. All procedures were for limb salvage. Superimposed infection was present in 42.3%. In 92 instances where intraarterial digital subtraction angiography successfully visualized the dorsal pedal artery, 91 bypasses were placed. In 12 other cases where the dorsal pedal artery was not visualized by intraarterial digital subtraction angiography but audible with the continuous-wave Doppler, bypasses were completed successfully in six. All procedures were performed with vein. Inflow was taken from the femoral artery in 48, popliteal artery in 45, tibial artery in 2, and from a femoral tibial graft in 2. Perioperative mortality was 1.92%. Actuarial graft patency, limb salvage, and patient survival were 82%, 87%, and 80%, respectively at 18 months. We conclude that bypass grafting to the dorsal pedal artery can be reliably performed with acceptable short-term results. An attempt should always be made to visualize the foot vessels angiographically, especially in diabetic patients, so that this valuable option in arterial reconstruction will not be overlooked.

Arterial Occlusive Diseases↗

PubMed1989

Routine intraoperative angioscopy in lower extremity revascularization.

The inability to see through blood remains the main obstacle to the widespread and routine use of angioscopy. Local irrigation with a balanced salt solution is presently the most widely used method to clear the blood. By applying basic principles of irrigation and using a unique, dedicated, irrigation pump, we found that routine angioscopy during lower extremity revascularization that yields consistent high-quality studies is feasible, clinically useful, and safe. Between May 1, 1987, and July 31, 1988, 136 intraoperative angioscopies were performed during 112 peripheral bypass procedures, 15 thrombectomies, 2 embolectomies, and 7 miscellaneous revascularization procedures. Mean total irrigation fluid used in the peripheral bypasses was 398 mL (range, 0 to 1400 mL). Good visual quality was obtained in more than 80% of angioscopies and the failure rate was only 1.8%. On the basis of the findings in 71 of the 136 angioscopies, 78 clinical or surgical decisions were made. No complications were directly attributable to the insertion of the angioscope or use of the pump.

Angiography↗

PubMed1988

Intracranial hemorrhage after carotid endarterectomy.

Among 1500 carotid endarterectomies performed between 1975 and 1984, 11 ipsilateral intracranial hemorrhages (IH) occurred between the first and tenth postoperative days for an incidence of 0.7%. The mortality rate among these patients was 36%. The only recognizable predisposing factor was relief of high-grade carotid stenosis (greater than 90%) whereas other factors such as age (58 to 81 years), preoperative hypertension (systolic blood pressure 120 to 160 mm Hg), preoperative head CT scans showing recent infarction (only one in five positive), and preoperative cerebral infarction (only 1 of 11 patients) did not play a role. All patients had normal coagulation studies. No patient required a shunt because all tolerated cross-clamping of the carotid artery. Postoperative systolic blood pressures were 200 to 240 mm Hg in 6 of 11 patients. The time of occurrence of IH extended from the immediate postoperative period to the tenth postoperative day (mean interval 3.3 days). Treatment consisted of craniotomy in five patients; four survived and one recovered completely. Of the six patients treated nonoperatively, three survived and two completely recovered. IH shares equal incidence with recurrent thrombosis, cross-clamping ischemia, and embolization as a cause of perioperative stroke. Although all except IH can be prevented by current practice, the means of preventing IH are not apparent; however, careful monitoring of blood pressure to prevent uncontrolled hypertension deserves consideration.

Aged↗

PubMedDate not supplied

Functional outcome in the elderly following lower extremity amputation.

Data regarding functional outcome in the elderly following major lower extremity amputation (LEA) are minimal. In the general diabetic population there is a significant mortality associated with these procedures, with the 5-year survival rates approaching only 40%. Contrasts between this group and the nondiabetic population will help to clarify the morbidity of these procedures and substantiate efforts at limb salvage. The authors review their experience with patients 80 years of age and above undergoing major LEA between 1990 and 1995 with a specific focus on postoperative mortality and functional status. Forty-one patients were studied, 67% of whom had diabetes mellitus. Postoperative functional status remained unchanged in 40% and worsened in 55% of patients, while residential status was unchanged in 68% and worsened in 32%. The median survival for patients with and without diabetes was 19 and 49 months, respectively. The 5-year survival for the entire group was 25% and was not statistically different in the two subgroups. The authors conclude that major LEA in the very elderly is associated with a considerable mortality and deterioration of functional and residential status.

Aged↗