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Biomedical subjects

F M Ameli

Publications and source records attributed to F M Ameli.

At least 19 recordsLinked to original sources
PubMed1992

Aortobifemoral bypass--an enduring operation.

Aortobifemoral bypass (ABF) has been available as a method for treating patients with aortoiliac occlusive or aneurysmal disease for 40 years. ABF has been successful in alleviating the symptoms of claudication and critical ischemia. The long-term patency rates have been excellent with low operative morbidity and mortality. Major improvements have been made in indications, preoperative assessment and operative and postoperative care. With careful follow-up the natural history of a patient who undergoes ABF is known. Predicting outcome is now possible and a cost:benefit analysis can be made. ABF has proved to be a successful and enduring procedure.

Angiography↗
PubMed1992

Vascular injury and repair associated with retroperitoneal lymphadenectomy for nonseminomatous germinal cell tumours of the testis.

Metastatic disease adjacent to major vascular structures in the retroperitoneum sometimes necessitates planned removal of portions of these vessels, or the vessels may inadvertently be injured when retroperitoneal lymphadenectomy is performed. In 78 patients who underwent retroperitoneal lymphadenectomy, 17 (22%) required vascular repair intraoperatively. The vena cava was most frequently involved (eight cases) followed by inadvertent injury to the renal arteries (five cases) or the infrarenal aorta (three cases). Resection of the infrarenal aorta was planned in two cases without postoperative complication. In six cases a resection of either the whole inferior vena cava or a portion of it was needed to remove all of the tumour. There were nine cases of inadvertent injury to the aorta, vena cava or a renal artery. The outcome after arterial repair was satisfactory with the exception of the inadvertent renal artery injuries, which required nephrectomy in three cases. Leg swelling was not a long-term sequela of either caval repair or resection.

Adolescent↗
PubMed1991

Intravenous digital subtraction arteriography in the evaluation of vascular grafts.

Between 1982 and 1986 intravenous digital subtraction arteriography was used to evaluate vascular grafts in 97 patients (54 males, 43 females). Indications included recurrent symptoms, absent or diminished pulses, a drop in Doppler pressure measurements, and clinical uncertainty with respect to graft patency. Problems identified included graft stenosis, stenosis of the anastomosis or its distal vessels, false aneurysm, arteriovenous fistula and emboli. Forty-eight operations were carried out following intravenous digital subtraction arteriography, and radiographic findings were verified surgically. Twice, intravenous digital subtraction arteriography did not show significant graft findings which were discovered at surgery. Thus intravenous digital subtraction arteriography showed a sensitivity of 95.8% and specificity of 100%. Complications following intravenous digital subtraction arteriography were: two patients developed urticaria, and one superficial thrombophlebitis. There were no cases of pulmonary edema or death. In conclusion intravenous digital subtraction arteriography is very useful in the diagnosis of graft-related problems if done on a selective basis looking at graft and anastomosis site only. Intravenous digital subtraction arteriography is done on an outpatient basis, has high sensitivity and specificity, good patient acceptance, is safe, fast and is less expensive than conventional arteriography.

Adult↗
PubMed1991

Giant cell arteritis presenting as limb claudication. Report and review of the literature.

Upper limb claudication and pulselessness is an uncommon presentation of giant cell arteritis (GCA), often resulting in delayed diagnosis. We describe such a case diagnosed by angiography, in which a temporal artery biopsy showed classic GCA, despite the absence of local signs or symptoms. A review of 26 similar cases revealed that in 81% of patients where the only manifestation of GCA was upper limb findings, temporal artery biopsy yielded positive findings. Steroid therapy clinically improved 24/26 patients. These findings suggest that a consideration of temporal artery biopsy early in the investigation will hasten diagnosis and appropriate therapy.

Aged↗
PubMed1991

End-to-end versus end-to-side proximal anastomosis in aortobifemoral bypass surgery: does it matter?

The proximal anastomosis is still a controversial issue in vascular surgery. To compare end-to-end (EE) and end-to-side (ES) proximal anastomoses, the authors undertook a prospective study with 3 years' follow-up involving 120 patients, all of whom had aortobifemoral bypass. Fifty-one (42.5%) patients received the EE and 69 (57.5%) the ES anastomosis. The indications for surgery were abdominal aortic aneurysm (EE 51%, ES 0%; p less than 0.05), claudication (EE 33.3%, ES 53.6%; p less than 0.05) and critical ischemia (EE 15.7%, ES 46.4%; p less than 0.05). Patients in the EE group were older (mean age: EE 66.1 +/- 2.8 years, ES 60.9 +/- 1.1 years; p less than 0.05) and had more ischemic heart disease (EE 39.2%, ES 27.5%; p less than 0.05). Postoperative mean increases in transcutaneous oximetry (EE 15.5 +/- 3.9 mm Hg, ES 12.6 +/- 2.3 mm Hg) and the ankle-brachial pressure index (EE 0.34 +/- 0.05, ES 0.30 +/- 0.03) were not significantly different in the two groups. The operative death rate was higher for the EE group (EE 11.8%, ES 1.4%; p less than 0.05). Early thrombosis occurred in six patients, two in the EE group and four in the ES group. Computed tomography, done 1 year postoperatively in 95 patients, revealed two small (less than 3 cm) distal anastomotic dilatations, one in each group. At 3 years, cumulative survival and patency were similar in both groups. The authors conclude that the two anastomotic groups had very similar short- and long-term results, except for the operative death rate which was higher in the EE group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

The effect of femoral arteriography on the incidence of groin contamination and postoperative infections.

A prospective study is presented on the effects of preoperative femoral arteriography on bacterial contamination and postoperative wound complications from groin incisions. Forty-four femoral reconstructive procedures (88 groin incisions) for aortoiliac disease were performed. Positive cultures occurred in 43.2% of patients and in 30.7% of the 88 incisions. There was no correlation found between the site of arteriography and positive cultures (Spearman correlation coefficient, p greater than .10). No correlation was found between the presence of hematoma due to arteriography and subsequent positive groin culture (Spearman correlation coefficient, p greater than .10). A higher incidence of positive cultures did occur for patients who had a difficult arteriographic procedure (Fisher's exact test, p = .020) or whose reconstructive procedure was greater than four hours (Fischer's exact test, p = .047). Seven patients had postoperative groin wound complications (15.9%), including three lymph leaks (6.8%) and four confirmed or suspected infections (9%). There were no graft infections. No correlation was found between the site of arteriography and the site of wound complication (Spearman correlation coefficient, p greater than .10). Neither positive culture results nor difficult arteriography nor presence of hematoma were accurate predictors of postoperative wound complications. We conclude that transfemoral arteriography does not increase the risk of complications of arterial reconstruction involving a femoral anastomosis.

Adult↗
PubMed1990

The role of central haemodynamic monitoring in abdominal aortic surgery. A prospective randomised study.

To test the hypothesis that central haemodynamic monitoring is not necessary in all patients undergoing abdominal aortic surgery, a prospective randomised study in 40 consecutive patients undergoing elective abdominal aortic surgery was carried out. Patients with unstable angina, recent myocardial infarction (less than or equal to 6 months), and left ventricular ejection fraction (LVEF) less than 0.50 were excluded. Twenty-one patients had perioperative central haemodynamic monitoring while 19 patients had central venous pressure monitoring alone. Parameters studied included, perioperative haemodynamics and fluid balance, perioperative cardiac drug administration, operation time and clamp time, postoperative renal function, incidence of postoperative ventilation and line complications, duration of hospital and ICU stay, and 30 day postoperative outcome. Results obtained were compared with a high risk group of patients (LVEF less than 0.50) undergoing similar surgery. Statistical analysis failed to show any difference in outcome for any variable measured in either low risk group. All serious postoperative cardiac complications occurred in patients with LVEF less than 0.50 (P less than 0.0001). These data suggest that patients with LVEF greater than or equal to 0.50 are at low risk of developing postoperative cardiac complications and can be successfully managed perioperatively without the added potential risks and costs of central haemodynamic monitoring.

Aged↗
PubMed1990

The influence of central haemodynamics on transcutaneous oxygen (TcpO2) measurements.

Transcutaneous oxygen measurements (TcpO2) have been shown to be an index of tissue perfusion and it has been suggested that the main haemodynamic variable influencing tissue perfusion is cardiac output, assuming that inspired oxygen remains constant. To investigate this hypothesis we studied 23 consecutive patients in order to identify if changes in cardiac output correlated with similar changes in TcpO2 measurements. No correlation was found to suggest that cardiac output was the main haemodynamic determinant of TcpO2 measurements.

Adult↗
PubMed1990

Is tube repair of aortic aneurysm followed by aneurysmal change in the common iliac arteries?

To address the concern that tube repair of an abdominal aortic aneurysm might be followed by aneurysmal change in the common iliac arteries, 23 patients who had undergone the operation were re-examined 3 to 5 years later. Although 9 had had minimal ectasia of these arteries preoperatively, in none of the 23 was there symptomatic or radiologic evidence of aneurysmal change on follow-up. Measurements of the maximum intraluminal diameters were made by computed tomography; they indicated no significant differences between the preoperative and follow-up sizes of the common iliac arteries. The variation in time to follow-up also showed no significant correlation with change in artery diameter.

Aneurysm↗
PubMed1990

Inflammatory abdominal aortic aneurysms and ureteric obstruction.

Inflammatory abdominal aortic aneurysms are rare, but when they occur the ureters may be involved in the perianeurysmal fibrosis. Treatment of this ureteric involvement is controversial. The authors present one such case, review the literature and describe what they believe is the appropriate method of diagnosis and treatment. This includes the use of computed tomography, retrograde pyelography, ureteral stenting, repair of the aneurysm and ureterolysis.

Aged↗
PubMed1990

Failure of bicycle exercise electrocardiograms to predict major post-operative cardiac complications in patients undergoing abdominal aortic surgery.

To determine if exercise electrocardiograms (EECGs) are justified in routine pre-operative screening for cardiac disease, we performed a prospective study on 77 consecutive patients scheduled for infrarenal aortic reconstructive surgery. All patients had EECGs performed 1-12 days prior to elective surgery. In addition to routine clinical assessment of cardiac disease, all patients were allocated a Goldman risk score. Four patients developed major post-operative cardiac complications of whom one patient died. EECG was not a significant predictor of outcome, as 48.6% of all EECGs were inadequate due to non-completion of the exercise protocol. Significant pre-operative predictors of outcome were a history of angina (p less than 0.01), myocardial infarction (p less than 0.001), congestive cardiac failure (p less than 0.0001), or a Goldman score of greater than 14 (p less than 0.05). By multivariate analysis of the pre-operative risk factors a history of congestive cardiac failure was found to be the most significant independent predictor of post-operative cardiac complications.

Adult↗
PubMed1989

Transient cerebral ischemia.

Stroke is a major cause of disability and death in North America. About 30% to 40% of patients with stroke have had transient ischemic attacks (TIAs). The recognition and treatment of TIAs and possibly of asymptomatic stenoses of the carotid arteries may be beneficial in preventing stroke. We review the epidemiologic features, natural history, pathogenetic features, clinical presentation, methods of investigation and management of patients with TIAs.

Aged↗
PubMed1989

A statistical assessment of the dependability of transcutaneous tissue oxygen tension measurements.

Transcutaneous oxygen tension measurements (PtcO2) were obtained for subjects in two groups: peripheral vascular patients (N = 15) and disease-free controls (N = 9). Readings were taken in each of three locations, arm, knee and foot, in supine and erect positions, at fixed and random times, on each of 3 consecutive days. The dependability (the proportion of true variance in total variance) of PtcO2 measurements was evaluated using a generalizability model. The preliminary generalizability study analysis indicated that day-to-day variation of PtcO2 level was larger than within-day variation. Therefore, in order to decrease the measurement error variance one would preferably increase the number of days for measurements (nd) rather than increase the number of measurements within each day (nt). A decision study analysis was also performed which resulted in estimates of error variance and two interdependent dependability measures: dependability coefficients (DCs) and signal to noise ratios (S/Ns). PtcO2 dependability values were generally different for the two groups. Cases had high DCs and S/Ns (DC greater than or equal to 0.9, S/N greater than or equal to 9) in all location-position combinations except for arm measurements. On the other hand, controls had low and unacceptable DCs and S/Ns (DC less than 0.8, S/N less than 4) in all location-position combinations. Cases and controls had generally lower dependability values when PtcO2 ratios were analyzed. The only two ratio-position categories for which dependability values were in the acceptable range (DC greater than or equal to 0.8, S/N greater than or equal to 4) were foot/arm erect and foot/arm supine for the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

The effect of postoperative smoking on femoropopliteal bypass grafts.

Effect of smoking habits on limb loss rates and cumulative patency rates of 136 arterial reconstructions performed for lower limb ischemia were analyzed in a five year follow-up retrospective study. Of 121 patients, 103 (85%) smoked before the operation and 43 of the smokers (42%) discontinued smoking postoperatively. Patients who continued to smoke more than 15 cigarettes per day (34 patients) increased the probability of losing their limb approximately five times at two years and three times at five years postoperatively, compared with nonsmokers and smokers of up to 15 cigarettes per day (87 patients) (p = 0.013). Cumulative patency rates of nonsmokers and smokers of up to five cigarettes per day (Group A, 66 patients) were not significantly influenced (p = 0.518) by preoperative symptoms (claudication versus limb salvage). However, for smokers of more than five cigarettes per day (Group B, 55 patients), at five years claudicants had a cumulative patency rate of 62.9% compared to 38.3% for limb salvage patients (p = 0.015). In group A at five years, autologous saphenous vein grafts had a cumulative patency rate of 74.2%, compared to 24% for prosthetic grafts (P = 0.013). In group B the CPR differences between autologous saphenous vein and prosthetic grafts were not significantly different (p = 0.394). Multiple interactions between smoking and variables like age, preoperative symptoms, and graft material demonstrate the complexity of the effects of smoking on cumulative patency rate and the need for sub-grouping and removal of confounding factors. In view of the adverse affects of continued smoking on postrevascularization prognosis, patients should be strongly advised to discontinue smoking.

Adult↗
PubMed1989

Percutaneous transluminal angioplasty without anticoagulation.

This paper presents the results of a retrospective study of 110 percutaneous transluminal angioplasties done over a period of two years on 110 consecutive patients. Anticoagulation or antiplatelet drugs were not used during or after percutaneous transluminal angioplasty. Life-table analysis was used to calculate success rates at one and three months following the procedure. Success rates were determined using three criteria: clinical improvement, pre- and post-percutaneous transluminal angioplasty Doppler studies, and radiographic appearance. Claudication was present in 87 (79%) patients and severe ischemia in 23 (21%) patients. Sixty-eight (62%) PCTAs were done in the iliac arteries, 35 (32%) in the femoral arteries, and 7 (6%) in the popliteal artery. The majority of patients (61%) had 50%-75% arterial stenosis and only 18% had complete occlusion. Percutaneous transluminal angioplasty in the iliac arteries had the best results with cumulative success rates of 90% and 85% at one and three months, respectively. Success rates in the femoral arteries were 83% and 79% and in the popliteal artery 71% and 57% at one and three months, respectively. None of our patients required amputation. Ten patients (9.1%) suffered the following complications within 30 days of percutaneous transluminal angioplasty: death (2), thrombosis (2), perforation (3), minor hematoma (2), and false aneurysm (1). In conclusion, we have shown that percutaneous transluminal angioplasty can be performed safely and effectively without the use of anticoagulation and its associated risks.

Adult↗
PubMed1989

Comparison between transcutaneous oximetry and ankle-brachial pressure ratio in predicting runoff and outcome in patients who undergo aortobifemoral bypass.

In a prospective study, transcutaneous oxygen tension and ankle-brachial pressure index (ABI) were measured pre- and postoperatively in 105 symptomatic patients who underwent aortobifemoral bypass to compare the ability of these two measurements to reflect the runoff status, determined by angiography, and to predict the outcome of surgery. Postoperatively, ABI better reflected the runoff status. The difference in mean ABI for good versus poor runoff was 0.17 (p less than 0.05). The difference in mean transcutaneous oxygen tension below the knee for the two runoff categories was relatively small (6.3 mm Hg, p less than 0.05). Post-minus preoperative increases in ABI reflected the runoff status better than increases in transcutaneous oxygen tension. For good runoff, the mean ABI increase was 0.25 and for poor runoff it was only 0.14 (p less than 0.05). Runoff and transcutaneous oxygen tension were found to be the best predictors of symptomatic recurrence. Poor runoff was associated with a relative risk of 2.5 (p = 0.017) and transcutaneous oxygen pressure of less than 40 mm Hg implied a relative risk of 2.3 (p = 0.029) for symptomatic recurrence. The most important predictor of graft failure was preoperative ABI. Transcutaneous oxygen tension and the ankle-brachial pressure index appear to be valuable noninvasive techniques for vascular assessment, offering different insights and different predictions for management and prognosis of peripheral vascular disease.

Ankle↗
PubMed1988

Indications and role of axillofemoral bypass in high-risk patients.

The purpose of this study was to determine whether axillofemoral bypass was justified as an alternative revascularization procedure to direct reconstruction and to specifically define the indications for this extraanatomical bypass. Forty-one patients operated on between 1978 and 1985 were evaluated. The average age was 69 years. Indications were based upon limb salvage for aortoiliac occlusive disease in the following situations: infected aortobifemoral bypass graft (8 patients) and high risk with co-existing medical problems (33 patients). Patients were classified according to Goldman's Multifactorial Index of Cardiac Risk and Cooperman's Cardiovascular Risk Index. Twenty-four patients had axillobifemoral bypass and 17 had unilateral axillofemoral procedures. In 66 femoral anastomoses there were 13 extended profundaplasties, 25 profunda arterioplasties, 11 profunda patch angioplasties and 16 anastomoses to the common femoral artery. Postoperative mortality was 4.8% (2 patients). Cumulative survival at 60 months was 43% +/- 11% and primary patency rate of the axillofemoral bypass was 69 +/- 9.8%. We conclude that axillo-femoral bypass is indicated in the presence of infection, in patients who fall into Goldman's Class III-IV or in patients with risk greater than 10% as calculated by Cooperman's equation.

Aged↗