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

[Pneumocystis carinii pneumonia in a kidney transplantation center in the proximity of an AIDS care unit].

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AIDS-Related Opportunistic Infections↗

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.

Blood Pressure↗