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Biomedical subjects

I M Ibrahim

Publications and source records attributed to I M Ibrahim.

60 records · Page 4Linked to original sources
PubMed1975

Patient selection and improved technical factors in small-vessel bypass procedures of the lower extremity.

Thirty-two small-vessel bypasses were constructed as limb-salvage procedures. The one month patency rate was 72 percent and the one year cumulative patency rate was 55 percent. Preoperative, intraoperative, and postoperative angiography was performed in most cases and the results correlated with the ultimate fate of the graft. Preoperative angiography is critical in determining the location of a suitable small vessel, including the peroneal artery, and the quality of the runoff. Intraoperative angiography is required to delineate correctable intraoperative defects usually appearing at the distal anastomotic area. Additionally, failure to demonstrate runoff or a pedal arch can help support a decision not to re-explore a graft should early closure occur. Postoperative angiography is essential to validate clinical success with graft patency and function. It also serves to discover potential graft defects that might otherwise lead to closure and potential limb loss. Selected cases of failed small-vessel bypass grafts may be salvaged by thrombectomy with or without graft revision. Small-vessel bypass is generally contraindicated if there is extensive tissue necrosis and infection extending into the proximal foot. In cases where the necrotizing infection is localized, particularly to the forefoot, then open drainage, debridement, or amputation should be performed together with small-vessel bypass. Finally, the risks indigenous to small-vessel bypass procedures demand optimal patient selection and exquisite operative technique.

Amputation, Surgical↗
PubMedDate not supplied

Dual function of the distal arteriovenous fistula for maintenance of arterial and venous prosthetic graft patency in the lower extremity.

Venous hypertension, severe swelling, and tissue necrosis occurred in a limb previously subjected to distal arterial bypass plus adjunctive arteriovenous fistula. Occlusion of the popliteal vein had not been recognized during the early treatment period. Subsequent to identification of this mechanism, limb salvage was achieved with an interposition graft of the popliteal vein using externally supported PTFE. The prereconstruction venous pressure gradient of 29 cm H2O was virtually abolished immediately after reestablishing venous outflow. The distal arteriovenous fistula, initially established to maintain prosthetic arterial graft patency, now serves, in this case, a dual function by additionally maintaining prosthetic venous graft patency. An intact deep venous system is critical for achieving successful arterial reconstruction and to avoid the complications associated with an occluded outflow tract in the face of augmented inflow.

Aged↗
PubMedDate not supplied

The use of modified human umbilical cord vein in femoral popliteal reconstruction.

Glutaraldehyde-tanned human umbilical cord veins were employed for reconstruction of the femoral popliteal segment in 80 instances. The primary indication for surgery was imminent loss of limb. The cumulative patency to 20 months was 84.8 percent. The primary mechanism for graft failure was thrombosis usually due to progressive atherosclerosis of the distal circulation (6 cases). There were no instances of infection, dilatation of the graft or aneurysm formation. The data indicate that the results obtained when the glutaraldehyde-tanned umbilical vein in femoral popliteal location are comparable and perhaps even superior to those obtained with the saphenous vein. This suggests that this graft material will be applicable as avascular prosthesis in many instances and will provide for limb salvage and function in patients who face potential loss of limb.

Aged↗