PubMed Health⌕ Search

Biomedical subjects

J C Avellone

Publications and source records attributed to J C Avellone.

12 recordsLinked to original sources
PubMed1987

A metropolitan experience with infrainguinal revascularization. Operative risk and late results in northeastern Ohio.

Despite being of fundamental importance, the late results of major arterial reconstruction rarely have been documented throughout a large metropolitan area. In this study of 932 patients entered into the computer registry of the Cleveland Vascular Society, 19 surgeons representing 13 community hospitals and referral centers in Cleveland and Akron report the intermediate-term outcome during a mean interval of 35 months after infrainguinal lower extremity revascularization performed in northeastern Ohio from 1978 through 1982. Operative risk (5%), the early amputation rate (7%), and actuarial 5-year survival (48% to 55%) for patients with rest pain or tissue necrosis were significantly worse (p less than 0.05) than comparable figures (0.6%, 0%, and 77%, respectively) for others who underwent procedures for disabling claudication. Although both materials had similar success above the knee, the cumulative 3-year patency rate of autogenous vein bypass to the distal popliteal (69% to 88%; p less than 0.05) and tibioperoneal arteries (43%; 0.05 less than p less than 0.1) was superior to the results of polytetrafluoroethylene grafts (32% to 50% and 19%, respectively). Moreover, polytetrafluoroethylene grafts required reoperations at three times the rate of vein grafts to maintain limb salvage.

Aged↗
PubMed1985

The early results of vascular surgery in patients 75 years of age and older: an analysis of 3259 cases.

The population in the United States older than 75 years of age will double by the year 2000. The computerized registry of The Cleveland Vascular Society includes 19,990 vascular procedures, which have been divided into two groups. Group A consists of 16,731 operations performed on patients younger than 75 years of age and group B consists of 3259 procedures performed on patients older than 75 years of age. The overall operative mortality rate in group A was 4.4% (736 of 16,731). In subsets of group B the mortality rates were: age 75 to 79 years, 11.3% (210 of 1862), age 80 to 84 years, 13.4% (125 of 932), age 85 to 89 years, 18.0% (68 of 376), and age 90 to 98 years, 28.1% (25 of 89). In carotid endarterectomy there were no significant differences in the stroke and operative mortality rates when groups A and B were compared. Group A stroke rate was 1.8% (94 of 5220), operative mortality rate was 1.5% (77 of 5220); group B stroke rate was 2.2% (17 of 782) and the mortality rate was 2.3% (18 of 782). For aortic reconstructions group A mortality rate was 7.1% (276 of 3905); group B operative mortality rate was 24.1% (148 of 615) (p less than 0.001). In femoropopliteal reconstructions group A operative mortality rate was 2.2% (55 of 2377) and group B mortality rate was 6.7% (38 of 571) (p less than 0.0001). For lower extremity thromboembolectomy group A operative mortality rate was 14.3% (113 of 789) and the mortality rate for group B was 28.4% (196 of 689) (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Control of postcarotid endarterectomy hypotension with baroreceptor blockade.

The reported incidence of hypotension after carotid reconstruction ranges from 21 to 50 percent. To evaluate baroreceptor dysfunction, 283 carotid reconstructions were studied. During 181 consecutive reconstructions, a transcutaneous Teflon catheter was positioned intraoperatively at the carotid bifurcation for postoperative injection of lidocaine as necessary. Of 283 reconstructions, 210 (74 percent) were not followed by hypotension. In the remaining 73 (26.5 percent), hypotension (systolic blood pressure less than 100 mm Hg) was seen. In 14 of the 73 cases of hypotension, vasoactive drugs, atropine, or a fluid bolus was administered with variable responses. In 27 of the 73, no treatment was instituted. In the remaining cases of hypotension, treatment consisted of 1 to 2 ml of lidocaine administered through the catheter. A prompt increase in systolic blood pressure from 93 to 139 mm Hg (means) within 30 minutes of treatment occurred in 29 of the 32 cases (91 percent). These data currently support routine catheter placement.

Blood Pressure↗
PubMed1984

The risk of vascular surgery in a metropolitan community. With observations on surgeon experience and hospital size.

From 1978 through 1981 complete perioperative information concerning a total of 10,189 peripheral vascular procedures performed in northeastern Ohio was recorded in the computer registry of The Cleveland Vascular Society. This report is an analysis of mortality and morbidity rates for all 5686 operations involving carotid endarterectomy (N = 2646), lower extremity revascularization (N = 1987), and abdominal aortic aneurysm resection (N = 1053). The operative mortality rate was 1.2% for carotid reconstruction, 2.8% for femoropopliteal or distal bypass, 3.5% for aortofemoral revascularization, and 11.9% for aortic aneurysm resection (elective operations 6.5%; emergency operations 32.9%). Postoperative strokes occurred after endarterectomy in 2.7% of patients having preoperative neurologic symptoms and in 2.0% of those with asymptomatic carotid stenosis. Lower extremity amputation was unavoidable in 1.5% of patients after aortofemoral reconstruction and in 6.0% after femoropopliteal or distal bypass. Statistical testing indicated that the operative mortality rate was not related to the respective size of the 27 hospitals involved in the survey. The relative annual experience of the 29 participating surgeons significantly influenced only the mortality rate of elective aneurysm resection and the amputation rate after femoropopliteal or distal revascularization. This study suggests that the results of major arterial reconstruction in metropolitan areas may be expected to be comparable to those of published series if the responsible surgeons are specifically trained and maintain an active interest in the field of vascular surgery.

Aorta, Abdominal↗
PubMed1984

Generated pulses.

A system to produce a "pulse" detected by a Doppler probe beyond the site of the embolectomy or an arterial anastomosis to test its patency and the distal vessels prior to completion of a proximal anastomosis or performing final angiographic studies is described.

Doppler Effect↗
PubMed1982

Operation for ruptured abdominal aortic aneurysms: a community-wide experience.

From 1975 through 1979, 29 members of The Cleveland Vascular Society operated on 1049 patients with abdominal aortic aneurysms; of these, 152 ruptured aneurysms. The postoperative mortality rate was 38% (58 of 152). In 27% (41 of 152) of the patients, a diagnosis was made prior to rupture, and the average interval from diagnosis rupture was 16 months. A history of diabetes, hypertension, or a single myocardial infarction (MI) prior to rupture was not associated with an increased mortality rate. Patients with a history of more than one MI prior to rupture had a 75% (six of eight) mortality rate. The average time from onset of symptoms to examination was 2 days 10 hours. When the initial diagnosis was correct, or an intra-abdominal disease was at least suspected, the mortality rate was 35% (47 of 135). When the initial diagnosis was incorrect and a cardiopulmonary or cerebral cause was suspected, the mortality rate was 75% (13 of 17). When the diagnosis was incorrect, the interval from diagnosis to surgery was 2 1/2 days. With only intramural bleeding or a small hematoma in the area of rupture, the mortality rate was 17% (4 of 24); when the hematoma was more extensive, the mortality rate was 43% (55 of 128). This study encompassed a large number of operations performed in a metropolitan area during a relatively short period of time, during which there had been few changes in operative technique or supportive measures. It demonstrated that the most critical factors influencing survival were correct initial diagnosis, the extent of the hematoma, and the history of more than one preoperative MI.

Aged↗
PubMed1978

Effectiveness of reoperation after late failure of femoropopliteal reconstruction.

Eighty-two femoropopliteal reconstructions were performed on sixty-six consecutive patients. Of seventeen late failures, thirteen were secondarily reconstructed. Clinical and angiographic studies demonstrated the reasons for failure in all patients except one. Seven patients were improved and six unimproved by reoperation. The best results were obtained when an inflow problem was found and there had been a long duration of initial patency.

Adult↗
PubMedDate not supplied

Hemodynamic consequences of axillo-axillary bypass.

The combination of the right carotid bifurcation stenosis and the left subclavian steal provides an intraoperative hemodynamic study demonstrating that the placement of an axillo-axillary bypass graft to correct the subclavian steal improves the intracranial perfusion despite the donor side carotid stenosis.

Arterial Occlusive Diseases↗