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Biomedical subjects

J R Hemp

Publications and source records attributed to J R Hemp.

7 recordsLinked to original sources

Vascular thoracic outlet syndrome: successful outcomes with multimodal therapy.

PURPOSE: Vascular thoracic outlet syndrome (TOS) can present with signs of arterial impingement or, more commonly, as venous obstruction. In an effort to decrease morbidity associated with vascular thoracic outlet syndrome, we have used an aggressive multimodal treatment approach. METHODS: Since November 1992, we have evaluated 29 patients with vascular thoracic outlet syndrome. Nine of ten patients with arterial thoracic outlet syndrome had first rib resections. Eighteen of 19 patients with venous occlusion underwent anticoagulation, thrombolysis, and first rib resection. Eight patients required additional endovascular therapy for persistent stenoses, either venous angioplasty alone (2) or angioplasty plus stent placement (6). RESULTS: Follow up extends to 75months with a mean of 24months. Patients with stents have been followed for a mean of 38months. Twenty-five of 28 patients managed with multimodal therapy were essentially asymptomatic at last follow up. CONCLUSION: Thrombolysis, anticoagulation, surgical decompression, and endovascular procedures act synergistically to improve results of therapy in patients with vascular thoracic outlet syndrome.

Adult↗

Left iliac vein occlusion: its clinical spectrum.

The cases reported here demonstrate the variability of the clinical manifestations of left common iliac venous occlusive disease. In each instance, therapy must be adjusted to meet the symptomatic needs of the individual patient. The experience reported here should reinforce the fact that occlusions even 25 months or longer in duration may be reopened. Continuing patency can be enhanced by stent placement.

Adult↗

Internal iliac artery aneurysm following aortic reconstruction.

Fewer than 100 internal iliac artery aneurysms have been reported in the English literature. Of these the incidence of true aneurysms occurring after aortic reconstruction is exceedingly low. A 73-year old man presented with 7 cm asymptomatic left internal iliac artery aneurysm 12 years after repair of an abdominal aortic aneurysm with a bifurcation graft. We report our experience with this patient along with a review of the literature and recommendations for aneurysm surveillance.

Aged↗

Prevention of distal limb ischemia during cardiopulmonary support via femoral cannulation.

The indications for prolonged cardiopulmonary support or extracorporeal membrane oxygenation are expanding. A potential serious complication of these techniques is distal limb ischemia. Techniques have been developed to provide the distal limb with blood flow. Unfortunately, specialized skills and materials are required. We describe a simple method of providing distal limb perfusion using ordinary pressure tubing and a standard cordis catheter. This technique is capable of reproducing normal superficial femoral artery blood flow.

Catheterization↗

Mitral valve replacement through the aortic root.

This report discusses the case histories of two patients who had had previous cardiac operations and required extensive reoperations including mitral valve replacement. In both patients the replacement of the mitral valve was performed through the aortic root. This rare approach to the mitral valve, conducted with remarkable facility in these patients, encourages more liberal use of transaortic mitral valve operations in selected patients.

Cardiac Surgical Procedures↗