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Biomedical subjects

J R Youkey

Publications and source records attributed to J R Youkey.

At least 37 records · Page 2Linked to original sources
PubMed1985

Management of patients with symptomatic extracranial carotid artery disease and incidental intracranial berry aneurysm.

Perioperative fluctuation of blood pressure and the use of anticoagulants during carotid endarterectomy may potentiate lethal aneurysm rupture in patients who have symptomatic extracranial carotid artery occlusive disease with incidental, asymptomatic, intracranial berry aneurysms. Ten patients having this combination are described in the present study. Of five men and five women whose mean age was 63 years, nine had symptomatic carotid bifurcation atherosclerosis, one had internal carotid fibromuscular dysplasia, and all had intracranial berry aneurysms ranging from 2 to 13 mm in diameter (mean diameter 6.6 mm). In seven patients, aneurysms were greater than or equal to 6 mm in diameter. Hypertension was present in seven patients and moderately severe in five. Three of the aneurysms were located in the intracranial internal carotid artery, five in the middle cerebral artery, three in the posterior communicating artery, one in the anterior cerebral artery, and one in the superior cerebellar artery. Twelve carotid reconstructive procedures were performed without morbidity related to aneurysm rupture. These included 10 carotid endarterectomies, one of which was combined with Dacron patch angioplasty and one of which was combined with a simultaneous coronary artery bypass; one carotid artery dilatation for fibromuscular disease; and one reoperative carotid endarterectomy with patch angioplasty. Three patients had correction of hemodynamically significant lesions, two of which were proximal to ipsilateral anterior circulation aneurysms. An intraluminal shunt and heparin anticoagulation therapy were used in all patients. Despite a concerted effort to control blood pressure, the patients' perioperative blood pressures ranged from 60/30 to 240/110 mm Hg. Three patients had subsequent elective clipping of intracranial aneurysms.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Arteries↗
PubMed1985

Saccular renal artery aneurysm as a cause of hypertension.

The case of a patient with renovascular hypertension related to an arterial kink is reported. The arterial kink was caused by a renal artery aneurysm and was not apparent with angiography. This is the first reported case in which renin-mediated hypertension was clearly related to a correctable mechanical problem from a saccular renal artery aneurysm. Indications for surgical repair of renal artery aneurysms and angiographic findings indicative of a functionally significant renal artery stenosis are reviewed.

Aneurysm↗
PubMed1985

Bright-light amaurosis fugax: an unusual symptom of retinal hypoperfusion corrected by external carotid revascularization.

The eye often serves as an important monitor of carotid artery disease by manifesting visual disturbances before cerebral events. The most typical ocular symptom complex is amaurosis fugax characterized by loss of vision in one eye that occurs suddenly and clears within seconds to minutes. This symptom is a hallmark of carotid artery disease and is usually caused by an embolic event. Although monocular visual disturbance on a hemodynamic basis is a more unusual manifestation of carotid artery disease, significant stenosis in combination with a low-flow state can cause transient, unilateral telescoping of vision. This report describes another visual disturbance associated with carotid artery disease in which unilateral visual loss occurred upon exposure to bright light. We term this syndrome bright-light amaurosis fugax and document successful treatment by external carotid artery revascularization in two patients.

Arteriosclerosis↗
PubMed1984

Focal motor seizures complicating carotid endarterectomy.

We studied four patients with focal motor seizures complicating carotid endarterectomy and compared them with 14 other cases reported previously. Seventeen of the 18 patients had high-grade carotid stenoses. A severe unilateral headache usually preceded seizure activity, which was followed by prolonged Todd's paralysis. Eight patients had histories of ipsilateral stroke. There was no association with perioperative hypertension. Two patients who were receiving heparin sodium had intracerebral hemorrhages that caused one of the two postoperative deaths. The patency of all endarterectomized carotid arteries was recorded by arteriography or noninvasive studies. These data suggest that patients who have severe unilateral headaches following ipsilateral carotid endarterectomy for high-grade stenoses are at risk for focal motor seizures. The roles of antithrombotic agents and anti-seizure medication in this setting are unclear.

Arterial Occlusive Diseases↗
PubMed1984

Dilemmas in dealing with the blue toe syndrome: aortic versus peripheral source.

Six patients with unilateral blue toe syndrome presented a diagnostic dilemma with regard to the source of embolization: central aortic versus peripheral. Two patients had moderately severe aortoiliac atherosclerosis associated with focal stenoses in the superficial femoral arteries, and four patients had mild aortoiliac disease associated with localized plaques confined to either the superficial femoral or popliteal arteries. In all patients, it was elected to explore the peripheral lesions first. At operation, ulcerated plaques or focal stenoses were found, and all lesions had adherent white thrombi on their surfaces. All patients were treated either by localized thromboendarterectomy or short reversed saphenous vein grafting. There was no morbidity or mortality. Recurrent embolization did not occur during a follow-up of 8 to 24 months. Distal atherosclerotic lesions should be sought to explain distal embolization before more complex aortoiliac disease is incriminated. In the presence of concomitant aortoiliac disease, it is mandatory to directly explore the peripheral lesion, open the artery, and carefully examine the lesion in situ. Thrombus adherent to the surface of an ulcerated plaque is evidence of an embolizing source. This approach is associated with minimal morbidity and may be curative. If these findings are not present, it would be appropriate to proceed with staged correction of aortoiliac disease.

Aged↗
PubMed1984

Thromboembolectomy of arteries explored at the ankle.

Experience with 11 cases of thromboembolectomy of leg arteries explored at the ankle is presented. Patency was established in 19 of 23 arteries (83%), resulting in salvage of 11 of 14 limbs (79%). This experience documents success of this technique with follow-up ranging from 2 to 70 months (mean followup, 24.7 months). Current indications for the procedure include 1) incomplete extraction of thrombus via the popliteal trifurcation, 2) incomplete transfemoral extraction of thrombus with restoration of a popliteal pulse, and 3) thromboembolus initially confined to the infrapopliteal arteries.

Adult↗
PubMed1984

Femoral anastomotic false aneurysms. An 11-year experience analyzed with a case control study.

Eighty-three femoral anastomotic false aneurysms occurring in 51 patients were diagnosed from 1972 through 1982. Twenty-two (27%) presented with acute events. Seventy (84%) were confirmed by sonography and/or arteriography. Bilaterality (29%), recurrence (18%), and associated aortic false aneurysms (8%) were significant problems. Eight-one were repaired with a six per cent complication rate, including one death related to preoperative rupture. The 51 patients were evaluated for associated illnesses, risk factors, and etiologies of their false aneurysms. The most common single cause (61%) was host vessel degeneration with an intact suture line remaining attached to a disrupted Dacron limb. Twenty-three patients with host vessel degeneration were matched with case controls not developing false aneurysms. These two groups were matched for gender, age, and year of AFB and compared for associated illnesses and risk factors. Incidences of cigarette smoking, hypertension, cerebrovascular disease, coronary artery disease, diabetes mellitus, previous femoral endarterectomy, outflow disease, other aneurysmal disease, multiple groin operations, wound complications, and training levels of surgeons performing initial AFBs were similar for both groups. Factors observed significantly more often in patients who developed false aneurysms included serum lipid abnormalities (p less than 0.05), braided synthetic suture material as opposed to monofilament polypropylene (p less than 0.05), and continued abuse of tobacco following AFB (p less than 0.005).

Aged↗
PubMed1984

Vascular injury related to lumbar disk surgery.

This report summarizes the Walter Reed Army Medical Center experience with six patients operated on from 1949 through 1982 for vascular injury related to lumbar disk surgery. All had common iliac artery injuries generated by L4-5 disk operations. Four patients had isolated arterial injuries and two had combined arteriovenous injuries. Three underwent vascular repair acutely, two with shock and one with a false aneurysm. Delay in diagnosis occurred in two patients who presented 6 weeks and 3 years postinjury with minimally symptomatic arteriovenous fistulae. A sixth patient had a known arterial injury and was operated on after a 1-month delay. All patients survived. Two patients had had repeated back operations, suggesting that this may be a risk factor for perforation of the anterior spinal ligament by an operative rongeur.

Adult↗
PubMed1984

Asymptomatic cervical bruit and abnormal ocular pneumoplethysmography: a prospective study comparing two approaches to management.

Fifty-seven patients with cervical bruits and abnormal ocular pneumoplethysmography but without symptoms were followed prospectively. Mean follow-up was 32 months and all patients were followed for at least 1 year. Twenty-nine patients consented to join a randomized study comparing treatment with aspirin, close follow-up, and no intervention unless symptoms developed [( NI: ASA] n = 14) versus intervention with arteriography and prophylactic surgery [( I: A/S] n = 15). Among patients who refused randomization, 14 were treated with NI: ASA and 14 with I: A/S. Endpoints for analysis included all unfavorable outcomes related to both management plans and included stroke, death of stroke, major angiographic and perioperative complications, asymptomatic carotid occlusion, and recurrent carotid artery stenosis. In both the randomized and nonrandomized portions of the study unfavorable outcomes were more frequent in patients treated with I: A/S, and by combining the results of both studies a significant difference was observed (N: ASA - 3.6% versus I: A/S - 31%; X:2 = 4.78; p less than 0.05). Among patients treated with NI: ASA, a single minor stroke occurred without warning. In patients from all groups who underwent arteriography, advanced carotid stenosis was found in 78% (mean percent diameter stenosis = 72% +/- 2%; mean residual lumen = 1.3 +/- 0.1 mm). We conclude that, despite the probability of underlying severe carotid stenosis, most patients with cervical bruit and abnormal ocular pneumoplethysmography but without symptoms are appropriately managed without intervention unless symptoms develop.

Aged↗
PubMed1983

Intramuscular hemangioma.

In two cases of intramuscular hemangioma of the paraspinous muscles, the tumors were treated with arteriographic embolization followed by immediate local excision. We found that this technique creates a hypovascular surgical field and facilitates the dissection. We believe this approach will decrease morbidity and potential mortality.

Adult↗
PubMed1983

Vascular trauma secondary to diagnostic and therapeutic procedures: 1974 through 1982. A comparative review.

One-hundred nineteen patients with 125 iatrogenic vascular injuries requiring surgical intervention were treated at Walter Reed Army Medical Center from 1974 through 1982. This experience was compared with that from 1966 through 1973 [1]. A decrease in the proportion of cases resulting from cardiac catheterization was partially offset by an increase in injuries from invasive monitoring and injuries from percutaneous transluminal dilation procedures. A threefold increase in cases resulting from urologic surgery was related to the evolution of an aggressive approach toward retroperitoneal metastatic tumor. Over half of the arterial injuries are now iliofemoral in location because of the routine use of the femoral approach for angiographic and cardiac catheterization procedures. The need for complex reconstruction in addition to thrombectomy increased fourfold. Delayed surgical intervention was a factor in 9 of the 12 patients with permanent disability. There was no death attributable to vascular reconstruction.

Angiography↗
PubMed1983

Dilation of knitted Dacron aortic prostheses and anastomotic false aneurysms: etiologic considerations.

Five patients with knitted Dacron aortic bifurcation prostheses developed prosthetic dilation and anastomotic false aneurysms. The interval between placement of prostheses and secondary presentation ranged from 4 to 10 years. Three patients presented with femoral false aneurysms (one ruptured) and two presented with aortic false aneurysms (one ruptured). In all cases, anastomotic sutures remained intact on the prosthesis and there was no evidence of infection. The mean (+/- SEM) increase in diameter of prostheses was 85.7 +/- 19.1% (range 76% to 137%). Dilated prostheses were removed in four cases and were tested for tensile strength and studied with scanning electron microscopy. These were compared to normal, nondilated knitted Dacron prosthetic fabric from the same manufacturer. There was no loss of breaking strength in dilated prostheses. Furthermore, on examination with scanning electron microscopy, there was no evidence of degeneration or fracturing of individual Dacron filaments. However, dilated prostheses were found to have a greatly expanded knit. The distance between loops was significantly increased and the number of fibers per 1000 microns was significantly less in comparison to normal knitted Dacron fabric. These studies confirm an association between prosthetic dilation and false aneurysm formation. Further, they suggest that the cause of prosthetic dilation is loss of compactness of the knit not associated with intrinsic Dacron fiber deterioration. A fabrication defect is most likely responsible.

Aged↗
PubMed1983

Percutaneous transluminal balloon angioplasty of the iliac artery for contralateral ischemia.

The cases of three patients with lower extremity ischemia from ipsilateral iliac artery occlusion and contralateral iliac artery stenosis are presented. Planned treatment was percutaneous transluminal angioplasty (PTA) of the contralateral iliac artery, rendering it an adequate donor vessel for subsequent femorofemoral bypass. Because of adequate collateral vessels across the pelvis, cross-femoral bypass was unnecessary following PTA. Current technology allows simultaneous intraoperative PTA and femorofemoral bypass. We do not recommend this on the basis of our experience.

Aged↗
PubMed1983

Etiologic factors for recurrent carotid artery stenosis.

Since 1966, 29 patients with recurrent carotid artery stenosis have been encountered. The mean (+/- SEM) internal between initial carotid endarterectomy and secondary presentation was 67.5 +/- 9.2 months (range 6 to 180 months). There was a disproportionate number of women with recurrent stenosis. The mean age at initial endarterectomy in patients with recurrent stenosis, 54.6 +/- 1.4 years, was significantly less (P less than 0.001) than that of all patients who had endarterectomy. To define the etiologic factors for recurrence, 21 of these patients were matched with case-control patients of the same age and sex who had undergone endarterectomy the same year but did not develop recognized recurrent stenosis. There was no significant difference in the incidence of hypertension, diabetes mellitus, coronary artery disease, bilateral carotid disease, other vascular operations, or family history for atherosclerosis in patients with recurrent stenosis compared to control patients. The indications for primary endarterectomy, angiographic distribution of disease, and operative details were similar in both groups. There was no difference in the incidence of regular, therapeutic aspirin ingestion following initial endarterectomy (52.5% in both groups). There was a striking difference in smoking habits. Ninety-five percent of patients with recurrent stenosis continued to smoke following initial endarterectomy, compared to 23.8% of control patients (P less than 0.001). Lipid fractionation studies were performed in both groups, and there were no significant differences in levels of cholesterol, triglycerides, high-density lipoprotein (HDL)-cholesterol, and total cholesterol/HDL-cholesterol ratio. Dose-response platelet aggregometry detected no differences between groups in the sensitivity of platelets to adenosine diphosphate (ADP), collagen, and epinephrine. Reoperation in patients with recurrent stenosis was associated with minimal morbidity, no deaths, and generally excellent results.

Anesthesia↗
PubMed1981

Simultaneous idiopathic chylopericardium and chylothorax.

We have reported the first described case of idiopathic simultaneous chylopericardium and chylothorax and discussed its diagnostic and therapeutic considerations. Efficacy of thoracic duct ligation, pericardiectomy, and pleurodesis for this entity is established.

Adult↗
PubMedDate not supplied

An algorithm for the surgical management of chronic abdominal aortic occlusion and occluded aortofemoral grafts.

An algorithm for the surgical management of chronic abdominal aortic occlusion is presented based upon experience of treating 60 consecutive patients. Of 33 patients with juxtarenal aortic occlusion, 17 underwent aortofemoral bypass (AFB), 10 descending thoracic aortofemoral (DTAF), 5 axillofemoral (AxF) bypass, and 1 ascending thoracic aortofemoral bypass. Of 11 patients with mid or distal aortic occlusion, 8 underwent AFB, 2 DTAF and 1 AxF. Of 16 patients with aortic graft occlusion, 1 underwent AFB, 10 DTAF and 5 AxF. Acceptable risk patients were selected for AFB (26). DTAF (22) was frequently preferred for patients with occluded aortic grafts or other hazardous intraabdominal pathology. AxF (11) was used for patients with severe cardiopulmonary risk, limited life expectancy from malignancy, or when emergency procedures were required for salvage of severely ischemic limbs in debilitated patients with chronic aortic occlusion. In the AFB, DTAF and AxF groups the perioperative mortality was 8%, 5% and 36% respectively, the late mortality was 15%, 36% and 45%, and the 5-year primary cumulative graft patency was 92%, 89% and 15%.

Aged↗