Biomedical subjects

K J Cherry

Publications and source records attributed to K J Cherry.

At least 73 records · Page 4Linked to original sources

PubMed1991

Stump pressure, the contralateral carotid artery, and electroencephalographic changes.

Electroencephalographic (EEG) monitoring and measurement of stump pressure are the most widely employed methods of assessing the risk of cerebral ischemia during carotid endarterectomy. The status of the contralateral carotid artery has also been thought to influence the need for placing a shunt. The relationship of EEG monitoring, stump pressure, and the contralateral carotid artery has not been completely delineated. We retrospectively reviewed these three variables in 113 patients undergoing 124 carotid endarterectomies. The contralateral artery was classified as occluded, stenotic (greater than 50% decrease in diameter), or nonstenotic. There was a 48% incidence of EEG changes with contralateral occlusion, 18% with stenosis, and 21% with nonstenotic arteries (p = 0.014). There was a 73% incidence of EEG changes when the stump pressure was less than 25 mm Hg, 32% when the stump pressure was 25 to 50 mm Hg, and 2% when the stump pressure was greater than 50 mm Hg (p less than 0.001). There was no significant difference in the mean stump pressure for patients with occlusion (43.8 mm Hg), stenosis (44.7 mm Hg), or nonstenotic contralateral arteries (51.3 mm Hg). All patients with contralateral occlusion and a stump pressure less than 25 mm Hg had EEG changes. No patient with a stump pressure greater than 50 mm Hg and a patent contralateral artery had EEG changes. Although the incidence of EEG changes in the majority of patients was not accurately predicted by the stump pressure and the status of the contralateral carotid artery, stump pressure less than or equal to 50 mm Hg was sensitive, identifying 97% of patients with EEG changes.

Aged↗

PubMed1991

Late iliac artery aneurysms and occlusive disease after aortic tube grafts for abdominal aortic aneurysm repair. A 35-year experience.

Controversy continues over whether patients treated with straight Dacron aortic tube grafts for an abdominal aortic aneurysm remain at significant risk for subsequent development of iliac aneurysm or occlusive disease. To address this issue, the authors performed a population-based analysis of 432 patients who had an abdominal aortic aneurysm diagnosed between 1951 and 1984. Aneurysm repair was performed eventually in 206 patients (48%). To ascertain differences in late development of graft-related complications, iliac aneurysms, and arterial occlusions, the authors compared all tube-graft patients with similar numbers of bifurcated-graft patients matched for age and year of operation. In the tube-graft group, no subsequent clinically evident or autopsy-proven iliac aneurysms or iliac occlusive disease were noted. Over a mean follow-up of 6 years (range, 4 to 18 years), new aortic aneurysms occurred in the proximal aorta in both tube and bifurcated-graft patients (5.0% and 2.5%, respectively). In contrast the cumulative incidence of graft-related complications was higher with a bifurcated prosthesis (12.8%) compared with a straight graft (5.0%) (p = 0.15). These problems generally occurred 5 to 15 years postoperatively and emphasize the need for long-term graft surveillance. The authors conclude that straight tube-grafts for repair of abdominal aortic aneurysms provide excellent late patency with minimal risk of subsequent iliac aneurysm development.

Aged↗

PubMed1991

Klippel-Trenaunay syndrome: the risks and benefits of vascular interventions.

Our experience with Klippel-Trenaunay syndrome (KTS), a rare congenital malformation, has increased considerably in recent years and now includes 144 patients (65 male and 79 female patients). Hemangioma was present in 137 patients (95.1%), varicosity in 110 (76.4%), and hypertrophy of the soft tissues or bones in 134 (93.1%). In most patients (71.5%) the disease involved one lower extremity. Diagnostic workup included roentgenogram to document limb length discrepancy, noninvasive arterial and venous evaluation, contrast venography, and nuclear magnetic resonance imaging. Most patients did well without treatment or with elastic compression only. Surgical treatment for the vascular malformation in KTS is rarely needed and it continues to be controversial. To evaluate the risks and benefits of vascular interventions, we examined in detail the clinical histories of nine patients who in the last decade underwent operation for a vascular malformation of the lower extremity. In seven patients we removed varicose veins or resected hemangioma of the lower extremity. Although none was cured, all five who underwent resection of varicose veins and one of the two patients who underwent resection of a hemangioma improved. Two additional patients, however, who underwent resection of varicose veins in another institution had worsening of the symptoms. In one patient we performed deep venous reconstruction for atresia of the superficial femoral vein, using the contralateral saphenous vein. Such operation in KTS has not been reported previously. The patient has a patent graft with a competent valve and clinical improvement 6 months after the operation. Although patients with severe chronic venous insufficiency, disturbing cosmetic appearance, or complications of hemangioma may benefit from surgical treatment, detailed preoperative imaging of the extremity and pelvis with magnetic resonance imaging and contrast venography is needed to decrease complications. Rarely, reconstruction for atresia or hypoplasia of the deep veins may be needed.

Adolescent↗

PubMed1990

Recent trends in the diagnosis and management of chronic intestinal ischemia.

This paper reviews the operative management over the past 27 years of 102 patients with chronic mesenteric ischemia, and summarizes recent clinical trends and ongoing research in this area. The most important trends in the diagnosis and management of chronic intestinal ischemia include: (1) increasing use of duplex ultrasound scanning in the initial evaluation of patients with possible intestinal angina; (2) rapidly evolving noninvasive clinical tests to assess mucosal perfusion (reflectance spectrophotometry, laser Doppler flow analysis, and tonometry); and (3) preferential use of antegrade mesenteric grafts or transaortic endarterectomy for mesenteric atherosclerotic occlusive disease. Surgical revascularization continues to provide excellent early relief of symptoms (93%) and a low late recurrence rate (10%). New noninvasive diagnostic tests for chronic intestinal ischemia and excellent results of surgical revascularization support a continued aggressive approach to the early recognition and treatment of patients with chronic intestinal angina. With the aging population, we anticipate that the number of patients with chronic intestinal ischemia will increase.

Angiography↗

PubMed1990

Reconstruction of the vena cava and of its primary tributaries: a preliminary report.

Encouraged by results from our research laboratory and from recent clinical reports, we performed reconstructions of the vena cava and/or its major tributaries on 16 patients (11 males and five females). Ages ranged from 8 to 81 years (median, 38 years). Eight patients had superior vena cava syndrome (benign, six; malignant, two). Two other patients had membranous occlusion of the inferior vena cava; four had iliocaval venous thrombosis; one had excision of the iliac veins for pelvic neurilemmoma; and one had inferior vena cava injury during orthotopic liver transplantation. The superior vena cava was reconstructed with spiral saphenous vein grafts in five patients and with expanded polytetrafluoroethylene in three. One spiral saphenous vein graft and one expanded polytetrafluoroethylene graft required revision; seven of the eight grafts were patent at follow-up, but one bifurcated spiral saphenous vein graft occluded at 3 months. The inferior vena cava and its tributaries were reconstructed with expanded polytetrafluoroethylene in five patients, spiral saphenous vein graft in two, and Dacron in one. At follow-up four of the expanded polytetrafluoroethylene grafts were patent. In contrast, one of the spiral saphenous vein grafts was occluded, and results of imaging studies of the other were inconclusive. Three of the five expanded polytetrafluoroethylene grafts had a concomitant temporary arteriovenous fistula at the groin; two had documented patency at follow-up. At the present time, spiral saphenous vein graft is our first choice for superior vena cava replacement. However, expanded polytetrafluoroethylene grafts are good alternatives and in the abdomen appear to perform better than spiral saphenous vein graft. These clinical results encourage us to perform further caval grafting in selected patients.

Adult↗

PubMed1990

The femoral neuralgia syndrome after arterial catheter trauma.

The increasing number of diagnostic angiograms and interventional vascular procedures has resulted in a heightened awareness of serious catheter-related vascular trauma. We reviewed 50 consecutive catheter injuries of the femoral artery that required surgical intervention and focused specifically on their long-term outcome. The most common traumatic lesion was femoral pseudoaneurysm (60%) followed by uncontrolled hemorrhage (23%) and arterial thrombosis (17%). The most frequent chronic complaint of these patients was the femoral neuralgia syndrome affecting 15 of 50 patients (30%). Typically, these patients complained of postcatheterization pain in the groin, which radiated down the anteromedial thigh (anterior femoral cutaneous nerves), and was associated with residual hyperesthesias. The neuralgia gradually improved in 6 weeks to 1 year in most patients. Chronic pain, however, necessitated multiple visits to a pain clinic or physical therapy unit in four patients (27%) and resulted in unemployment in three (20%). We conclude that current catheter-related arterial injuries are commonly associated with a chronic femoral cutaneous neuralgia syndrome that has not been emphasized previously.

Aged↗

PubMed1989

Unusual manifestations of abdominal aortic aneurysms.

Repair of an asymptomatic infrarenal abdominal aortic aneurysm is straightforward and can be accomplished with low morbidity and mortality rates. However, certain complications of abdominal aortic aneurysm, such as contained rupture, inflammatory aneurysm, aortovenous fistula, infected aneurysm, primary aortoenteric fistula, and lower-extremity atheroembolism can be both limb- and life-threatening. Unusual signs and symptoms in a patient with an abdominal aortic aneurysm should alert the physician to the possibility of one of these complications. Careful history-taking and physical examination and appropriate diagnostic imaging, combined with a well-planned operation, will minimize the morbidity and mortality rates otherwise associated with these complications.

Aorta, Abdominal↗

PubMed1989

Concomitant abdominal aortic aneurysm and colorectal carcinoma: priority of resection.

Seventeen patients (15 men and two women) underwent operation for concomitant abdominal aortic aneurysm (AAA) and colorectal carcinoma (Ca) during a recent 12-year period. Ages ranged from 59 to 89 years (median 75.2 years). Diameter of the AAA ranged from 3.5 to 9.5 cm (median 5.5 cm). The Ca was staged by the Astler-Coller modification of Dukes' classification as B1 in three patients, B2 in eight, C2 in three, D in two, and unclassified in one. Personal preference, presence of symptoms, and extent of malignant involvement determined preference of resection. The Ca was eventually resected in 16 patients and the AAA in nine. Thirteen patients underwent resection of the Ca first, two the AAA first, and two concomitantly. Eight patients (47%) underwent resection of both the AAA and Ca, eight underwent resection of the Ca only, and one underwent resection of the AAA only. There were three deaths in 24 operations. Follow-up ranged from 5 weeks to 8 years (median 1 1/2 years). Only five patients (29.4%) were long-term survivors without evidence of recurrent Ca and all occurred in the eight patients (62.5%) who had undergone resection of both the Ca and AAA. Three late deaths occurred as a result of complications from the unresected AAA in the eight patients who had undergone resection of the Ca only (37.5%). We conclude that if the Ca is not symptomatic and localized the AAA should be resected first. However, both lesions need to be resected eventually for long-term survival.

Aged↗

PubMed1989

Noninvasive evaluation of the swollen extremity: experiences with 190 lymphoscintigraphic examinations.

Lymphoscintigraphy (LS), performed with technetium 99m-labeled antimony trisulfide colloid (Cadema Medical Products, Inc., Middletown, N.Y.), was used as a noninvasive diagnostic examination to evaluate the lymphatic circulation in 190 extremities of 115 patients. Forty-six patients had primary lymphedema, 48 had secondary lymphedema, and 21 patients had other causes of limb swelling. To determine the value of LS in surgical decision making, preoperative and postoperative LS of 16 patients who underwent surgical repair of the lymphatic abnormality were studied separately. Semiquantitative evaluation of the lymphatic drainage and visual interpretation of the image patterns were reliable to differentiate lymphedema from edemas of other origin (sensitivity: 92%, specificity: 100%). Although certain image patterns were characteristic of either primary or secondary lymphedema, LS could not consistently differentiate between the two types. Episodes of cellulitis in lymphedema clearly delayed lymph transport. LS was helpful in patient selection and follow-up after lymphatic surgery, but it did not prove patency of lymphovenous anastomoses. It was diagnostic in the evaluation of lymphangiectasia and was used to document successful surgical treatment of reflux of chyle. LS is safe and reliable and has no side effects. It should replace contrast lymphangiography in the routine evaluation of the swollen extremity.

Adolescent↗

PubMed1989

Technical principles of direct innominate artery revascularization: a comparison of endarterectomy and bypass grafts.

Occlusive lesions of the innominate artery that require operation occur infrequently. Direct repair has been performed with low morbidity and mortality. There is debate over the best method of direct reconstruction. Twenty-six patients undergoing transsternal innominate artery repair over a 12-year period were reviewed to determine if either grafting or endarterectomy was superior and what technical factors might be responsible for success or failure. Most of the patients were women. Twenty-four of the patients had atherosclerotic lesions, whereas the other two had Takayasu's arteritis. Either neurologic or right upper extremity symptoms were present in 24 patients. Sixteen patients had grafting, and 10 underwent endarterectomy. There was one death. There were no strokes or transient ischemic attacks. Three patients experienced recurrence of their symptoms; all had failures of reconstruction. The use of a bifurcated graft in one patient was probably responsible for one recurrence of symptoms. Single limb grafts with added side arms are probably preferable to bifurcated grafts. Innominate artery grafting and innominate endarterectomy are equally effective, although grafting is applicable to more patients. Direct transsternal repair is the procedure of choice to correct innominate occlusive disease in patients who are good candidates for correction.

Adult↗

PubMed1988

Thoracoabdominal aortic aneurysm repair. Analysis of postoperative morbidity.

Between 1980 and 1986, 101 nondissecting thoracoabdominal aortic aneurysms (TAAAs) were repaired at the Mayo Clinic, Rochester, Minn. Overall mortality was 15% with a 9.6% mortality for elective repair. Nonfatal complications occurred in 44% of patients and included myocardial infarction in 9%, paraplegia in 5%, and renal failure in 4%. In an attempt to reduce morbidity and mortality associated with TAAA repair, one of our vascular surgical services set up a routine protocol of preoperative evaluation, standardized operative technique, and specific guidelines for perioperative management. Fifty-five of the 101 patients underwent elective repair on this service without the use of shunts or bypass. Mortality was reduced to 1.8% and the rate of myocardial infarction was reduced to 1.8%; none of these patients developed renal failure. However, paraplegia/paraparesis still occurred in 5.4% and pulmonary insufficiency occurred in 29%. Preoperative cardiac evaluation and intraoperative reduction of cardiac afterload are important factors in reducing myocardial infarction and death associated with TAAA repair and should be integrated into the management of these patients. However, preexisting pulmonary and renal disease in some patients may limit the surgeon's ability to reduce rates of some complications.

Adult↗

PubMed1988

Surgical resection of carotid body tumors: long-term survival, recurrence, and metastasis.

We retrospectively reviewed a 20-year experience with 59 carotid body tumors in 55 patients examined at our institution in order to determine the long-term results of surgical resection, including the rates of distant metastasis, local recurrence, and long-term survival. Complete surgical excision was possible in 52 of the 55 patients (95%). Perioperative mortality was only 2% (1 of 59 procedures), and no operative deaths occurred during the last 10 years of the study. Survival of patients after resection of a carotid body tumor was equivalent to that for sex- and age-matched control subjects. Only one patient (2%) had development of metastatic disease during long-term follow-up. Three patients (6%) had recurrence of the carotid body tumor after complete excision. All recurrent tumors were observed in patients with multiple paragangliomas or a family history of cervical paragangliomas. Therefore, we advocate early surgical resection of all carotid body tumors in low-risk patients. Such early resection maximizes the possibility of cure and minimizes the risks of neurovascular complications associated with large and neglected tumors.

Adolescent↗

PubMed1988

Trends in neurovascular complications of surgical management for carotid body and cervical paragangliomas: a fifty-year experience with 153 tumors.

Almost 75% of carotid body and cervical paragangliomas are adherent to or surround adjacent arteries and cranial nerves. Their resection can result in neurovascular injury, stroke, and excessive blood loss. To assess trends in neurovascular complications, we reviewed 153 carotid body and cervical paragangliomas that were surgically managed between 1935 and 1985. Results of the past 10 years were compared with two previous time periods: period I (1935 to 1965), when carotid artery reconstruction was uncommon at our institution, and period II (1966 to 1975), when methods of intraoperative electroencephalographic monitoring and carotid patch angioplasty were being developed. During the past 10 years (period III), surgical approach to these tumors has included intraoperative monitoring of cerebral blood flow, selective use of shunts, vein patch or graft reconstructions after extensive tumor resections, and mobilization of the parotid gland to facilitate adequate exposure of high tumors. Although tumor resection was attempted in 80% of patients in period I, surgical resection was complete in 98% during periods II and III. Three trends were observed: (1) The perioperative stroke rate has decreased dramatically from 23% in period I to 2.7% in period III (p = 0.007); (2) the perioperative mortality rate has been reduced from 6% in period I to no deaths in the past 10 years, but (3) the rate of postoperative cranial nerve dysfunction remains unchanged over 50 years (period I, 46%; period III, 40%). The median tumor size among patients with postoperative complications was significantly larger than those without complications (median size: 17 vs. 7 cm3, p = 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988

Late cerebrovascular accidents after repair of abdominal aortic aneurysms.

In this follow-up of 1,112 patients operated on for abdominal aortic aneurysm (AAA) it was noted that cerebrovascular accidents (CVAs) caused significant (8.2%) late mortality. Seventy-one patients developed non-fatal or fatal CVAs at 5.9 +/- 2.9 (mean +/- SD) years after the initial aneurysm repair. The incidence of CVA was 4.2% and 9.5% within five and ten years, respectively. In patients with preoperative evidence of both hypertension and heart disease, the incidence of CVA within five years was 9.1% compared to an incidence less than 4% in patients with either or neither of these risk factors (p less than 0.01). Multivariate analysis of individual risk factors revealed that only age (p less than 0.001), hypertension (p less than 0.001), angina pectoris (p less than 0.02) and other heart disease (p less than 0.001) were independently associated with a reduced survival free of CVA. Thus, cerebrovascular accidents are responsible for significant late morbidity after AAA repair. Patients at high age or with evidence of hypertension and heart disease carry a greater risk for this complication.

Adult↗

PubMed1987

Renovascular operations in patients with chronic renal insufficiency: do the benefits justify the risks?

To define the benefits and risks of renal revascularization or nephrectomy in patients with both severe hypertension and chronic renal insufficiency, we analyzed 98 patients who underwent renovascular operations after serum creatinine levels exceeded 2 mg/dl. This subset of patients was selected from a retrospective review of 652 renal operations performed at the Mayo Clinic for renovascular disease between 1970 and 1981. Special attention was given to the type of operations, their effect on hypertension and renal function, specific factors that affected operative deaths, and late survival. Unilateral renal operations were performed in 48 patients with bilateral procedures in 50. Simultaneous aortic reconstruction was necessary in 55 patients (56%). Postoperative diastolic blood pressure was less than 90 mm Hg in 55% of patients and 90 to 100 mm Hg in an additional 33%. Seventy-six percent of patients required less antihypertension medication. Serum creatinine improved or stabilized in 69%. Ninety percent of patients avoided any early or late renal dialysis. The operative mortality rate was 7.1% and tended to be higher in patients with a serum creatinine greater than 3 mg/dl and in those with past myocardial infarction (p = 0.05). The late survival rate was 64% at 5 years. The main cause of operative and late death was myocardial infarction. In conclusion, most patients with renovascular hypertension and early chronic renal insufficiency can be benefited by surgical revascularization or nephrectomy. Future improvement in early and late survival may require a more aggressive approach to the identification and correction of significant coronary artery disease.

Adult↗

PubMed1987

Cerebral hyperperfusion syndrome: a cause of neurologic dysfunction after carotid endarterectomy.

Neurologic deficits evident when patients initially awaken from surgery are generally due to intraoperative embolization or inadequate cerebral protection in patients with marginal cerebral perfusion; neurologic deficits occurring in the immediate postoperative period are usually related to acute carotid occlusion or embolization. However, in a small subset of patients, transient postoperative neurologic dysfunction seems to be related to a syndrome of cerebral hyperperfusion rather than a lack of adequate cerebral blood flow. This study describes the courses of 10 patients with classic findings of cerebral hyperperfusion syndrome. Typically, this syndrome occurred in patients with longstanding severe chronic cerebral ischemia and occurred after correction of a very high-grade carotid stenosis. Intraoperatively, there was often a dramatic increase in xenon-labeled cerebral blood flows, with postocclusion flows sometimes attaining three to four times baseline levels. Postoperatively, the patients initially did well. However, over the next several days, many of them began to complain of unilateral headache on the operated side and subsequently had seizures. Electroencephalography obtained during this period uniformly revealed periodic lateralizing epileptiform discharges on the side of the brain ipsilateral to the endarterectomy. Although neurologic dysfunction fully resolved in all of the patients in this group, it is possible that intracerebral hemorrhage may occur in some patients with hyperperfusion syndrome. The pathophysiology of this syndrome is believed to be related to preoperative loss of cerebral autoregulatory mechanisms caused by chronic cerebral ischemia.

Adult↗

PubMed1987

Late survival in abdominal aortic aneurysm patients: the role of selective myocardial revascularization on the basis of clinical symptoms.

Coronary artery disease is recognized as the major cause of perioperative and late death after abdominal aortic aneurysm (AAA) repair. Routine coronary angiography and prophylactic myocardial revascularization for all significant lesions, regardless of symptoms, have been recommended as a means of reducing this mortality risk. We have advocated a more selective approach in which coronary angiography and myocardial revascularization are performed on the basis of cardiac symptoms. Studies have shown that this selective approach is just as effective as the prophylactic approach in reducing perioperative deaths. To evaluate the effect on late survival of selective myocardial revascularization on the basis of symptoms, we reviewed the preoperative coronary status and course of 485 patients who successfully underwent AAA repair between 1980 and 1985. Late survival was evaluated by means of the Kaplan-Meier method and compared with life expectancy of an age- and sex-matched population. Late survival of the entire group of patients was no different from that of the matched population. Patients with no preoperative evidence of coronary artery disease did significantly better than expected (p = 0.05), whereas those patients with uncorrected or previously bypassed coronary disease had survival no different from that expected. When age was considered as a variable, patients in their 50s and 60s had survival significantly worse than the matched population (p less than 0.001 and p = 0.003, respectively). Patients in their 70s and 80s had survival as good as or better than the matched population, regardless of coronary status.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed1986

Conventional repair of abdominal aortic aneurysm in the high-risk patient: a plea for abandonment of nonresective treatment.

Recent reports in the literature have promulgated nonresective treatment of abdominal aortic aneurysm as a safer procedure than conventional aneurysmectomy with graft replacement in high-risk patients. This review of 106 high-risk patients who underwent conventional aneurysm repair between 1980 and 1985 was undertaken to compare the relative risks, perioperative morbidity, and operative mortality of these patients to that reported for patients treated by nonresective therapy. Excluded were those patients who had rupture initially or underwent a concomitant renovascular procedure. Patients were considered to be at high risk if they met one or more of the following criteria: age equal to or greater than 85 years; receiving oxygen at home, PO2 less than 50 torr, or forced midexpiratory flow less than 25% of predicted; serum creatinine equal to or greater than 3 mg/dl; biopsy-proven cirrhosis with ascites; retroperitoneal fibrosis; or New York Heart Association functional class III-IV angina, left ventricular ejection fraction less than 30%, recent congestive heart failure, complex ventricular ectopy, large left ventricular aneurysm, severe valvular disease, recurrent congestive heart failure or angina after coronary artery bypass grafting, or severe unreconstructed coronary artery disease confirmed by angiography. The mortality rate for conventional aneurysm repair in high-risk patients was 5.7%, compared with a reported 7% mortality rate for nonresective therapy. In those patients with severe cardiac dysfunction, intraoperative pharmacologic manipulation and the selective use of intra-aortic balloon counterpulsation appeared helpful in achieving survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗