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Biomedical subjects

K V Krishnasastry

Publications and source records attributed to K V Krishnasastry.

12 recordsLinked to original sources
PubMed1994

External iliac ligation and axillary-bifemoral bypass for blue toe syndrome.

BACKGROUND: This report describes six patients with atheroemboli to both lower extremities that originated from the abdominal aorta. All patients had severe bilateral rest pain and ulceration or gangrene. Each had severe coronary artery disease and other medical problems, which precluded direct aortic reconstruction. METHODS: Ligation of the external iliac arteries was performed to prevent continual passage of emboli into the lower extremities. Revascularization was effected by axillary-bifemoral bypass. RESULTS: Initial limb salvage was accomplished in twelve threatened extremities. One patient required a single toe amputation. One axillary graft failed after 3 months and was successfully replaced with a contralateral graft. These patients have been followed for up to 52 months without limb loss; the mean follow-up is almost 2 1/2 years. CONCLUSIONS: In patients with severe coronary artery disease and blue toe syndrome, the combination of external iliac ligation and axillary-bifemoral bypass is an effective and durable procedure to prevent worsening ischemia and to salvage threatened lower extremities.

Aged↗
PubMed1992

Management of ruptured abdominal aortic aneurysm and concomitant biliary sepsis.

Since 1984 three patients have been treated for a ruptured abdominal aortic aneurysm and acute biliary sepsis. The biliary tract disease included two cases of gangrene of the gallbladder, one with perforation. Two patients had cholangitis. All patients underwent repair of the ruptured aneurysm and cholecystectomy under the same anesthetic. Two individuals required common duct exploration: one at the time of the initial operation and the other 6 days later. Despite a high incidence of postoperative complications in these elderly men, all survived surgery and are alive and well after periods of 1 to 7 years. There have been no graft infections.

Aged↗
PubMed1990

The possibility of distal embolization from a femoral-popliteal prosthesis above the knee. A consideration against its routine use in this position.

The preferential use of a synthetic arterial graft in the above-knee femoral-popliteal position is advocated by many surgeons for a variety of reasons. Our recent experience with three cases of substantial deterioration of runoff vessels within a brief period, which may have resulted from embolization from such a conduit, is presented along with other arguments against the routine use of a prosthesis in this position. The procedure with the best possible outcome, namely, one utilizing autogenous vein, should be performed at the outset in all patients except those with a limited life expectancy or those in whom a lengthy procedure would be hazardous.

Adult↗
PubMed1990

Traumatic juxtarenal aortocaval fistula and pseudoaneurysm.

We discuss the treatment of a fistula located between the aorta and inferior vena cava which was caused by trauma. Fewer than 30 such cases have been reported in the English literature. A juxtarenal pseudoaneurysm and aortocaval fistula resulting from a gunshot wound, unrecognized upon the initial presentation of the patient, is reported herein.

Aorta, Abdominal↗
PubMed1990

Late results of preferential use of tube versus bifurcation grafts for abdominal aortic aneurysmectomy.

The advantages of tube versus bifurcation graft replacement of abdominal aortic aneurysms are well known, yet the risk of future development of iliac occlusive or aneurysmal disease still leads many to use bifurcation grafts routinely. Several studies have reported little risk of this development when patients are followed clinically. They suffer, however, from lack of an objective means of identifying iliac aneurysms. Among 83 patients undergoing abdominal aortic aneurysmectomy during a 53 month period, 36 who had received a tube graft were available for follow-up. After a mean of 54 months from the time of surgery, these patients were evaluated by abdominal and pelvic computed tomography to determine the incidence of subsequent iliac aneurysm formation. No patient had developed symptoms or signs of iliac occlusive disease during this interval. In addition, no residual aortic aneurysms or new iliac aneurysms were noted. In the absence of iliac occlusive or aneurysmal disease, straight graft replacement is the preferred therapy for abdominal aortic aneurysms. The risk of future development of these lesions is minimal.

Aged↗
PubMed1990

Lower extremity revascularization via the lateral plantar artery.

Lower extremity bypass grafts to the tibial and crural arteries are commonly employed to treat patients with atherosclerotic limb-threatening ischemia. Although occasional series have mentioned bypasses to a plantar artery, few of these specifically examine the results of arterial reconstructions using these vessels. Six patients underwent femoral to lateral plantar artery (LPA) bypass within a 19-month period for gangrene of the forefoot. There was one early graft failure and in the five completely autogenous reconstructions, graft patency and limb salvage had been achieved during a follow-up ranging from three to 22 months. The LPA is an acceptable site for anastomosis of lower extremity bypass grafts and the early results presented herein support its more liberal use when proximal sites are unavailable.

Aged↗
PubMed1990

Abdominal aortic aneurysmectomy without preoperative angiography. A prospective study.

In an attempt to analyze whether routine angiography is necessary prior to elective abdominal aortic aneurysmectomy (AAA), a prospective study was designed in which this examination was obtained only for specific indications. These included significant hypertension, renal dysfunction, symptoms of visceral ischemia, suprarenal extension of the aneurysm or a coexisting thoracic aneurysm, and diminished or absent femoral pulses. A consecutive series of 124 abdominal aortic aneurysms is reported, in which 110 procedures were performed electively. Preoperative angiograms were obtained in only ten patients (9.1%) and in nine of these an alteration in the usual operative strategy resulted. In the remaining 100 patients undergoing elective AAA without preoperative aortography, acceptable morbidity and mortality rates were obtained despite the intraoperative discovery of iliac aneurysms in 25 patients (23%) and accessory renal arteries in three patients (2.7%). In the absence of specific indications for angiography, the mainstay of the preoperative evaluation for abdominal aortic aneurysms should be computed tomography (CT). The preoperative workup can be done entirely on an outpatient basis.

Aged↗
PubMed1990

Primary venous aneurysms.

Venous aneurysms are rare lesions. They may, however, be the source of pulmonary emboli and can result in death. We have recently treated several patients who had venous aneurysms of the upper extremity and jugular system. In these locations, venous aneurysms appear to have a safe natural history, although two patients required surgery after the development of symptoms. These cases are presented, with a review of venous aneurysms occurring at other sites and their cause.

Adult↗
PubMed1987

Fungal graft infections: case report and review of the literature.

Fungal intravascular graft infections are rare. In addition to our case, which forms the basis of this article, only 13 documented instances could be found in the literature in the 20-year period from 1966 to 1986. Three of these cases (21%) had both fungus and bacteria grown in culture. Candida and Aspergillus species constituted most of the infecting organisms (79%). There was no obvious difference in the clinical presentations between fungal and bacterial infections. In two cases (14%), there was a strong predisposition toward fungal infection: one in a patient with pulmonary histoplasmosis and one in a patient with leukemia. Appropriate intervention appears to be graft excision and extra-anatomic bypass with concomitant therapy with amphotericin B. Survival with this approach was 84%, whereas other methods yielded a survival rate of 20%.

Adult↗