Routine revascularization with resection of infected femoral pseudoaneurysms from substance abuse.
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Aneurysm↗
Biomedical subjects
L Semel
Publications and source records attributed to L Semel.
Management of suspected mycotic suprarenal aortic aneurysm.
Mycotic aortic aneurysm is an uncommonly encountered entity. The diagnosis and management are challenging problems. Involvement of the visceral aorta creates additional problems in management. Experience with a patient having this diagnosis and the dilemma in treatment forms the basis of this report.
Aged↗
Atraumatic control in calcified arteries.
We have attempted distal saphenous vein bypasses for limb salvage in increasingly difficult situations. Severe calcification in the recipient artery makes vascular control and anastomosis troublesome. An atraumatic method of intraluminal control, which has been of aid in this situation, is described.
Anastomosis, Surgical↗
Routine revascularization with resection of infection femoral pseudoaneurysms from substance abuse.
Infected femoral artery pseudoaneurysms in narcotic addicts present challenging management options. Our policy of routine revascularization is based on the concern that a high rate of amputations must follow ligation and resection alone or with selective delayed revascularization. Fifteen of 16 patients with infected pseudoaneurysms of femoral arteries, treated with resection and bypass grafts, were observed from 1 to 44 months. Obturator bypass grafts were used in 10 patients, iliac-femoral grafts in three, axillopopliteal in one, and right external iliac crossover to left popliteal in one patient. One limb, unsalvageable at presentation, was amputated primarily, along with resection of pseudoaneurysm and femoral artery ligation, without bypass grafting. One iliac-femoral graft became infected and then thrombosed 4 months after operation. Unsuitable distal arteries and impending necrosis led to above-knee amputation. One late failure among 15 revascularization attempts (7%) is significantly lower than the 11% to 33% amputation rates reported in the literature with resection of pseudoaneurysm alone and delayed selective revascularization. The other 14 patients had functioning limbs without claudication or rest pain. Our experience indicates that revascularization at the time of resection of infected pseudoaneurysm offers better prospects for limb salvage.
Adult↗
Extended reconstruction rate for limb salvage with intraoperative prereconstruction angiography.
A prospective study was performed between May 1982 and March 1987 to assess the value of intraoperative prereconstruction angiography (IPA) in limb salvage. Eligibility was limited to patients with rest pain, ischemic ulcers, or gangrene limited to the toes: only candidates for infrapopliteal bypass were included. Seventy-eight such patients were examined with preoperative angiography. Delayed films, selective catheterization, reactive hyperemia, or vasodilators were used routinely. In only 11 of 78 patients (14%) was the runoff adequately visualized, demonstrating the tibial vessels and the pedal arch. The remaining 67 patients (86%) (with nonreconstructable disease by currently accepted outflow criteria) had surgical exposure of a tibial or pedal artery for IPA. In 56 of these patients (84%) good runoff was demonstrated and bypass was performed. The reconstruction rate was 86% (67 of 78 patients), significantly higher than the 33% rate reported by others. The operative mortality rate was 2.8% (2 of 78 patients). We concluded that in severe ischemia preoperative angiography is often inadequate in demonstrating runoff, even with adjunctive measures to dilate the outflow vessels. IPA through the tibial and pedal vessels eliminates all of the proximal vascular resistance, thereby providing a "completion angiogram" before reconstruction. This in turn extends reconstructability to many patients who would otherwise undergo primary amputation.
Angiography↗
Coexisting carotid stenosis in patients undergoing cardiac surgery: indications and guidelines for simultaneous operations.
The coexistence of critical carotid stenosis with coronary artery or valvular heart disease occurs in a small percentage of patients requiring open heart surgical procedures. Recognition of such combined lesions by noninvasive carotid testing identifies patients at risk for neurologic events. Our experience with 62 patients having combined simultaneous carotid and cardiac operations among 2,400 open heart surgery patients was compared with the results in 110 patients with only carotid endarterectomy operations. The outcomes indicated that carotid endarterectomy can be performed simultaneously with open heart surgical procedures with morbidity and mortality rates similar to those of isolated cervical artery operations. Thus, patients with significant coexisting carotid artery disease defined with specific criteria and coronary artery disease need not be exposed to cerebral ischemic events or to myocardial infarctions that often accompany staged operations.
Carotid Artery Diseases↗
Nontraumatic clostridial myonecrosis and mycotic aneurysm formation.
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Adenocarcinoma↗
Bullet embolism.
Bullet embolism is a rare complication of vascular trauma. During the last ten years we have treated six patients with bullet embolism. Three patients had inferior vena caval injuries with embolizations of the bullets to the heart or pulmonary arteries. Two had infrarenal aortic injuries with embolization to vessels of the lower extremities. One patient with a shotgun injury to the superficial femoral artery and vein had both arterial and venous embolizations. The site of vascular penetration was repaired in all six patients. All peripheral arterial bullet emboli were removed except for an asymptomatic shotgun pellet in the peroneal artery. One bullet was removed from a right atrium and another from a proximal pulmonary artery. Emboli in the distal pulmonary artery branches were left undisturbed in two patients. All six patients survived without any complications. A 14-year review of the literature is presented in order to emphasize some important features of this rare pathology.
Adult↗
Limb loss despite functioning distal bypass.
Five patients are reported who failed to heal ischemic foot wounds despite patient, functioning in situ saphenous vein grafts to infrapopliteal arteries. All were diabetic and two died before amputation could be performed. Contributing to this paradoxical failure of attempted limb salvage were: (a) extensive preexistent gangrene, (b) infection and failure of wound management, and (c) occlusive disease in runoff beds despite the distal site of anastomosis. Distal occlusive disease included one or more of the following: (a) stenosis in a named artery of the foot, (b) stenosis of collaterals from the peroneal artery, and (c) incomplete pedal arches. Distal in situ saphenous vein bypass should continue to be broadly applied for limb salvage, but careful judgement in patient selection and attention to the management of the ischemic wound itself remain critical to success.
Aged↗