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Biomedical subjects

L Sichel

Publications and source records attributed to L Sichel.

10 recordsLinked to original sources
PubMed2001

[Critical ischemia of the diabetic patient].

BACKGROUND: Critical ischemia of the lower limbs is the final result of diabetic arteriopathy. The surgeon is more and more forced to choose between amputation d emblée and the attempt to revascularization in very old patients and in deficient general conditions. Shall we point out some principle to address our strategy? METHODS: To answer this question we reviewed retrospectively our surgical choices and the results obtained during two years, from January 1997 to December 1998 (medium follow-up 11.3 months), at the Emergency Division of the Cannizzaro Hospital of Catania. In this period 143 diabetic patients were selected by our ambulatory. Of these, nineteen had a critical lower limb ischemia and therefore were submitted to a revascularization and/or amputation. All the revascularized patients were controlled by Doppler-sonography immediately after operation and then daily, till their discharge. Controls were done at the first, third, sixth month and after one year, except for patients who complained a new objective or subjective ischemic symptomatology. RESULTS: The primary patency rate was 84.2% and the secondary patency rate was 89.4%. The amputation rate due to the procedure failure was 5%. The complications were three: two graft infections (10.5%) and one early thrombosis of a femoro-popliteal bypass graft, due to technical defect (5.2%). Perioperative mortality rate was 15.7%. CONCLUSIONS: These results, if related with those reported in the letterature about amputations, are in favour of the attempt to revascularization.

Aged↗
PubMed1996

[Klippel-Trenaunay syndrome].

The Klippel-Trenaunay syndrome is a rare congenital pathology which includes varices, hemangiomas and hypertrophy of limbs. The Authors report two cases and pay particular attention to the diagnostic and therapeutical protocols. Although these aspects are still open questions, the Authors conclude that conservative therapy is often sufficient while surgery is requested only in the severe forms.

Adult↗
PubMed1986

[Complications of vascular prosthesis].

The main complications deriving from the use of vascular prostheses in the surgical reconstruction of the arteries are thrombosis, infection and the appearance of pseudoaneurysms. Among 233 aorto-femoral b.p., prosthetic thrombosis occurred in 45 patients creating the need for 66 reoperations, 19 early and 47 tardive. In 387 aorto-iliac reconstructions, infection arose early in 11 cases, tardively in 6. Out of 1118 vascular reconstructions there were also 28 pseudoaneurysms (2.5%). After remarks on the aetiopathogenesis of such complications, methods that can be used to prevent them are discussed and personal results of treatment are presented.

Aneurysm↗
PubMedDate not supplied

Acute thrombosis of the infrarenal aorta. Therapeutic problems.

Acute thrombosis of the infrarenal aorta is a rare event, usually complicating aortic atherosclerotic lesions or aortic aneurysms. During the last twelve years, we treated 10 acute aortic thromboses out of 353 acute ischemias of the lower limbs (2.8%). The high mortality of our series (60%) is related to advanced age (71 years on average), severe underlying cardiopathy, and the frequent involvement of the renal and mesenteric vessels. In our experience Fogarty catheter thrombectomy is usually ineffective, and the surgical approach in high risk patients should be confined to axillobifemoral bypass graft.

Acute Disease↗
PubMedDate not supplied

Long term results of extra anatomical bypasses.

The authors discuss their own experience with extra anatomical bypasses. It is composed by 214 patients who underwent 224 extra anatomical bypasses: 167 axillofemoral bypasses, 50 femorofemoral bypasses and 7 trans-obturator bypasses. The indications included the presence of infections, or a previously thrombosed aortic prosthesis, or infected aneurysm, in 12.1% of the cases; in 6.2% of the cases the extra anatomical bypass was due to acute ischaemia of limb. In 81.7% it was chosen because of the presence of some general or local contraindication to direct aortoiliac reconstruction. The results are comparable to those reported in the literature. The only unusually high datum is the rate of early infections in femorofemoral bypasses (12%). On the ground of these results, the Authors stress the value of extra-anatomical bypasses as an alternative to direct aortoiliac reconstructions.

Aged↗
PubMedDate not supplied

[Axillofemoral bypass: a potential solution of acute ischemia of the lower limb].

When deobstruction by Fogarty catheter fails, the axillofemoral bypass can be considered as a therapeutic solution of the acute ischaemia of the limb. The authors discuss a case occurred in their experience and focus their attention on the therapeutic potentiality of this kind of revascularization. As a matter of fact it is important to consider that the operation should not only eliminate the acute ischaemia, but also correct the atherosclerotic lesions that led to it. Therefore, if deobstruction by Fogarty catheter does not restore a good inflow, in high risk patients with acute arterial thrombosis of the limb, there is a well indication for extra-anatomic revascularization.

Acute Disease↗