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Biomedical subjects

M Haimov

Publications and source records attributed to M Haimov.

69 records · Page 4Linked to original sources
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Salvage surgery for recurrent neck carcinoma after multimodality therapy.

Recurrent carcinoma of the neck after treatment by radical neck dissection and radiotherapy leads to a progressive downhill course if no further therapy is instituted. Nine such patients having fixed, recurrent neck tumors with carotid artery involvement underwent 10 salvage procedures with carotid artery resection and replacement. One patient developed a transient hemiparesis that resolved in 3 days, and in another, a permanent hemiparesis occurred. Three patients have survived longer than 12 months. One patient is free of disease at 42 months following two salvage operations. We attribute the low operative morbidity to the frequent use of the subclavian artery for proximal anastomosis and myocutaneous flaps to resurface cutaneous and mucosal defects. We conclude that salvage surgery with carotid artery replacement can be performed on selected patients who have failed combined therapy as a palliative and possibly curative measure.

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The modified bovine carotid artery as a vascular substitute in man. Personal experience and review of the literature.

The modified bovine heterograft is one of the vascular prostheses currently available for clinical use. This report reviews the mode of preparation of the heterograft and its physical and biological qualities. The experience of the authors with this heterograft for vascular reconstruction in 32 patients and for the construction of s.c. arteriovenous (A-V) fistulas in 80 patients is reported. The modified bovine heterograft was found to be a satisfactory prosthesis when used in vascular reconstruction above the inguinal ligament or for the construction of A-V fistulas for hemodialysis. In reconstructions in the femoropopliteal segment of the circulation, the use of the heterograft by the authors was associated with an unacceptable rate of morbidity and graft failures. Experience reported in the literature has so far been incomplete and inconclusive, with one-year patency rates ranging between 20 and 74%.

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Aorto-caval fistula: a clinical spectrum.

Ten cases of aortocaval fistula (ACF) associated with abdominal aortic aneurysm (AAA) were reviewed. In 5 cases the ACF became apparent after evacuation of the thrombus; only 5 patients presented with features of patent ACF. Four patients in addition presented with extra-caval rupture of the aneurysm. Based on these variables, a classification relating ACF and AAA was developed. In this series all patients were male with a mean aneurysm size of 8.5 cm. All patients required bifurcation grafts for reconstruction. A multifactorial etiology related to enlargement and rupture of all aneurysms seems to apply to ACF. Eight of 10 patients survived. Awareness of this entity and proper preparation allow for successful outcome in the treatment of this condition.

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Evaluation of axillo-axillary artery bypass for the treatment of subclavian or innominate artery occlusive disease.

Because of the higher morbidity and mortality of transthoracic procedures, extrathoracic techniques to revascularize the subclavian or innominate artery, such as carotid subclavian and axillo-axillary artery bypasses have gained wide acceptance. The present work evaluates the results of axillo-axillary bypass in 33 patients who underwent this procedure in the past 13 years. There were 13 males and 20 females with a mean age of 61 years. The occlusive disease was present in the subclavian artery in 19 patients and in the right subclavian artery in 14 patients. Eleven patients presented with central nervous system symptoms and 10 patients complained of ischemic arm symptoms. The remaining 12 patients had both central neurological and upper extremity complaints. Twenty-one of these patients were followed for up to 5 years (mean follow-up 21 months). One patient died during the procedure from myocardial infarction (mortality of 3.03%). Patency of the bypass was determined by palpation of the graft pulse, doppler examination, and brachial arterial pressure determination. The patency rate, after 5 years, calculated by life table analysis, was 72%. In conclusion, axillo-axillary artery bypass can provide durable relief of symptoms with an acceptably high patency rate and low morbidity and mortality. It is the technique of choice in high-risk patients.

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Experience with arterial substitutes in the construction of vascular access for hemodialysis.

Thirty autogenous saphenous vein grafts, 91 modified bovine heterografts and 96 PTFE grafts were used in the construction of vascular access for hemodialysis. The indication for the use of an arterial substitute was the unavailability of suitable artery or vein for the construction of a standard subcutaneous arteriovenous fistula. Ten of these grafts were placed in the lower extremity while the rest were placed in either the forearm or upper arm. All three types of grafts provided an immediate satisfactory solution to a difficult problem. When compared in terms of longterm patency, the autogenous saphenous vein proved to be inferior to either the modified bovine heterograft or the PTFE graft. Comparing all three grafts, the PTFE graft is currently our vascular substitute of choice for patients requiring grafts for arteriovenous fistulas for hemodialysis.

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