Aortic aneurysm rupture after extracorporeal shock wave lithotripsy.
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Aged↗
Biomedical subjects
M K Lazarides
Publications and source records attributed to M K Lazarides.
Factors affecting the lifespan of autologous and synthetic arteriovenous access routes for haemodialysis.
OBJECTIVE: To try and establish a consensus about the ideal secondary access for haemodialysis by assessing factors that affect the longevity of various access routes. DESIGN: Multicentre survey, by questionnaire. SETTING: General hospital, Athens. SUBJECTS: All 1516 patients in the Athens area receiving chronic haemodialysis. MAIN OUTCOME MEASURES: Longevity of present and any previous access routes (n = 2323). Data including type of access, age, sex and the existence of diabetes, hypertension, hyperlipidaemia, or other systematic diseases were recorded. RESULTS: Some 1220 (80%) of the patients were using autologous access, 1049 (69%) arteriovenous (AV) fistulas at wrist and 171 (11%) at elbow. Variables were analysed using Cox's proportional hazard model. Age and female sex were significantly associated with failure of autogenous access (p < 0.001) although not affecting synthetic grafts. Autogenous fistula at the elbow was the only secondary access that was less likely to fail than the initial (baseline) fistula at the wrist. Among the various grafts, straight arm grafts had the best prognosis and straight forearm grafts were the most likely to fail (p < 0.001). CONCLUSION: An AV fistula at the elbow should be considered the second best after the fistula at wrist, but is not always feasible. A synthetic graft is more likely to be needed in elderly patients and women, in whom an autogenous AV fistula is more likely to fail.
Age Factors↗
Popliteal artery and trifurcation injuries: is it possible to predict the outcome?
The records of 18 consecutive patients with popliteal and/or trifurcation civilian arterial injuries, who underwent revascularisation procedures during a 5-year period, were retrospectively assessed. All patients were classified using four, previously described, severity scoring systems in an effort to investigate the accuracy of predicting the outcome of this type of injury. Classification of the severity of popliteal artery trauma would be useful (a) for setting objective criteria (if any) for primary amputation and (b) for retrospective assessment of the results in vascular audit. The amputation rate in this group was 28%. Limbs which could not be salvaged were all in the "trifurcation" group and in this subset of patients the amputation rate was 71% (5/7). The scoring index having the higher overall accuracy (94%) was the mangled extremity syndrome index (MESI) with a predictive value for amputation of 83%. The use of these indices as criteria for primary amputation needs further evaluation as no scoring system was specific enough to permit primary amputation on that basis alone. The predictive value for limb salvage was 100%, for all four scoring systems enabling their use in vascular trauma audit.
Adult↗
The use of vein valve cutter in reverse brachiocephalic arteriovenous fistula creation.
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Adolescent↗
Iatrogenic arterial trauma associated with hip joint surgery: an overview.
Four cases of iatrogenic arterial injuries following hip surgery are reported. An overview of the literature revealed 122 additional cases. In 93 (74%) of these cases the arterial damage occurred following total hip replacement, 27 (21%) were related to hip fracture correction and six cases complicated other hip surgery procedures. Revisional hip surgery was found to be a definite risk factor. Injuries associated with hip replacement differ significantly in various characteristics of those associated with hip fracture correction. There was a 9% mortality and a 17% permanent disability rate in patients with arterial trauma following total hip replacement. In this group a significantly higher permanent disability rate was noticed in patients who first presented with ischaemia (p less than 0.05). No relationship between the location and mechanism of injury and the outcome was found. Mortality and permanent disability rates of 4% and 11%, respectively, were noticed in patients with injuries related to hip fracture correction.
Adult↗
Iatrogenic and noniatrogenic arterial trauma: a comparative study.
During a 6-year period 22 patients were operated on because of iatrogenic arterial trauma (group A) and 43 sustained noniatrogenic arterial injury (group B). The group A injuries were caused by various arterial catheterization procedures for angiography or cardiac investigation (55%) or surgical interventions (45%). Haemorrhage was more common in group B than in group A (p less than 0.001). The mortality rate did not differ significantly between the groups (14% vs. 9%). Permanent disability was more common in group B (p less than 0.05), due mainly to higher incidence of associated venous, neural, skeletal or visceral injuries. Bypass operations tended to be more often performed in group B than in group A, but the difference was not statistically significant. Retrospective assessment of the appropriateness of technique, made separately by two vascular surgeons, revealed instances of potentially avoidable iatrogenic arterial injury. The rising incidence of iatrogenic arterial trauma may therefore be considered 'reducible'.
Adult↗
Peroneal artery pseudo-aneurysm following blunt injury.
The peroneal artery is injured less frequently than the popliteal and tibial arteries, because of its anatomical relationships. Pseudo-aneurysm of the peroneal artery due to a blunt injury is a rare complication. These injuries are usually occult, but more have been identified with the introduction and increasing use of angiography, following a high clinical suspicion of the trauma team involved. We report a case of peroneal artery false aneurysm following blunt trauma, presented with intermittent haemorrhage. In trauma, isolated peroneal artery pseudo-aneurysms, although rare, may occur. Early diagnosis can be confirmed by angiography and when less-invasive procedures cannot be applied, a posterior approach is an attractive surgical option in the management of proximal peroneal artery traumatic lesions.
Adult↗
Severe facial ischaemia caused by ergotism.
A case of ergotamine induced severe face ischaemia mimicking acute arteritis is presented. The unique clinical picture was due to bilateral involvement of both external carotid arteries. No case of ergotism with such a localization has been previously described in the literature.
Arteritis↗