Biomedical subjects

M Kazmers

Publications and source records attributed to M Kazmers.

3 recordsLinked to original sources

PubMed1980

Anastomotic arterial aneurysms. A continuing challenge.

Aneurysms occurring at the site of arterial reconstruction continue to pose a challenge to surgical ingenuity. Our experience with the surgical treatment of 29 nontraumatic anastomotic aneurysms (AA) in 24 patients is analyzed. Twenty-two aneurysms presented in the femoral region. Dacron((R)) grafts and braided Dacron sutures had been used in 70 and 86% of AA, respectively. Immediate or late reoperation had been necessary 14 times in eight patients. Average time elapsed between the initial procedure and AA repair was 65 months. Indications for repair were expansion/rupture (nine patients), graft occlusions (12 patients), aortoenteric fistula (two patients) and presence of AA (six patients). The predominant operative finding was suture line dehisence due to an attenuated arterial wall (13 patients), problems with suture material (three patients), infection (two patients), and indeterminate (13 patients). The majority of the aneurysms (20) were partially excised and arterial limbs revascularized with interposition Dacron grafts, usually to the profunda femoris artery. Two of three postoperative deaths ensued in patients with aortoenteric fistulas. Omission of silk suture material has not eliminated AA and indeed, braided synthetic suture material had been used in most of the original procedures. A significant number of AA sites had had multiple reoperations. Operative findings suggested structural degeneration of the native artery as an important etiologic factor. Important technical principles in uninfected AA include: early control of inflow and outflow vessels, avoidance of dissection of the entire AA, and interposition of a new Dacron graft to the outflow vessel. No immediate limb loss and no recurrences occurred with this approach, with a maximum follow-up period of 72 months. Early elective repair of most AA is emphasized to avoid graft occlusion and potential technical mishaps associated with repair of large aneurysms.

Aged↗

PubMed1980

Amputation level following unsuccessful distal limb salvage operations.

Distal arterial grafting for limb salvage remains controversial. Among the criticisms is the potential adverse effect of failed distal bypass on subsequent amputation level. Measurement of popliteal pressure with Doppler ultrasound is useful in predicting healing at the below-knee (BK) level and, pressure of greater than or equal to 60 mm Hg was associated with 87% BK healing in 51 limbs undergoing amputation without prior distal bypass. This study examined the outcome in 40 limbs amputated after unsuccessful distal revascularization and compared the final amputation level with that predicted by popliteal pressure measurements obtained prior to bypass. Forty limbs underwent amputation after unsuccessful limb salvage following attempted femoropopliteal grafts (13), femorotibial grafts (10), a combination of both procedures (10) or tibial artery exploration alone (7). Of 33 limbs with initial pressure of greater than or equal to 60 mm Hg, eventual healing at the BK level was achieved in only 17 (52%). Four of seven limbs with initial pressures of less than 60 mm Hg healed at the BK level, and increased popliteal pressure prior to amputation was shown in three of these. Of the total 40 limbs, only 21 (53%) obtained final healing at the BK level. These results indicate that unsuccessful limb salvage attempts adversely affected ultimate amputation level in limbs initially considered to be candidates for BK amputation.

Adult↗

PubMed1976

The role of thoracic aortic occlusion for massive hemoperitoneum.

Forty patients with abdominal injury and massive hemoperitoneum had left thoracotomy and thoracic aortic occlusion. All 40 patients had tense abdominal distention and 37 patients were hypotensive at the time of skin incision despite aggressive resuscitation with blood and crystalloid solution. Laparotomy was performed initially in 11 patients; seven patients had sudden cardiovascular collapse as the abdominal wall tamponade was released and four patients remained hypotensive. With thoracotomy and thoracic aortic occlusion six of the 11 patients were resuscitated and had their injuries repaired. Thoracotomy and thoracic aortic occlusion were performed before laparotomy in 29 patients: seven patients remained hypotensive and expired; blood pressure was promptly restored in 22 patients and 11 of them survived the operative procedure. Left thoracotomy and thoracic aortic occlusion, before laparotomy, is offered as an alternative approach in patients with refractory hypotension and tense, abdominal distention. This technique aids in rapid restoration of vital signs, insures continued perfusion of the brain and myocardium, provides proximal arterial control, and prevents sudden cardiac arrest as the abdominal wall tamponade is released.

Abdominal Injuries↗