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Biomedical subjects

P M Levin

Publications and source records attributed to P M Levin.

33 records · Page 2Linked to original sources
PubMed1988

Anastomotic false aneurysms of the abdominal aorta and the iliac arteries.

Anastomotic false aneurysm (AFA) of the aorta or iliac artery is a potentially lethal complication of prosthetic grafts. To study this complication, the records of 18 patients with 22 noninfected AFAs (15 aortic and seven iliac) were reviewed. Patients with an intact AFA had a pulsatile abdominal mass, abdominal pain, an occluded graft, peripheral emboli, or a femoral anastomotic false aneurysm. All patients with a ruptured AFA were in shock, but 67% (four of six) had symptoms before hemorrhage. For diagnosis, single-plane angiography was 69% accurate (11 of 16), computed tomography was 100% accurate (six of six), and ultrasound was used once and suggested an AFA. Three patients with an AFA less than 5 cm diameter were initially observed; however, all three aneurysms rapidly enlarged and one ruptured. The operative mortality rate was 8% (1 of 12) for patients with an intact aneurysm and 67% (four of six) for patients with a ruptured aneurysm. Treatment was resection of the AFA and replacement with a new graft. Retroperitoneal AFAs often appear years after the initial operation, and life-long follow-up is required for patients with an aortic or iliac graft. All retroperitoneal AFAs should be resected since the outcome of patients with a ruptured AFA is poor.

Aged↗
PubMed1982

Aneurysmectomy in the octogenarian. A study of morbidity and quality of survival.

The records of 52 octogenarians who underwent resection of an abdominal aortic aneurysm were reviewed. Thirty-five elective operations were performed with an operative mortality of 8.6 percent, which was twice that of the group less than 80 years of age. Seventeen emergency operations were performed for rupture with an operative mortality of 58.8 percent. Postoperative follow-up in the elective group found that by 6 months 93 percent of surviving patients had returned to their preoperative status. Survival rates by life table analysis were 67 percent at 1 year, 52 percent at 3 years, and 14 percent at 5 years. In the ruptured group, all patients at risk were alive at 1, 3, and 5 years. We advise elective resection of an abdominal aortic aneurysm in the octogenarian with good functional capacity using the same criteria that we use for younger patients. Most octogenarians can anticipate a prompt return to their usual environment and a meaningful postoperative life-style.

Aged↗
PubMed1981

Management of postoperative stroke after carotid endarterectomy.

Major postoperative stroke after carotid endarterectomy is often due to carotid thrombosis, and prompt thrombectomy can reverse the neurologic deficit. We advise reoperation providing the stroke occurs within several hours of carotid endarterectomy, preferably when the patient is in the recovery room, and reoperation can be done immediately. We do not delay reoperation for angiography. Reoperation has not been beneficial for strokes that occur later in the patient's course or when there has been a severe preoperative neurologic deficit. Patients with a mild postoperative stroke, especially if the stroke represents worsening of a preoperative deficit, will often improve without intervention.

Carotid Arteries↗
PubMed1979

Carotid bruit: a follow-up report on its significance in patients undergoing an abdominal aortic operation.

The records of 516 patients who underwent an elective abdominal aortic operation for aneurysmal or occlusive disease are reviewed. Four patients operated on twice are considered an individual patient for each operation. Excluding 27 patients who had a prior carotid endarterectomy, there were 84 with a carotid bruit. Thirty-six patients without a carotid bruit had experienced an episode of cerebral ischemia. Four patients had a postoperative stroke. There was no correlation between the stroke and presence of a carotid bruit or history of cerebral ischemic symptoms. We do not challenge the validity of prophylactic carotid endarterectomy but question if the need for an abdominal aortic operation should be considered indication for carotid angiography and surgery in patients with a carotid bruit.

Adult↗
PubMed1977

Ipsilateral blindness: a complication of carotid endarterectomy.

We report on three patients in whom ipsilateral blindness developed following carotid endarterectomy. Fundoscopic examination of the retina documented ischemia and the visual field defects were permanent. In one patient, the internal carotid artery was patent and thought to be the conduit for embolization to the eye. Two patients had chronic occlusion of the internal carotid artery, and blindness resulted from atheromatous emboli to the eye through the external carotid artery in one and from postoperative thrombosis of the external cartoid artery in the other. Our experience calls attention to this infrequently reported complication of carotid endarterectomy and emphasizes the importance of the external carotid artery, especially when the internal carotid artery is occluded.

Aged↗
PubMed1976

Delayed vein repositioning. A procedure for improving inadequate radial-cephalic arteriovenous fistulas.

Patients undergoing hemodialysis, whose radial-cephalic arteriovenous fistulas (RCAVFs) were unsatisfactory because of poor accessibility, were treated by surgical repositioning of the full length of arterialized cephalic vein in the forearm. Marked improvement in accessibility for more than one year was achieved in 15 of 18 delayed venous repositioning operations. This procedure is recommended for improving certain types of inadequate RCAVF.

Adult↗
PubMed1975

Ruptured abdominal aortic aneurysms. Surgical treatment.

The records of 62 consecutive patients with ruptured abdominal aortic aneurysms were analyzed to determine what factors contribute to lower mortality. Survival was directly related to the immediate preoperative hemodynamic status of the patients. In 18 cases in which operation was carried out with patients stable, 83 percent of the patients survived. Even if shock was present by the time of operation (37 cases), a 68 percent survival rate was achieved. Cardiac arrest occurred before obtaining aortic control in seven patients and one survived. Survival rates were increased if certain preoperative, operative and postoperative guidelines were followed. Since the combined operative mortality and late graft failure rate in 125 elective aneurysmectomies done during the same decade was under 5 percent, all abdominal aortic aneurysms with few exceptions should be surgically treated before rupture occurs.

Aged↗
PubMed1975

Bovine heterografts for hemodialysis.

Long-term results with 52 bovine, 53 saphenous vein and 78 radial-cephalic arteriovenous fistulas (AVF) were analyzed. Side-to-end radial-cephalic AVF provided the best patency data, and remain the preferred access system for hemodialysis. Bovine AVF were next in ranking with better patency rates than for the saphenous vein AVF studied. Corrected one-year patency rates were 71 percent for bovine, 45 percent for saphenous and 91 percent for radial-cephalic AVF. The incidence of nonthrombotic complications with bovine AVF was higher than with saphenous vein AVF. Distal ischemia due to "steal" and certain bleeding and wound complications were unique to bovine AVF. Excellent dialysis blood flow rates and easy accessibility were provided by bovine grafts. When a satisfactory radial-cephalic AVF cannot be created, bovine graft AVF is an acceptable alternative for hemodialysis access.

Adult↗