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P Rudondy

Publications and source records attributed to P Rudondy.

13 recordsLinked to original sources
PubMed1992

[Place of the right gastro-epiploic artery in coronary revascularization by exclusive arterial grafts].

From March 1990 to July 1991, 35 patients underwent coronary artery bypass grafts using the right gastro-epiploic artery (GEA). Twenty-nine patients had exclusively arterial grafts using a combination of GEA and internal mammary artery (IMA) in situ. The selection criteria for this group of 29 patients included a life expectancy exceeding ten years to avoid the need for reoperation due to deterioration of the grafts. This group consisted of 27 men and two women under the age of 70 years (mean age: 58 years, range: 36 to 70), 11 patients (38%) were under the age of 50 years and 15 (52%) were under the age of 60 years. Cardiac status was relatively well preserved. The mean ejection fraction was 58% (range: 25-70%). Fourteen patients (48%) had had a preoperative myocardial infarction. Fifty-five p. cent were smokers, 41% suffered from HT and 31% had a dyslipidaemia. Six patients (20%) had respiratory failure, 6 others (20%) were severely overweight and 2 patients were diabetic. According to the NYHA classification, 14 patients (48%) were stage IV, 9 patients (31%) were stage III and 6 patients (20%) were stage II. The mean number of bypass grafts per patient was 2.8 and 8 sequential bypass grafts (27%) were performed. The GEA was used in 29 cases, the left IMA was used in 28 cases, the right IMA was used in 13 cases and the epigastric artery was used as a free graft in 3 cases. Associated lesions included a resected left ventricular aneurysm. No associated valve procedures were performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Secondary aortoduodenal fistulas: value of initial axillofemoral bypass.

Between January 1970 and April 1989, 20 patients underwent operation for secondary aortoduodenal fistulas. When the preoperative diagnosis was certain and emergency control of bleeding not required, initial axillofemoral bypass was performed before ablation of the infected aortic prosthetic graft during the same operation. When diagnosis was uncertain or severity of bleeding required emergency laparotomy, the therapeutic plan varied over time. Until 1980, we performed either a direct repair (three cases) or the ablation of the aortic graft followed by secondary axillofemoral bypass (four cases). After 1980, the order of procedures was 1) control of bleeding whenever necessary, 2) axillofemoral bypass, and 3) ablation of the aortic graft. Postoperative mortality was two of 13 in patients undergoing initial axillofemoral bypass, compared with six of seven patients undergoing direct surgery or initial ablation of the aortic graft. Of the 12 patients surviving the postoperative period, three died of aortic stump hemorrhage, four, 12, and 14 months after operation. Two patients had a new aortic graft inserted. Repeat replacement of the abdominal aorta graft was performed in one case and ascending thoracic aortobifemoral bypass in the other because of secondary thrombosis of the axillofemoral bypass. We conclude that initial axillofemoral bypass before dealing with the aortic graft improves the immediate prognosis in operations for secondary aortoduodenal fistulas. This procedure does not, however, preclude the possibility of aortic stump infection which can lead to recurrent aortoduodenal fistula. The risk of infection or secondary occlusion of axillofemoral bypass is minimal. Secondary prosthetic replacement is not systematically necessary.

Aged↗
PubMed1991

Descending thoracic aorta as an inflow source for late occlusive failures following aortoiliac reconstruction.

From November 1984 to March 1990, 10 descending thoracic aorta-to-femoral artery bypass procedures were performed after failure of one or several aortoiliofemoral reconstructions. All patients were men, mean age 60 years. Indications included noninfected false aneurysm of an infrarenal end-to-side aortoprosthetic anastomosis in one case; one occlusion of an axillofemoral bypass; degradation of an aortobifemoral prosthetic graft; two occlusions of aortofemoral bypass; and five occlusions of aortobiliac or aortobifemoral bypasses. Eight bifurcated grafts, one aortoprosthetic tube graft, and one aortopopliteal tube graft were inserted. One patient died 23 days postoperatively of multiple organ failure. Three patients underwent a successful seconary lower limb reconstruction procedure (prosthetic limb thrombectomy, embolectomy, femoral bifurcation angioplasty in one case each). Mean survival time was 14 months (range 3-48 months). Two patients were lost to follow-up, and one died of myocardial infarction six months postoperatively with a patent bypass. Graft thrombosis occurred in two patients. One was treated by thrombectomy at five months, the other was treated by in-situ thrombolysis at 15 months. Both of these patients had patent grafts at 12 and 21 months, respectively. The four other patients had patent grafts at 48 months. Primary patency was 55.5% (5/9 survivors) and secondary patency was 100% (9/9). This is a relatively simple method for constructing an extraanatomic aortofemoral or aortobifemoral bypass in late failures of aortoiliofemoral reconstructive surgery without having to re-enter the abdomen.

Aged↗
PubMed1991

[Revascularization of the distal portion of the deep femoral artery. Indications and results].

Most of the times, the distal part of the deep femoral artery is not affected by atheromatous disease. It constitutes an acceptable alternative, whenever the femoral bifurcation is not usable for bypass. This artery is readily approached directly, at a point removed from Scarpa's fascia. We used this technique on 60 patients. Indications included: multiple reoperations (45 cases, 75%), infection of Scarpa's fascia (2 cases, 3%), calcified or thrombosed femoral bifurcation (13 cases, 22%). Lim salvage for decubital pain, grade-IV or acute ischemic disease involved 49 cases (82%). After a mean 28.5 month follow-up period, arterial permeability was 74% and 53% after one year and 5 years, respectively. These results are compared with literature data. Long-term permeability is related to two factors: proximal bypass implantation site and the state of the popliteal reentry and arterial network of the leg. Utilization of the distal segment of the deep femoral artery via an elective approach is interesting of the deep femoral artery via an elective approach is interesting and sensible, whenever the femoral bifurcation is unusable owing to progressive atheromatous disease, repeated surgery or infection.

Adult↗
PubMed1990

The albumin-coated knitted Dacron aortic prosthesis: a clinical study.

Between June 1987 and January 1989, a total of 123 albumin-coated, knitted Dacron aortic prosthetic grafts were used in 120 patients. The aim of this study was to determine the degree of graft impermeability to blood as well as short- and medium-term patency of the graft material. Patients were grouped as follows: group I (64 patients), operation for chronic aortoiliac obliteration; group II (45 patients), operation for abdominal aortic aneurysm; group III (14 patients), operation on the thoracic aorta. Ninety-one bifurcated and 32 albumin-coated grafts were inserted. Abnormal bleeding was seen in five cases but did not lead to any adverse clinical consequences and stopped spontaneously. In group I there were two instances of early thromboses thought to be due to hemodynamic compromise, which were successfully treated surgically. In group III, two patients had early thrombosis due to coagulation disorders. These were treated by thrombectomy and medical therapy. One hundred and fourteen patients (95%) were followed for a mean of 8.2 months (range 1-18 months). Three late complications related to the prosthesis were observed: one patient had a false aneurysm occurring at month 14 and was corrected surgically. Two other patients experienced thrombosis of their graft treated by extraanatomical bypasses. Primary patency at the end of the follow-up period was 93% while secondary patency was 98%. There were no early or late infectious complications. We conclude that albumin-coated Dacron prosthesis is a reliable material for aortic replacement. Intraoperative loss of blood is reduced and short- and medium-term patency is comparable to those of uncoated aortic prosthetic material.

Adult↗
PubMed1990

[Justifications and benefits of exploratory thoracotomy in stage IIIb bronchopulmonary cancer].

From January 1980 to December 1984, 270 patients underwent exploratory surgery for Non Small Cell Lung Cancer with or without peritumoral lymph node involvement. In group 1: for 167 patients (62%) unresectable cancer was found. In group 2: for 103 patients (38%) an extensive resection was feasible. This study allows comparison of these two groups and confirms the value of exploratory thoracotomy. The resection was extended to the superior vena cava in 12% of cases, the trachea and carina in 28.15% and the left atrium in 49.50%. Survival in group 1 was similar to that of non operated patients (i.e. less than 10% at one year) and the mortality was 1.2% with no operative mortality. Survival of group 2 was considerably better: 58% at 1 year, 26% at 3 years, 23% at 5 years. The mortality was 3.9% with no operative mortality. Three year survival of patients with T4 N0 was clearly higher than that of T4 N2 (38% versus 17%). Although the results were poor for patients with N3 disease and those who underwent incomplete resections, they were nonetheless better than in those patients with unresectable tumors (16% versus 9% at 18 months). We conclude that: exploratory thoracotomy is safe, a significant number of patients (38% in our series) may benefit from this approach, and that it is sometimes hazardous to contra-indicate surgery for patients suffering from lung cancer only on the basis of X-Ray findings.

Carcinoma, Bronchogenic↗
PubMed1988

Unfastening of an Adams-de Weese clip: an uncommon cause of recurrent pulmonary embolism after interruption of the inferior vena cava.

Recurrent pulmonary embolism after placement of a caval clip is uncommon. We report the case of a patient admitted for recurrent venous thrombosis of the lower limbs, 11 years after placement of an Adams-de Weese clip. Severe pulmonary embolism occurred in spite of anticoagulant treatment. After an unsuccessful attempt to insert a Greenfield filter, surgery was performed. The clip was found to have come unfastened; simple repeat closure was performed. We were unable to find any similar reports in the literature. In spite of its rarity, this cause should be considered when faced with recurrent pulmonary embolism in patients having undergone inferior vena caval clipping.

Constriction↗
PubMedDate not supplied

Stroke prevention during carotid surgery in high risk patients (value of transcranial Doppler and local anesthesia).

In a series of 114 cases, carotid surgery was performed under local anesthesia by cervical block in order to assess cerebral status. Preoperative transcranial Doppler was used to select high risk patients for shunting. Intraoperatively brain function was checked by carotid arterial blood pressure monitoring and transcranial Doppler. No stroke occurred during the procedure. Postoperatively two deaths (1.8%) occurred, one due to intracerebral hemorrhage and one to a late myocardial infarct. The predictive value of both transcranial Doppler and stump pressure monitoring for shunting was 97% respectively. In combination, the two methods provided 100% protection. During the same period, 1406 patients underwent carotid surgery under general anesthesia. Carotid surgery stroke can be prevented either by using transcranial Doppler together with carotid stump pressure monitoring when the procedure is performed under general anesthesia or by operating under local anesthesia.

Aged↗
PubMedDate not supplied

Long-term peripheral stent evaluation using angioscopy.

To evaluate incorporation of peripheral artery stents into the arterial wall, we performed angioscopy on 13 patients fitted with Palmaz endoluminal stents. Of the 15 stents inspected, 5 were in the iliac artery, 9 in the femoral artery and 1 in the popliteal artery. The indications for placement were occlusion in 4 cases and high-grade stenosis in 11 cases including 3 restenosis after balloon dilatation and 1 restenosis after surgery. In 9 cases prosthesis insertion was preceded by laser treatment (Trimedyne Nd:YAG Cardiolase 4000). The decision to use a stent was based on radiologic findings in 3 cases (residual stenoses, dissections) and on angioscopic visualization in 7 cases (2 dissections, 5 flaps). In the remaining cases stent placement was performed electively. The only postoperative treatment was antiplatelet therapy (Ticlopidin). At the time of examination, the mean duration of placement was 6 months (extremes: 2 and 12 months). Inspection was made using Sopro-Meadox angioscope with a 0.75 mm probe mounted on an occlusive balloon for stents in the iliac artery and with a 2.2 mm probe with a working channel and sometimes a deflecting device for stents in the femoral or popliteal artery. Angioscopy was successful in all cases. Angiography was always performed at the same time as endoscopy. Endothelialization was observed in all cases. It appeared as a uniform and smooth whitish layer with a thickness proportional to the duration of placement. Endothelialization was most rapid in femoropopliteal arteries, total coverage being achieved within 4 months. Endothelialization took the longest on medial side of the iliac artery which may remain partially exposed after 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Vessel Prosthesis↗
PubMedDate not supplied

Carotid surgery under cervical block anesthesia. A simple method of heart and brain protection in high risk patients.

Between January 1, 1985, and December 15, 1987, 60 patients underwent surgery for carotid lesions under local cervical block anesthesia. Sixty-seven reconstruction procedures were performed including 64 endarterectomies and 3 vein bypasses. During the same 3 year period, 938 other reconstruction procedures were carried out under general anesthesia for a total of 1005 procedures. These 60 patients, who accounted for 6.7% of our indications, were selected for surgery under local anesthesia because they were at high risk for cardiac and neurologic complications. As far as staging is concerned, this subgroup of patients included: 14 asymptomatic cases (stage 0), i.e., 21%; 44 transient ischemic attacks (stage I), i.e., 66%; 2 progressive stroke (stage II), i.e., 3%; 7 patients with neurologic sequels (stage III), i.e., 10%. In all 79% of the patients were symptomatic. The asymptomatic patients all presented bilateral tight stenosis sometimes with thrombosis of the contralateral carotid. The technique of local anesthesia and endarterectomy were classic: closing with a bougie to calibrate the lumen, systematic intraoperative arteriography and immediate correction of technical failures (2 times); no death occurred among the patients in stages 0, 1 and II; 1 early asymptomatic occlusion that was not corrected was noted; in one case, a ligation of the carotid was necessary after technical failure, without consequences; one death occurred in stage III after intracerebral hemorrhage. On the basis of our experience local cervical block anesthesia appears to be a simple and reliable method of ensuring intraoperative diagnosis of cerebral ischemia. It eliminates all intraoperative cerebral complications secondary to ischemia and allows a better understanding of the physiopathologic mechanisms underlying perioperative neurologic complications. The absence of neurologic and cardiac complications in this series of very high risk patients enables us to extend eligibility for surgery to include patients with unstable cardiac and cerebral disease.

Aged↗