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Biomedical subjects

W V Garrett

Publications and source records attributed to W V Garrett.

12 recordsLinked to original sources
PubMed1988

Interruption of the vena cava by means of the Greenfield filter: expanding the indications.

Between 1978 and 1985, 88 patients underwent insertion of the Greenfield vena cava filter. In 21 of the 88 patients (23.9%) the filter was inserted prophylactically. Sixteen of the 21 prophylactic insertions were performed before total joint replacement in patients with a history of venous thromboembolism. Operative morbidity (4.6%) was minor and occurred only early in the series. The operative mortality rate was 4.6%. None of the deaths were related to filter insertion or pulmonary embolism. Follow-up in 65 patients (73.9%) ranged from 1 to 60 months (mean, 16.4 months). Leg edema developed in 9.2% (6/65), stasis ulceration in 3.1% (2/65), caval occlusion in 7.5% (3/40), and recurrent nonfatal embolism in 3.1% (2/65) of the patients. In the patients who received prophylactic filters before total joint replacement, there were no filter-related complications or episodes of pulmonary embolism. This series confirms the safety and effectiveness of the Greenfield filter and suggests that the indications for its use might be liberalized to include prophylactic insertion of the device in certain high-risk patients.

Adult↗
PubMed1988

Dorsal sympathectomy for hyperhidrosis--the posterior paravertebral approach.

Definitive therapy for hyperhidrosis is sympathectomy. The authors have used a posterior approach to perform 36 dorsal sympathectomies for upper extremity hyperhidrosis in 18 patients (12 female, 6 male). All 18 patients suffered from excessive sweating of the upper extremity (17 palmar, 1 axillary) that caused significant psychological and occupational problems. Eleven patients (61.1%) had lower extremity involvement as well. For all 18 patients conservative medical treatment had failed. Bilateral operations were performed, via a posterior extrapleural approach, through the bed of the third rib. All 36 limbs were relieved of excess sweating. There were no deaths and only two minor wound complications. In no patient did Horner's syndrome develop. Long-term follow-up did not reveal any recurrence of hyperhidrosis. Two patients did complain of compensatory hyperhidrosis of the lower extremities. Dorsal sympathectomy was effective in all of the patients with upper extremity hyperhidrosis in this series. The posterior approach is technically simple, allows simultaneous bilateral operations, and is associated with only infrequent minor complications.

Adolescent↗
PubMed1986

Arterial embolectomy: a 34-year experience with 400 cases.

A series of 400 peripheral arterial embolectomies performed in 326 patients over a 34-year period is presented. Operative mortality was 11.0 per cent overall and 10.0 per cent in patients after the introduction and use of Fogarty catheters. The plateau in mortality is related to the association with serious underlying cardiac disease. The amputation rate was 9.5 per cent, with a corresponding 90.5 per cent limb salvage rate. Cardiac disease was the most common cause of emboli and was responsible for the majority of deaths. Mortality was considerably higher in patients with aortic and iliac emboli and in patients with recent myocardial infarcts. Amputation rates were higher with femoral and popliteal emboli and correlated directly with the time delay from onset of symptoms to performance of embolectomy. Higher amputation rates in the second half of the series are related to liberalization of the indications for embolectomy. Prompt operative management of patients with peripheral arterial emboli remains the treatment of choice. Low mortality and amputation rates can be achieved with early embolectomy and routine use of heparin.

Adolescent↗
PubMed1986

Persistent sciatic artery and vein: an unusual case.

Persistent sciatic artery is a rare anomaly that has been reported in 48 patients in the North American literature. No report has contained more than two cases. This article discusses the first reported case of bilateral persistent sciatic arteries in a patient who also has normally developed superficial femoral arteries. This unique situation allowed removal of the superficial femoral artery for a malignant femoral nerve schwannoma without a concomitant reconstructive arterial procedure. A similar anomaly of the venous system permitted the operation to be done without compromising venous outflow.

Adult↗
PubMed1982

Mesenteric vascular problems. A 26-year experience.

Mesenteric vascular problems are infrequent, but may be catastrophic. During a 26-year period, 55 private patients were treated for the following disorders: (1) 12 patients with visceral artery aneurysms, (2) 8 with celiac compression syndrome, (3) 13 with chronic mesenteric ischemia, (4) 12 with acute mesenteric ischemia, and (5) 10 with mesenteric ischemia associated with aortic reconstructions. Splenic artery aneurysms were managed by excision and splenectomy, while celiac and hepatic had excision with graft replacement. Patients with celiac compression syndrome underwent lysis of the celiac artery. Two patients had compression of both celiac and superior mesenteric artery (SMA). One patient required vascular reconstruction of both arteries for residual stenoses. Patients having chronic mesenteric ischemia were treated with bypass grafts, with one death (7.7% mortality) and good long-term results. Those with acute mesenteric ischemia were treated by SMA embolectomy, bowel resection, or both, with a mortality of 67%. When associated with aortic reconstructions, mesenteric ischemia carried a mortality of 100% if bowel infarction occurred after operation, but when prophylactic mesenteric revascularization was performed at the time of aortic surgery, prognosis was greatly improved, with only one death among six patients. An aggressive approach including prompt arteriography with early diagnosis and surgical therapy is advocated for these catastrophic acute mesenteric problems.

Adult↗
PubMed1978

Intraoperative assessment of arterial reconstruction by Doppler ultrasound.

The Doppler ultrasonic velocity detector is a simple, inexpensive and versatile device for intraoperative monitoring of the integrity and hemodynamics result of vascular reconstructive surgical procedures. With this instrument, an ankle-arm systolic pressure index may be obtained before and after aortoiliac and femoral reconstructive surgical procedures. If the ankle pressure index does not increase following aortofemoral bypass and a thromboembolic vascular accident has been ruled out, it is unlikely that the patient will be significantly helped by that procedure alone. The use of a sterile Doppler probe permits qualitative assessment of arterial velocity signals following femoropopliteal bypass, carotid endarterectomy and mesenteric or renal vascular procedures. The Doppler detector may also be used to assess periorbital flow dynamics following carotid endarterectomy. Selective intraoperative arteriography can be based upon the presence of residual flow abnormalities detected by Doppler ultrasound.

Aorta↗
PubMed1978

Aortocaval fistula associated with aneurysm of the abdominal aorta: current management using autotransfusion techniques.

Two patients with aortocaval fistula associated with abdominal aortic aneurysm were managed successfully using a patient care plan which includes proper monitoring of the hemodynamic state, careful dissection of the aneurysm, and return of blood loss by autotransfusion while the patient is fully anticoagulated with heparin. This unusual and serious problem in vascular surgery can be managed in an orderly and controlled fashion using these techniques.

Aged↗
PubMed1977

Doppler ultrasound and supraorbital photoplethysmography for noninvasive screening of carotid occlusive disease.

Doppler ultrasound and supraorbital photoplethysmography were 95 per cent accurate in identifying or excluding significant carotid obstruction in 156 vessels of seventy-six consecutive patients undergoing arteriography. Plethysmography was more sensitive but less specific than Doppler ultrasound. These technics provide simple, rapid, and accurate detection of significant carotid occlusive disease.

Carotid Artery Thrombosis↗