SEARCH · PubMed Health

Results for “Reconstruction”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,063 records · Page 59Linked to original sources

PubMed1994

Autologous breast reconstruction with use of transverse rectus abdominis musculocutaneous flap: Mayo clinic experience with 147 cases.

OBJECTIVE: To assess the results of transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions of the breast. DESIGN: We retrospectively reviewed 147 consecutive cases of TRAM reconstructions of the breast performed at the Mayo Clinic between 1981 and 1992. MATERIAL AND METHODS: The median patient age was 47 years, and the median duration of follow-up was 29 months. In 25 patients, both rectus pedicles were used, 15 of those for bilateral reconstruction. The other 122 patients had unipedicled unilateral reconstruction. Only 9% of the breast reconstructions were immediate. Analysis of risk factors in the patient population revealed smoking in 16%, preoperative irradiation of the chest wall in 20%, preoperative chemotherapy in 27%, and both radiotherapy and chemotherapy in 12%. RESULTS: The mean overall operative time was 4 hours and 43 minutes (4 hours and 20 minutes for unipedicled flaps and 5 hours and 46 minutes for bipedicled reconstructions). No blood transfusion was needed in 47% of patients; of those who received transfusions, 78% required 2 units or less. In 58 of the 147 patients (39%), an operation was performed on the contralateral breast. Follow-up operations were necessary in 71% of patients. The overall frequency of complications was as follows: hernia that necessitated surgical repair, 7.5%; full TRAM ischemic loss, 3.7%; partial TRAM loss, 9.9%; and fat necrosis, 11.7%. No pattern of increased complications was noted in subgroups of patients who smoked or who had received preoperative irradiation, chemotherapy, or both. In comparison with our early cases, the last 50 TRAM procedures were generally associated with fewer complications. The rates of occurrence of complications in our series of patients were similar to those reported in the literature. CONCLUSION: The TRAM flap provides satisfactory results for reconstruction of the breast.

Aged↗

PubMed2003

Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. A new and innovative procedure.

BONE--PATELLAR TENDON: The "no hardware" technique for ACL reconstruction is a new method that offers many advantages and is straightforward to perform. Its main innovative feature is that it does not require bone-block harvesting from the patella. This reduces donor site morbidity and prevents patellar fractures. The bone tunnels are made using tube harvesters and compaction drilling. This minimizes trauma and obviates the risk of bone necrosis. The articular entrance of the tibial tunnel is completely occupied by the grafts. This prevents a windshield-wiper effect and synovial fluid ingress into the tunnel, and enhances graft incorporation. The fact that no hardware is used with both patellar tendon or hamstring grafts significantly reduces the overall cost of the operation and facilitates revision surgery. The quadriceps tendon is also a very good graft. It is thick and has good biomechanical properties and low donor site morbidity. Its disadvantages are: weakness of quadriceps after the operation, an unsightly scar, and some difficulty in graft harvesting [58]. Also, postoperative MRI is not fraught with the problem of metal artifacts. It is difficult to decide which of the methods currently available for ACL reconstruction is the best because most of them give satisfactory results. In the future, assessments of knee ligament reconstruction techniques should look at long-term stability combined with low complication rates. Ease of revision surgery and low cost should also be taken into consideration, given the large annual volume of knee ligament reconstructions (50,000 in the United States alone) [59]. We believe that our technique addresses most of these issues, and that it constitutes a useful alternative method for ACL reconstruction. SEMITENDINOSUS--GRACILIS: This technique, which was used with 915 patients from June 1998 to February 2002, shows a particularly low rate of postoperative morbidity. The reason is probably to be found in the "waterproofing" of the bone tunnels, which lead to less postoperative bleeding and swelling. No drains were used. Rehabilitation follows the same protocol as used for the reconstruction using patellar tendon grafts (accelerated/functional). As expected, there was no widening of the femoral tunnels and little widening of the tibial tunnels. Interestingly, tibial tunnel enlargement was significantly less in a nonaccelarated rehabilitation group than in the accelerated group [60] without affecting stability. The measured internal torque of the hamstrings, as well as their flexion force, already had returned to normal 12 months postoperatively. In a prospective randomized (unpublished) study comparing this technique with ACL reconstruction with BPT grafts with medial or lateral third with only one bone plug (from the tibial tuberosity, see technique described above), we found no significant difference between both groups in subjective scores, stability, KT-1000 values, Tegner activity score, and IKDC at 1-year follow-up. Only the results of kneeling and knee walking testing were significantly better in the hamstring group [61]. In summary, the advantages of this presented technique are: (1) the knot of the graft is close proximally to the anatomic site of the insertion of the ACL, thus avoiding the Bungee effect.; (2) the press-fit tunnel fixation prevents synovial fluid entering the bone tunnels, windshield-wiper effect, and longitudinal motion within the tunnel; the intensive contact between the bony wall of the tunnel and graft collagen over a long distance without any suture material results in quick and complete graft incorporation; and (3) no fixation material means no hardware problems, facilitates revision surgery, and lowers overall costs.

Anterior Cruciate Ligament↗

PubMed2003

Hepatic artery reconstruction prior to orthotopic liver transplantation.

BACKGROUND: This study examines the types of arterial reconstruction for grafts prepared for orthotopic transplantation procedures. METHODS: Between 1993 and February 2003, 200 organs were harvested for orthotopic liver transplantation. Arterial variations were found in 28 cases (14%), among which 16 cases (8%) required vascular reconstruction with 4 cases due to accidentally damaged during liver harvesting. RESULTS: Among the 200 organs harvested for liver transplantation, arterial variations requiring reconstruction were found in 12 cases (6%); these included: replacing an accessory left hepatic artery from the left gastric artery (9/1 reconstruction); replacing an accessory left hepatic artery from the upper mesenteric artery (2/1 reconstruction), and replacing an accessory right hepatic artery from the upper mesenteric artery (10/10 reconstructions). The splenic artery was typically used for anastomosis (seven cases, 58.3%) as well as the gastroduodenal artery (two cases, 16.7%) or the right gastric artery (one case, 8.3%). In the remaining two cases, a more complex technique was required. CONCLUSIONS: Reconstruction of graft vessels before an orthotopic liver transplantation procedure does not increase the risk of vascular complications.

Hepatectomy↗

PubMed2000

Penile reconstruction combined with bladder closure in the management of classic bladder exstrophy: illustration of technique.

OBJECTIVES: Interest has increased in combining procedures during reconstruction of bladder exstrophy in an effort to reduce the number of procedures required for reconstruction and to improve results. This study illustrates our technique of reconstruction and summarizes our current experience with the combination of epispadias repair and bladder closure during initial reconstruction or following prior failed bladder closure. METHODS: Twenty-four boys with classic bladder exstrophy underwent combined bladder closure and epispadias repair. The mean patient age was 20 months, and 18 boys had a prior failed closure. Osteotomies were performed in all patients. RESULTS: No instances of bladder prolapse or dehiscence were noted on follow-up. Urethrocutaneous fistula developed in 7 patients. Eventual bladder neck reconstruction has been performed in 11 boys (6 boys are dry day and night, 3 are dry during the day with occasional wet episodes at night, 2 have required follow-up bladder augmentation and continent diversion for persistent incontinence), and 1 boy had augmentation at the same time as bladder neck reconstruction. Twelve boys are awaiting adequate capacity for bladder neck reconstruction, and 1 is awaiting bladder augmentation and continent stoma construction. CONCLUSIONS: Epispadias closure can be safely combined with bladder closure in select patients with classic bladder exstrophy. Complication rates and cosmesis approximate that achieved with staging the two procedures. This achievement represents strict patient selection and attentive follow-up.

Abnormalities, Multiple↗

PubMed1998

Evaluation of intraocular foreign bodies by spiral computed tomography and multiplanar reconstruction.

OBJECTIVE: This study aimed to evaluate the ability of spiral computed tomography (CT) and multiplanar reconstruction in the assessment of intraocular foreign bodies. DESIGN: The study design was experimental. MATERIAL: Three foreign bodies (metal, glass, and plastic) implanted into the globe of a cadaveric head were studied. INTERVENTION: Spiral CT in the axial plane was used. Beam collimation and table increment were both 3 mm, whereby overlapping axial slices were reconstructed at 1-mm intervals. The data were transferred to a workstation, and reconstructions in the coronal and sagittal plane were performed. MAIN OUTCOME MEASURES: The ability to detect and evaluate localization, shape, and size of the foreign bodies in all three imaging planes was assessed. RESULTS: All foreign bodies were detected in the axial and in both reconstructed planes. The metal foreign body caused imaging artifacts in the axial plane. In the reconstructed planes. imaging artifacts were less severe, and evaluation of localization and shape was improved. Glass and plastic foreign bodies were well seen in all planes, and shape and localization were well demonstrated. Appropriate window settings improved determination of size of the different foreign bodies. CONCLUSIONS: Spiral CT of the orbit and multiplanar reconstruction offers a promising tool for evaluation of intraocular foreign bodies. Advantages of spiral CT compared to conventional CT are data acquisition in only one axial plane; shortened examination time; reduced radiation exposure; reduced imaging artifacts from metallic foreign bodies in the reconstructed planes; and demonstration of localization, shape, and size of the foreign body in three imaging planes.

Eye Foreign Bodies↗

PubMed1997

A simple method for 3D lesion reconstruction from two projected angiographic images: implementation to a stereotactic radiotherapy treatment planning system.

INTRODUCTION: The most used imaging modality for diagnosis and localisation of arteriovenous malformations (AVMs) treated with stereotactic radiotherapy is angiography. The fact that the angiographic images are projected images imposes the need of the 3D reconstruction of the lesion. This, together with the 3D head anatomy from CT images could provide all the necessary information for stereotactic treatment planning. We have developed a method to combine the complementary information provided by angiography and 2D computerized tomography, matching the reconstructed AVM structure with the reconstructed head of the patient. MATERIALS AND METHODS: The ISIS treatment planning system, developed at Institute Curie, has been used for image acquisition, stereotactic localisation and 3D visualisation. A series of CT slices are introduced in the system as well as two orthogonal angiographic projected images of the lesion. A simple computer program has been developed for the 3D reconstruction of the lesion and for the superposition of the target contour on the CT slices of the head. RESULTS AND CONCLUSIONS: In our approach we consider that the reconstruction can be made if the AVM is approximated with a number of adjacent ellipses. We assessed the method comparing the values of the reconstructed and the actual volumes of the target using linear regression analysis. For treatment planning purposes we overlapped the reconstructed AVM on the CT slices of the head. The above feature is to our knowledge a feature that the majority of the commercial stereotactic radiotherapy treatment planning system could not provide. The implementation of the method into ISIS TPS shows that we can reliably approximate and visualize the target volume.

Cerebral Angiography↗

PubMed2001

Spatial reconstruction of human motion by means of a single camera and a biomechanical model.

The value of the results of the inverse dynamic analysis procedures used in the study of human tasks is dependent on the quality of the kinematic and kinetic data supplied to the biomechanical model that supports it. The kinematic data, containing the position, velocity and acceleration of all anatomical segments of the biomechanical model, result from the reconstruction of human spatial motion by means of the evaluation of the anatomic points positions that enable to uniquely define the position of all anatomical segments. Furthermore, the motion data must be kinematically consistent with the structure of the biomechanical model used in the analysis. The traditional photogrammetric methodologies used for the spatial reconstruction of the human motion require images of two or more calibrated and synchronized cameras. This is due to the fact that the projection of each anatomical point is described by two linear equations relating its three spatial coordinates with the two coordinates of the projected point. The need for the image of another camera arises from the fact that a third equation is necessary to find the original spatial position of the anatomical point. The methodology proposed here substitutes the projection equations of the second camera with the kinematic constraint equations associated with a biomechanical model in the motion reconstruction process. In the formulation the system of equations arising from the point projections and biomechanical model kinematic constraints, representing the constant length of the anatomical segments, are solved simultaneously. Because the system of equations has multiple solutions for each image, a strategy based on the minimization of a cost function associated to the smoothness of the reconstructed motion is devised. It is shown how the process is implemented computationally avoiding any operator intervention during the motion reconstruction for a given time period. This leads to an automated computer procedure that ensures the uniqueness of the reconstructed motion. The result of the reconstruction process is a set of data that is kinematically consistent with the biomechanical model used. Through applications of the proposed methodology to several sports exercises its benefits and shortcomings are discussed.

Biomechanical Phenomena↗

PubMed2002

Loading response following anterior cruciate ligament reconstruction during the parallel squat exercise.

OBJECTIVE: To determine if individuals 1.5-15 months post-anterior cruciate ligament reconstruction demonstrated an equal loading response on their involved and uninvolved lower extremity during a parallel squat exercise versus a control group. DESIGN: Four-group repeated measures design with one between-subject factor (time post-anterior cruciate ligament reconstruction) and two within-subject factors (knee angle and added weight). BACKGROUND: It has been a clinical observation that post-anterior cruciate ligament reconstruction, individuals do not place equal amounts of weight upon each lower extremity during double-leg exercises. METHODS: Twenty-four subjects were in each of the experimental groups, 1.5-4 months, 6-7 months, and 12-15 months post-anterior cruciate ligament reconstruction, while 24 subjects without history of lower extremity pathology/injury served as the control group. Pedar in-shoe sensors were placed inside the subjects' shoes to record loading response patterns during the exercises. All performed 3 sets of 9 randomized squats to each of the three knee flexion angles (30 degrees, 60 degrees, and 90 degrees ) with the three different weights (20.45 kg bar only, 35%, and 50% body mass) using a Smith squat rack. A three-way repeated measures ANOVA (P < 0.050) was used to compare the differences between groups in loading response statically between the uninvolved and involved lower extremity for each of the different weights at each knee flexion angle during the squat exercise. RESULTS: The three-way repeated measures ANOVA revealed that there was a significant group effect (P < 0.001). Thus, the amount of time post-anterior cruciate ligament reconstruction affected the difference in the subjects' loading response for the uninvolved and involved lower extremities. There was also a three-way interaction, indicating that the difference in loading response was dependent on the group, amount of knee flexion, and amount of added weight (P = 0.010). CONCLUSION: These data suggest that subjects significantly load their uninvolved lower extremity until 12-15 months post-anterior cruciate ligament reconstruction. RELEVANCE: Based on the results of this study, caution may be warranted when adding resistance during the parallel squat for an individual's first year post-anterior cruciate ligament reconstruction, particularly with less knee flexion to avoid compensation and injury.

Adult↗

PubMed2003

The temporal fasciocutaneous island flap for oncologic oral and facial reconstruction.

PURPOSE: This study reports the anatomy, operative technique, and postoperative results of the temporal fasciocutaneous island flap (TFCIF), as used for facial and intraoral reconstruction. MATERIALS AND METHODS: Retrospective study of 15 patients who underwent TFCIF reconstruction. The anatomic basis and surgical technique are described. The flap was used for mucosal reconstruction after cheek or maxillary resection. It was used for facial tissue loss in 2 cases: orbital osteoradionecrosis and exposure of a mandibular reconstruction plate. RESULTS: This technique provides a safe and rapid solution for intraoral reconstruction; however, it cannot be used for the anterior floor of the mouth. The best indication that we have found is the reconstruction of hemimaxillectomy, allowing closure of buccosinusonasal communication and prosthetic rehabilitation. The main disavantage is that hair regrowth limits its use to patients who need postoperative radiotherapy. Donor site morbidity is minimal. Only a partial failure was observed. CONCLUSION: The TFCIF is a rapid, safe, and useful flap for oral and facial reconstruction after oncologic resection. Its arc of rotation limits, however, its use to the posterior part of the oral cavity.

Carcinoma, Squamous Cell↗

PubMed1997

A comparison of vascularized and nonvascularized bone grafts for reconstruction of mandibular continuity defects.

PURPOSE: This study compared vascularized and nonvascularized bone grafts for the reconstruction of segmental defects of the mandible. PATIENTS AND METHODS: The results in 39 patients having vascularized bone grafts (38 fibulas and one iliac crest) and 29 patients having nonvascularized bone grafts (26 iliac crest [22 corticocancellous block grafts, four cancellous bone grafts in a tray] and three rib grafts) for segmental mandibular reconstruction were evaluated in terms of overall success rate, total number of surgeries performed, total blood loss, total number of hospital days, and total number of hours in the operating room. RESULTS: Of 39 vascularized bone grafts, two failed (95% success rate), whereas of 29 nonvascularized bone grafts, seven failed (76% success rate). Failure for the nonvascularized bone grafts was closely correlated to the length of the defect. Nonvascularized bone graft patients underwent an average of one more surgical procedure for total reconstruction than vascularized bone graft patients, including osseointegrated implants. However, vascularized bone graft patients spent a mean of over 14 additional days in the hospital for all of their reconstructive procedures and an additional 3 hours in the operating room as compared with nonvascularized bone graft patients. Blood loss was similar in both groups (1,100 mL). Only 20% to 24% of patients in each treatment group have completed reconstruction to include osseointegrated implants. CONCLUSIONS: The success rate for vascularized bone grafting is high and is the treatment of choice when primary reconstruction is required, when the patient has been previously irradiated, or when simultaneous replacement of soft tissue is required. Vascularized bone grafts are also the treatment of choice for mandibular replacements over 9 cm in length. Nonvascularized bone grafts create a better contour and bone volume for facial esthetics and subsequent implant insertion, and may be the treatment of choice for secondary reconstruction of defects less than 9 cm in length.

Adolescent↗

PubMed1998

Comparison of fixation strengths of locking head and conventional screws, in fracture and reconstruction models.

PURPOSE: Claimed clinical advantages of the locking-head mandibular reconstruction plating system include the ability to achieve stability with fewer numbers of screws per bony segment as compared with conventional screws. The purpose of this study was to test the hypothesis that increased resistance to displacement will be obtained when using locking-head as compared with the same number of conventional screws per segment in both fracture and reconstruction models. MATERIALS AND METHODS: Eight groups were tested based on the screw number (two or four), screw type (locking-head or conventional), and fracture (bony apposition) or reconstruction model (1-cm defect). Two-dimensional beam mechanics using adult bovine ribs and the Instron machine were used to develop a load-displacement curve up to 150 N for each specimen. An osteotomy was then created and the segments were reduced, with preload (fracture model) or with a 1-cm defect (reconstruction model), and plated using the Synthes locking-head plate with either two or four bicortical locking-head (4.0-mm) or conventional (2.7-mm) screws per segment. The fixed ribs were loaded to 150 N, and the displacement was recorded. RESULTS: Locking-head screws provided superior resistance when using two screws per segment in the reconstruction model as compared with conventional screws. Minimal difference was seen between other screw types within a model. The fracture model offered significantly greater (3.1 to 3.7X) resistance to displacement than did the reconstruction model. CONCLUSIONS: Locking-head screws provided significantly increased resistance to displacement when only two screws per segment were used in the reconstruction model. When four screws per segment were used, there was no significant difference between locking-head and conventional screw types in either model. The effect of bony buttressing is significant and may explain why miniplates often fail in the atrophic mandible but are successful in the fully dentate patient.

Animals↗

PubMed2003

[Complete chest wall reconstruction after en bloc excisions with Gore-Tex/Marlex/Flap sandwich. A retrospective study of 14 cases].

To assess the results of surgical resection and chest wall reconstruction we reviewed our experience with the complete chest wall reconstruction after en bloc excisions according to an original algorithm based on the location of the thoracic defect. The 14 reconstructions were performed by the senior author. We found 5 central, 6 lateral and 3 borders locations. In the central locations with a total resection of the sternum the reconstruction was realized by Gore-tex's mesh in depth, metal hooks (staples) and Marlex's mesh under a musculocutaneous flap of coverage. In case of lateral location the reconstruction was realized by Gore-tex's mesh covered with a musculocutaneous flap, the borders locations were reconstructed by Marlex's mesh and flap of coverage. The histological diagnoses were: one desmoid tumor, eight sarcomas, a recurrence of hepatocarcinoma and four recurrences of breast cancer. The superficial coverage performed by latissimus dorsis flap 12 for cases and rectus abdominis flap for two cases. All the patients were able to produce a spontaneous breath after surgery. Two deaths at distance and an infection were to regret. On the whole the algorithm of reconstruction according to the location of the defect allows a simplification of the indications.

Adolescent↗

PubMed2000

Reconstruction and navigation system for intraoperative brachytherapy using the flab technique for colorectal tumor bed irradiation.

PURPOSE: To present the development of a new navigation and reconstruction system based on an electromagnetic free-hand tracker and on CT imaging for treatment planning of intraoperative high-dose-rate brachytherapy (IORT-HDRB) in the sacral region. Our aim is to improve accuracy and to enable individualized treatment planning and dose documentation to be performed for IORT-HDRB using a flab technique. METHODS AND MATERIALS: The material consists of an electromagnetic 3D tracker system, a PC workstation with Microsoft Windows NT 4.0 operating system, and a recognition program for continuous speech. In addition, we designed an external reference system constructed of titanium and Perspex, which is positioned in the pelvis, and a special digitizer pen for reconstruction of the flab geometry. The flab design incorporates a series of silicon 10-mm-diameter spherical pellets. Measurements were made with a pelvic phantom in order to study the accuracy of the system. The reconstruction results are stored and can be exported via network or floppy to our different treatment planning systems. RESULTS: Our results for the reconstruction of a flab with six catheters and a total of 100 spherical pellets give mean errors in the range (2.5 +/- 0.6) mm to (3.5 +/- 0.8) mm depending on the positions of the pelvic phantom and transmitter relative to the operation table. These errors are calculated by comparing the reconstruction results of our system with those using a CT-based reconstruction of the flab geometry. For the accuracy of the navigation system for the pelvic phantom, we obtained mean errors in the range (2.2 +/- 0.7) mm to (3. 1 +/- 1.0) mm. CONCLUSIONS: The new system we have developed enables navigation and reconstruction within the surgical environment with a clinically acceptable level of accuracy. It offers the possibility of individualized treatment planning and effective documentation of the 3D dose distribution in IORT-HDRB using a flab technique.

Brachytherapy↗

PubMed1989

A mechanical study of six digital pulley reconstruction techniques: Part I. Mechanical effectiveness.

A laboratory study on fresh-frozen human cadaver limbs compared six types of flexor tendon pulley reconstruction in the fingers. The reconstructions used were those described by (1) Bunnell, (2) Karev, (3) Weilby, and (4) Lister, and two types developed by us that have not been previously described. The pulleys were studied in specific configurations to determine their effectiveness in transforming tendon excursion into finger flexion. In each finger, comparison was made between the amount of tendon excursion required for full flexion with an intact pulley system versus the various types of reconstructed pulleys. The ratio of these two values was defined as the mechanical effectiveness of the pulley reconstruction. The Karve reconstruction was most effective at 108.2%, which was significantly different from the other five reconstructions (p less than 0.01). The remaining reconstructions ranged in effectiveness from 80.0% to 88.5%.

Aged↗

PubMed1985

Reconstruction of the carotid artery in radical neck dissection.

No permanent cure of head-and-neck cancer can be expected when the cancer infiltrates into the wall of the carotid artery. When the carotid artery was resected, the resultant hemiplegia poses very difficult postoperative rehabilitation problems, even though the cancer is eradicated. The recent development of vascular surgery has made reconstruction of the carotid artery feasible. In this paper, the authors reported the indications of reconstruction of the carotid artery in radical neck dissections and the surgical procedures. The indication of reconstruction of the carotid artery is determined by using of angiography, CT-scan and echography. Especially, echography is useful for determining the possibility of reconstructing the carotid artery. In the case of the infiltration type, we can start to remove tumor after preparing for the reconstruction of the carotid artery. The principle of surgical procedures consists of by-pass shunt with a vascular graft between the common and internal carotid arteries, excision of the artery with tumor and insertion of a vascular graft with end-to-end anatomoses. Concerning the selection of a vascular graft, an auto-vein graft is preferable to a synthetic graft in consideration of the postoperative patency of the vascular flow. Moreover, in the case of reconstructing the artery, preoperative irradiation has often been applied and a wide removal of the soft tissue is required, so it is recommended that the myocutaneous flap be used to cover the reconstructed area.

Blood Vessel Prosthesis↗

PubMed1995

Spinal cord protection during thoracoabdominal aortic aneurysm repair: results of selective reconstruction of the critical segmental arteries guided by evoked spinal cord potential monitoring.

PURPOSE: The purpose of this study is to evaluate the results of spinal cord protection based on selective reconstruction of the segmental arteries. METHODS: Twenty-one patients who underwent repair of aneurysms (nine descending thoracic and 12 thoracoabdominal: three type I, six type II, and three type III) were analyzed. Ten patients had postdissection aneurysms. Operative techniques consisted of evoked spinal cord potential (ESP-dsc) monitoring and femorofemoral bypass in all cases, segmental resection in 12, and mild systemic hypothermia in eight. Arteries critical for cord blood flow were selectively reconstructed; if ESP-dsc showed change after resection of an aortic segment, arteries originating from this segment were reconstructed. RESULTS: ESP-dsc change was observed in 12 patients. Arteries found to be critical were at the T8-L1 level in all but three cases. Selective reconstruction was performed in 10 of these 12 patients. ESP-dsc change could be reversed before reconstruction in four cases, three by control of back-bleeding critical arteries. Selective reconstruction resulted in return of ESP-dsc in seven other patients. Spinal cord injury occurred in five patients, two of whom did not undergo selective reconstruction. CONCLUSION: These results suggest that our current technique allows determination of critical arteries but does not completely prevent injury.

Adult↗

PubMed1997

Geometric dimension changes with carotid endarterectomy reconstruction.

PURPOSE: The geometry of carotid endarterectomy (CEA) reconstruction is a major determinant of carotid bifurcation hemodynamics that, in turn, may play a significant role in the likelihood of early postoperative thrombosis and early and late restenosis. The purpose of this study was to measure the geometry of various types of CEA reconstructions. METHODS: Six carotid artery diameters and lengths were measured during surgery, before and after CEA. Three reconstruction methods were used in 562 CEA procedures: a greater saphenous vein patch in 389, a synthetic patch in 157, and primary closure in 16. Veins 6 mm or more in distended diameter were trimmed before use as a patch. Synthetic patches were 8 to 11 mm in width. Patch reconstruction was used when the length of the arteriotomy required to obtain a complete distal endarterectomy end point extended beyond the internal carotid artery bulb. Saphenous vein patches were used when it was available and adequate. Neither gender nor internal carotid artery diameter was used as a criteria for the selection of the reconstruction method. RESULTS: Before endarterectomy, the 302 male carotid arteries had 7% to 15% greater linear dimensions than the 260 female arteries (p < 0.001). Both vein and synthetic patch reconstruction produced up to 16% changes in linear dimensions except for almost doubling of the length of the internal carotid bulb. Patching made the elliptical common carotid bulb significantly more round, but the maximum diameter of curvature of the carotid bulb remained unchanged. Primary closure slightly decreased the diameter of the internal carotid bulb. CONCLUSIONS: CEA patch reconstruction has two major effects on carotid geometry: an increase in internal carotid bulb length and a more round common carotid bulb. The former allows for a gradual transition from the terminal common carotid bulb to the uniform diameter more distal internal carotid artery. It also separates the two major causes of disturbed flow: the bifurcation and the step-down in internal carotid artery diameter. Primary closure has minimal effect on preoperative geometry.

Carotid Artery, Common↗

PubMed1999

Infrainguinal arterial reconstruction for claudication: is it worth the risk? An analysis of 409 procedures.

PURPOSE: Infrainguinal reconstruction traditionally has been reserved for patients with limb-threatening ischemia. Surgery for debilitating claudication, however, has been discouraged as a result of the perceived fear of bypass graft failure, limb loss, and significant perioperative complications that may be worse than the natural history of the disease. In this study, the results of infrainguinal reconstructions for claudication performed during the past 10 years were evaluated for bypass graft patency, limb loss, and long-term survival rates. METHODS: Data were collected and reviewed from the vascular registry, the office charts, and the hospital records for patients who underwent infrainguinal bypass grafting for claudication. RESULTS: From 1987 to 1997, 409 infrainguinal reconstructions were performed for claudication (9% of all infrainguinal reconstructions in our unit). The patient population had the following demographics: 73% men, 28% with diabetes, 54% smokers, and an average age of 64 years (range, 24 to 91 years). Inflow was from the following arteries: iliac artery/graft, 10%; common femoral artery, 52%; superficial femoral artery, 19%; profunda femoris artery, 16%; and popliteal artery, 2%. The outflow vessels were the following arteries: 165 above-knee popliteal arteries (40%), 150 below-knee popliteal arteries (37%), and 94 tibial vessels (23%). The operative mortality rate was 0%, and one limb was lost in the series from distal embolization. The primary patency rates were 62%, 77%, and 86% for above-knee popliteal artery, below-knee popliteal artery, and tibial vessel reconstructions at 4 years, and the secondary patency rates were 64%, 81%, and 90%, respectively. Cumulative patient survival rates were 93% and 80% at 4 and 6 years as compared with 65% and 52%, respectively, for infrainguinal reconstructions performed for limb salvage. CONCLUSION: Infrainguinal arterial reconstruction for disabling claudication is a safe and durable procedure in selected patients. These data indicate that concern for limb loss, death, and limited life span of the patients with this disease may not be warranted.

Adult↗