Axillofemoral bypass: a ten-year review.
Wheeler JR, Gregory RT, Synder SO Jr, Gayle RG, Mason MS.
During a ten-year period (1969-1980), 106 grafts were implanted in
the axillofemoral and axillobifemoral positions. This retrospective
study is based on life table analysis of cumulative patency rates in
both axillofemoral and axillobifemoral grafts, with and without
thrombectomy. Dacron grafts were used exclusively from 1969 to 1979,
and PTFE from 1979 to 1980. Cumulative patency for Dacron
axillobifemoral grafts was 97 +/- 3% at 32 months (73 +/- 21% at 42
months). Patency in both unilateral and bifemoral grafts was
significantly increased by thrombectomy. Dacron and PTFE
axillobifemoral graft patency was not significantly different.
Perioperative mortality was 8% in a group of patients whose survival
rate at four years was only 50 +/- 10% from associated disease.
Axillobifemoral grafting presents an alternative to aortoiliac
reconstruction in elderly patients with severe associated disease in
whom the risk of anatomic bypass is prohibitive.
PMID: 6211151 [PubMed - indexed for MEDLINE]
Cholecystectomy concomitant with other
intra-abdominal operations. Assessment of risk.
Kovalcik PJ, Burrell MJ,
Old WL Jr.
In a retrospective study, 1,416 cholecystectomies performed during a
three-year period were reviewed to define the risk of
cholecystectomy when combined with another intra-abdominal
procedure. Group 1, cholecystectomy alone (1,148 patients), with
subsets of cholangiography and/or common bile duct exploration, had
a complication rate of 14.29% and a mortality of 0.52%. Group 2,
primary cholecystectomy combined with secondary intra-abdominal
surgery (214 patients), had a complication rate of 19.63%. Group 3,
primary intra-abdominal surgical procedure with incidental
cholecystectomy (54 patients), had a complication rate of 20.37%.
Mortality for groups 2 and 3 was 2.24%. The rate of nonfatal
complications was increased slightly when a second surgical
procedure was performed (14.29% v 19.78%). Pairing cholecystectomy
with other intra-abdominal surgery is advised only when surgical
exposure is adequate, the patient's condition is satisfactory, and
operating time is not prolonged greatly.
PMID: 6615214 [PubMed - indexed for MEDLINE]
Surgical implications of fibrinolytic
Hurley JJ, Burrell MJ,
Auer AI, Woods JJ Jr, Binnington HB, Hershey FB.
Intraarterial fibrinolytic therapy was used in 37 cases (34
patients) of severe peripheral ischemia. Nineteen patients (56
percent) required surgical intervention (5 amputations and 14
successful reconstructive procedures). Twenty-four patients (71
percent) were significantly improved (average ankle-to-arm index
0.84), whereas only 5 patients (15 percent) lost their limbs. Five
patients were angiographically unchanged with no or slight
improvement in the ankle-to-arm index (0.22 to 0.32) and were
discharged on anticoagulant therapy. One death and two
cerebrovascular accidents occurred. The usefulness of intraarterial
fibrinolytic therapy needs to be evaluated within the total realm of
vascular surgery. It offers options for therapy where previously
none existed. Some situations might be treated equally well with
either intraarterial fibrinolytic therapy or surgery. Finally,
surgery might be required to maintain initial successful results
with intraarterial fibrinolytic therapy or to rescue intraarterial
fibrinolytic therapy failures in striving to achieve superior
results in limb salvage.
PMID: 6507758 [PubMed - indexed for MEDLINE]
Substrate utilization in leg muscle of
men after heat acclimation.
Kirwan JP, Costill DL, Kuipers H,
Fink WJ, Kovaleski JE, Fielding RA.
Eight men were heat acclimated (39.6 degrees C and 29.2% rh) for 8
days to examine changes in substrate utilization. A heat exercise
test (HET), (cycling for 60 min; 50% maximal O2 consumption) was
performed before (UN-HET) and after (ACC-HET) the acclimation
period. Muscle glycogen utilization (67.0 vs. 37.6 mmol/kg wet wt),
respiratory exchange ratio (0.85 +/- 0.002 vs. 0.83 +/- 0.001), and
calculated rate of carbohydrate oxidation (75.15 +/- 1.38 vs. 64.80
+/- 1.52 g/h) were significantly reduced (P less than 0.05) during
the ACC-HET. Significantly lower (P less than 0.05) femoral venous
glucose (15, 30, and 45 min) and lactate (15 min) levels were
observed during the ACC-HET. No differences were observed in plasma
free fatty acid (FFA) and glycerol concentrations or glucose,
lactate and glycerol arteriovenous uptake/release between tests. A
small but significant increase (P less than 0.05) above resting
levels in FFA uptake was observed during the ACC-HET. Leg blood flow
was slightly greater (P greater than 0.05) during the ACC-HET (4.64
+/- 0.13 vs. 4.80 +/- 0.13 l/min). These findings indicate a reduced
use of muscle glycogen following heat acclimation. However, the
decrease is not completely explained by a shift toward greater lipid
oxidation or increased blood flow.
PMID: 3624132 [PubMed - indexed for MEDLINE]