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  • 1
    ISSN: 1615-5947
    Keywords: Arteriography, transfemoral ; cardiac catheterization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Complications of transfemoral arteriography requiring surgery are rare but carry significant morbidity. To evaluate clinical factors that might relate to such complications, we retrospectively reviewed our experience from January 1, 1985, to December 31, 1988 (four years). Forty-seven complications requiring surgery occurred among 10,589 cases. The risk was higher after cardiac catheterization than after peripheral arteriography (0.55% versus 0.17%, p〈0.025). In nearly 40% of these cases, arterial puncture was not in the common femoral artery. Acute bleeding complications were more likely among patients with puncture outside the common femoral artery (p〈0.001). Older patients and women were at slightly higher risk for complications requiring surgery, but this difference was not statistically significant. The frequency of bleeding complications was not significantly higher among patients who were anticoagulated following the procedure. The distribution of puncture sites was identical in obese and nonobese patients. Three patients died (two from myocardial infarction, one from multisystem organ failure). Two limbs did not improve; one required major amputation. Four limbs had persistent paresthesia and two had persistent weakness. We conclude that complications of transfemoral arteriography requiring surgery occur more frequently among patients who are undergoing cardiac catheterization and who suffer aberrant punctures. Age, sex, body habitus, and anticoagulation have less impact on patient risk.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1615-5947
    Keywords: Gangrene ; femoropopliteal bypass ; infrainguinal bypass ; limb salvage ; infection ; femorotibial bypass ; atherosclerosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To determine the features of a successful clinical strategy, we analyzed the results of 100 consecutive lower extremity vascular reconstructions performedexclusively for tissue loss and gangrene of the legs and feet. Eighty patients underwent 100 procedures on 80 limbs. Follow-up was 95% complete (every six months, mean 2.2 years). Forty inflow procedures to the femoral artery were performed with 13 simultaneous infrainguinal bypasses. Sixty bypasses were performed from the femoral artery to the popliteal (25) or tibial arteries (35). Sixty-eight percent of the identified ulcerations healed, and limb salvage was achieved in 70% of patients by life-table analysis. The cumulative patency for all reconstructions was 48% (five years), for tibial bypasses 60% (four years). Femoropoliteal bypasses had the poorest patency and healing rates (〈40%), while combined inflow-outflow procedures and femorotibial bypasses had the highest rates of healing (77%, 66%). There were two operative deaths, three graft infections, seven wound infections, and 12 acute graft thromboses. Vascular reconstructions for extensive tissue loss or gangrene can be performed with a morbidity and mortality comparable to procedures performed for less severe disease with a high rate of limb salvage. The long term success of surgical therapy depends primarily on the most direct revascularization of ischemic, infected tissues, using autologous conduits whenever possible.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From 1990 to 1992 there was a 43% increase in the number of carotid endarterectomies (CEAs) performed at our institution. Not coincidentally the North American Symptomatic Carotid Endarterectomy Trial study was published in August 1991. To determine whether CEAs could be performed safely at community medical centers, records of 181 consecutive CEAs performed during a 30-month period at a suburban community medical center were reviewed. CEAs were performed by 14 surgeons: six vascular, three thoracic, and five general surgeons. Among all patients 87% had lesions with ≥70% stenosis. Seventy percent of CEAs were performed on symptomatic patients, 84% of whom had stenoses ≥70%. Among asymptomatic patients 96% had stenoses ≥70%. There were five instances of neurologic complications in the perioperative period—two transient ischemic attacks, two reversible ischemic neurologic deficits, and one permanent neurologic deficit. One patient died. The mortality rate was 0.6%, the combined major stroke/mortality rate was 1.2%, and the any stroke/mortality rate was 2.2%. There were five patients with nonfatal major complications — one with myocardial infarction, one with pulmonary edema, one with congestive heart failure, and two with postoperative arrhythmia. Thirteen minor complications included eight cases of cranial nerve dysfunction. These data demonstrate that CEAs can be performed safely at community medical centers.
    Type of Medium: Electronic Resource
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