The incidence of postoperative graft stenosis and need for revision varies with bypass grafting technique. Reversed vein bypasses and grafts modified at operation may be more prone than in situ vein bypass grafts to develop stenosis and thus require intensive surveillance. Infrainguinal vein graft failure and the need for revision may be reduced by the adoption of bypass grafting techniques that include valve lysis and intraoperative duplex scan assessment.
Hurricane Georges (category 2) struck Key West, Florida, on September 25, 1998. Lower Florida Keys Hospital, which serves Key West and the Lower Keys, had previously been evacuated of inpatients and staff. An emergency response team composed of three emergency medicine (EM) physicians and four EM nurses was sent at the request of the state to maintain emergency department (ED) operations at the hospital. Eighty-six patients presented to the ED during the 72-hour period. Medical problems accounted for the majority of visits (52.3%), with minor trauma next (41.9%). Initially, patients requiring hospitalization were evacuated, but as the storm neared, this was stopped. Six patients required hospitalization at Lower Florida Keys Hospital during the period that evacuations were unavailable. Four deaths occurred during the 24-hour period. Complicating factors included environmental conditions, limited laboratory and radiologic studies, limited medication stocks, and closure of local pharmacies before and after the hurricane. More than 300 nursing home patients were housed at the nearby jail shelter. Knowledge of such high-risk groups that remain in the vicinity is crucial to planning a response plan.
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