No abstract

The operative mortality rate for abdominal aortic aneurysm resection remains high (20% to 66%) for high-risk patients. The high-risk factors are severe cardiac, respiratory, and renal insufficiency and morbid obesity. Those advocating the alternative nonresective treatment of aneurysm thrombosis and axillofemoral bypass grafts have reduced the operative mortality rate to between 0% and 7%. However, in a collective series of 87 patients, there was a mortality rate of 10.3% in the patients with aortic aneurysms treated by the nonresective method and an incidence of reoperation for complications of axillofemoral graft of 31.0%. Many of these patients had subsequent operations and/or radiologic procedures to complete the process of aneurysm thrombosis (23.0%). Because there is an increasing trend toward this method of treatment, we reviewed our experience with the conventional aneurysm resection in a similar group of patients. Of 105 consecutive patients, 19 qualified as high risk. One patient died, resulting in an operative mortality rate of 5.2%. Cerebral, cardiac, and renal morbidity was transient and subsequent operations were not required. Eighteen patients were discharged as well. In the remaining 86 patients, one died, resulting in an operative mortality rate of 1.2%. The mortality rate for the entire series was 1.9%. Indications for the nonresective treatment appear to be increasing by the addition of other risk factors. This trend is of concern. We believe that there are limited indications for the treatment of aortic aneurysms without resection. However, the procedure should not be offered lightly as an alternative form of treatment.

No abstract

Successful long-term central venous access is a complex subject. The concept of "long term" implies that continued surveillance will be required. This also requires the catheter to be placed, initially, in its best configuration. To achieve long-term performance and durability, a thorough understanding of all aspects related to the catheter, catheter placement, and catheter maintenance is essential.

No abstract