Prevention of distal embolism during arterial reconstruction

Starr, David S.; Lawrie, Gerald M.; Morris, George C.

doi:10.1016/0002-9610(79)90293-9

Cited by 31 publications

(2 citation statements)

References 6 publications

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“…Because of significant problems with coagulation, heparin is avoided. Postoperative ischemic complications in the lower limbs are usually embolic in origin and are best avoided by early clamping of the iliac arteries and careful back-flushing and, if necessary, passage of Fogarty catheters prior to restoration of blood flow to the legs [32].…”

Section: Discussionmentioning

confidence: 99%

Progress in the treatment of ruptured abdominal aortic aneurysm

et al. 1980

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This report summarizes the clinical, pathological, and surgical aspects of ruptured abdominal aortic aneurysm. The significant risk of rupture of these aneurysms is well documented. Although large aneurysms are more prone to rupture, the risk of rupture of small aneurysms less than 4 cm in diameter is well established. While most aneurysms are a result of atheroselerosis, a small number are mycotic in origin or secondary to a dissection trauma or previous aortic surgery. Rupture of abdominal aneurysms occurs into the retroperitoneum in about 3/4 of cases, and into the peritoneal cavity in the remainder. Occasionally rupture occurs into the small bowel or the inferior vena cava with fistula formation. The classical clinical features are abdominal or back pain, hypotension, and a pulsatile tender abdominal mass, but in many cases diagnosis has been delayed because of atypical presentations, in particular the absence of hypotension. Successful treatment requires immediate operation with control of the proximal abdominal aorta. Graft replacement is then performed. Avoidance of technical problems is essential, in particular damage to the great veins. Utilizing these principles we have achieved a major reduction in mortality rate in our own experience. In a series of 61 patients, overall mortality was only 14.8%. The causes of death were related to preoperative hypotension causing acute myocardial infarction, renal failure, and respiratory failure. The major factor~ responsible for these improved results were immediate operation with rapid proximal aortic control, avoidance of left thoracotomy, absence of technical errors, and expeditious completion of the surgical procedure. Despite these improved results, emphasis must continue to be placed on prevention of rupture by diagnosis and treatment of the unruptured aneurysm.The purpose of this report is to summarize the clinical, pathological, and surgical aspects of ruptured abdominal aortic aneurysm. The significant risk of rupture of an abdominal aortic aneurysm has been well documented. In the classical study of Estes [1] published in 1950, survival in a group of patients followed without surgical resection was only 18.9% at 5 years; 63.3% of deaths were due to rupture of the aneurysm. More recent reports have confirmed these findings. In a study [2] of 223 patients with abdominal aortic aneurysms that were not operated upon, the survival rate was only 54.3% at 1 year and 17.2% at 5 years, and 35% of all deaths were due to rupture of the aneurysm. In another report of 52 patients followed up without operation until all were dead, 43% of deaths at 1 year were due to rupture of the aneurysm, and by 10 years 52% of the patients had died from rupture [3].The risk of rupture has been related to the size of the aneurysm. Large aneurysms have been observed to rupture mo,'e frequently than small aneurysms. The incidence of rupture of aneurysms over 10 cm in diameter is about 6 times that of aneurysms 4 cm or under in diameter [2,3]. However, even very small aneurysms may ruptu...

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Section: Discussionmentioning

confidence: 99%

Progress in the treatment of ruptured abdominal aortic aneurysm

et al. 1980

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“…Aus diesem Grund sollte das GefaB so friih wie m6glich nach distal mit einer nicht traumatisierenden Klemme verschlossen werden [13]. Gefahr der Embolisierung nicht nur in die Peripherie, sondern auch in das Iliaca-interna-Stromgebiet.…”

Section: Physiologie Der Miinnliehen Sexualfunktionunclassified

Sexualfunktion nach gef��chirurgischen Eingriffen im aorto-iliacalen Bereich ?ursachen und vermeidung von potenzst�rungen

Thetter¹,

Hochstetter

Dongen³

1984

Langenbecks Arch Chiv

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Neurogenic and vasculogenic impotence after aortoiliac reconstruction is an unpleasant problem in vascular surgery. The importance of maintaining or restoring intraoperatively a sufficient hypogastric artery blood flow is emphasized. Postoperative neurogenic sexual disabilities are irreversible and are due to interruption of sympathetic nerve fibers supplying the genital system. Dissecting the terminal aorta and the iliac arteries the hypogastric sympathetic plexus--which descends across the bifurcation--can be easily damaged. This is the cause of the high incidence of failure of ejaculation after aortoiliac surgery. In order to avoid this neurogenic sexual dysfunction a retromesenteric approach to the aortoiliac region is anatomically suggested by A. v. Hochstetter. It enables the exposure of the abdominal aorta and the iliac arteries without disrupting the superior hypogastric plexus and its variants. Respecting the integrity of the sympathetic plexus and a sufficient flow in the internal iliac artery the frequency of postoperative disturbances of erection was reduced from 17% (1199 patients) to 12.3% (570 patients). The incidence of postoperative loss of ejaculation in the same groups of patients decreased from 81% to 20%.

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Diffuse Disseminated Atheroembolism

Coppeto¹

1984

Arch Ophthalmol

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Prevention of distal embolism during arterial reconstruction

Cited by 31 publications

References 6 publications

Progress in the treatment of ruptured abdominal aortic aneurysm

Progress in the treatment of ruptured abdominal aortic aneurysm

Sexualfunktion nach gef��chirurgischen Eingriffen im aorto-iliacalen Bereich ?ursachen und vermeidung von potenzst�rungen

Diffuse Disseminated Atheroembolism

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