Journal of Vascular and Endovascular Therapy

Description

Surgical bypass is a safe procedure with negligible mortality and minimal morbidity. It has not lost its relevance and is an appropriate treatment in patients deemed unresectable on peroperative assessment. Success after surgical revascularization of the lower extremities, traditionally defined by graft patency or limb salvage, fails to consider other intuitive measures of importance. The purpose of the study was to construct a more comprehensive definition of clinical success and to identify clinical predictors of failure.

Weight-Bearing

The Victorian Infection Control Surveillance Project (VICSP) is a multicenter collaborative surveillance project established by infection control practitioners. Five public hospitals contributed data for patients undergoing coronary artery bypass graft (CABG) surgery. Each institution used standardized definitions of SSI, risk adjustment, and reporting methodology according to the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. Data on potential risk factors were prospectively collected. We documented aggregate and comparative SSI rates among five Victorian public hospitals performing CABG surgery and defined specific independent risk factors for SSI. VICSP data offer opportunities for targeted interventions to reduce SSI following cardiac surgery. Little information is available on the financial impact of surgical site infections (SSI) after major surgery. In order to calculate the cost of SSI following coronary artery bypass graft surgery (CABGs), a 2-year retrospective case-control study was undertaken at Alfred Hospital, a university-affiliated tertiary referral centre. Nineteen trials were identified. Eight involved a total of just over 1200 patients. Four trials compared bypass surgery with angioplasty (PTA) and one each with thromboendarterectomy, thrombolysis, exercise, and spinal cord stimulation. Four included patients with intermittent claudication (IC) and CLI, two were restricted to claudicants, and two to CLI. Vein grafts were used for distal reconstructions and synthetic prostheses for aortoâ?iliac or ilioâ?femoral bypasses. Six trials included mortality. In general, trial quality was good; blinding was not possible. Patients with critical limb ischemia (CLI) have an increased risk of major amputation. The initial treatment approach for CLI may significantly impact the subsequent risk of major amputation or death. The objective of this study was to describe the initial treatment approaches of patients with CLI and the limb outcomes associated with each approach. Current guidelines recommend revascularization for the majority of patients with CLI, while leaving the method of revascularization to the discretion of the treating physician and care teamCitation10–12. In this study, we describe the outcomes of patients with CLI based on an initial treatment strategy of endovascular intervention, surgical bypass, minor amputation, or conservative management. To address this question, we utilized a large payer database of individuals with commercial and Medicare supplemental insurance to estimate the risk of major amputation or inpatient death based on initial treatment strategy. For those patients undergoing major amputation, the incremental expenditure to the payer per member per month was also estimated.

Cochrane

A ventricular aneurysm developed after myocardial infarction in a 50-year-old man. It was large enough to cause a bizarre configuration of the heart shadow in chest roentgenograms and was found at thoracotomy to measure 10 cm. in diameter. Extracorporeal circulation, employing a bubble diffusion oxygenator and roller-type complete occlusion pumps, was established by inserting one catheter into the common iliac artery through the right common femoral artery and another catheter, with openings at two levels for the superior and inferior venae cavae, through the right common femoral vein. The adherent parietal pericardium was dissected from the surface of the aneurysm, and the aneurysm was then completely excised, with the edges trimmed back to the fuctioning myocardium of the left ventricle. Closure was made with a continuous suture of silk reinforced with interrupted mattress suture of silk, and the suture line was 10 cm. in length. The patient's early postoperative course was moderately complicated by fever, but after this subsided on the third day his recovery was uneventful. He was dismissed from the hospital in ambulatory condition 18 days after operation. Since this initial report, another patient with a similar lesion underwent operation successfully.