Search PubMed⌕ Search

Biomedical subjects

A D Chant

Publications and source records attributed to A D Chant.

At least 55 records · Page 3Linked to original sources
PubMed1989

Phaeochromocytoma and abdominal aneurysm: confirmation of diagnosis after aortic surgery using mIBG imaging.

Four cases of dissecting thoracic aneurysm associated with phaeochromocytoma have been reported in the World literature, of which only one survived surgery. We report what we believe to be the first case of intra-adrenal phaeochromocytoma presenting as a leaking abdominal aneurysm; which is of further interest as post-reconstruction 131-I meta-Iodobenzylguanidine (mIBG) imaging confirmed the existence of the tumour, despite equivocal urinary metanephrines.

3-Iodobenzylguanidine↗
PubMed1989

Limitations of percutaneous transluminal angioplasty in the treatment of femoro-distal graft stenoses.

Non-invasive follow-up of 94 femoro-distal reconstructions has identified 14 graft related stenoses (4 proximal anastomotic, 4 intragraft and 7 distal anastomotic). Stenoses treated by percutaneous transluminal angioplasty (PTA) recurred by 6 months. Stenoses treated by surgical revision remained satisfactory with a mean follow-up of 13 months. In this series, formal surgical revision appears to be superior to PTA for the treatment of graft stenoses.

Aged↗
PubMed1988

Inflow site: its effect on femoropopliteal and distal graft patency.

In a series of 245 vein grafts, results of 163 from the common femoral artery were compared with 82 from the proximal superficial femoral artery. Groups were comparable for risk factors, except that significantly more of the superficial femoral artery group were anastomosed to a single calf vessel (P less than 0.02). Early technical failure was similar in both groups (14 per cent common femoral artery, 12 per cent superficial femoral artery, P = n.s.). Cumulative life table patency rates at 1 and 3 years were 77 per cent and 72 per cent in common femoral artery grafts, and 80 per cent and 70 per cent in superficial femoral artery grafts (P = n.s.). Analysis of 92 veins in situ (65 common femoral artery and 27 superficial femoral artery) showed 1-year patency rates of 75 per cent in common femoral artery grafts and 79 per cent in superficial femoral artery grafts (P = n.s.). These results suggest that the proximal superficial femoral artery is a safe inflow site for distal bypasses.

Adult↗
PubMed1988

Early experience with B mode ultrasound mapping of the long saphenous vein prior to femorodistal bypass.

B mode ultrasound was used to assess and map the long saphenous vein in 20 limbs prior to femorodistal bypass. The assessment was compared with operative findings. Eighteen of 19 adequate veins and 8 of 9 anatomical abnormalities or major divisions were correctly identified. B mode ultrasound allows accurate marking of the vein, facilitating dissection, alerts the surgeon to possible difficulties and is an ideal non-invasive technique for preoperative assessment of the long saphenous vein.

Aged↗
PubMed1987

Random control trial of a short course of aspirin and dipyridamole (Persantin) for femorodistal grafts.

The effect of a short course of anti-platelet agents, started preoperatively, on the patency of femorodistal bypass grafts is unknown. One hundred and forty-eight such grafts were randomized to act as controls or to receive dipyridamole 200 mg b.d. for 48 h pre-operatively and dipyridamole 200 mg b.d. with aspirin 300 mg daily for 6 weeks after surgery. Patients were well-matched and the mean pre-operative pressure index of 0.37 rose to 0.78 during the first postoperative week. No deaths were attributable to the treatment. Ninety-three grafts were autogenous vein and the remainder were prosthetic (GORE-TEX (PTFE), human umbilical vein or externally supported Dacron). At 1 year autogenous vein cumulative patency was 75 per cent. Overall results showed higher patency in the treated group (P = 0.012) which was entirely accounted for by the difference between prosthetic dipyridamole and aspirin group (85 per cent patency) and prosthetic control groups (53 per cent patency, P = 0.005) and arose during the first postoperative month. There were 11 deaths and 8 amputations in the dipyridamole and aspirin group and 8 deaths and 12 amputations in the control group. It is concluded that a six week perioperative course of dipyridamole and aspirin allows the patency of prosthetic femorodistal bypass to approach that of autogenous vein, and the regimen therefore is recommended for patients who may require a prosthetic graft.

Aspirin↗
PubMed1987

Salvage autotransfusion in aortic surgery: initial studies using a disposable reservoir.

Transmission of disease by allogeneic transfusion can be avoided using several techniques by which a patient receives his own blood. Sixty patients undergoing aortic surgery consented to salvage interoperative autotransfusion. A mean of 895 ml shed blood was reinfused under full heparinization, representing 12-74 per cent of total blood loss. Bank blood requirements fell from 4.9 units to 3.4. No important haematological or clinical complications were noted (including coagulation studies) but haemolysis was detected 4 h postoperatively by plasma haemoglobin levels of 0.05 +/- 0.03 g/dl. This preliminary study confirms the applicability of salvage autotransfusion during elective vascular surgery by demonstrating an appreciable saving in bank blood transfusion (70 per cent).

Aorta↗
PubMed1987

Duplex ultrasound monitoring of arterial grafts: prospective evaluation in conjunction with ankle pressure indices after femorodistal bypass.

Duplex scanning and ankle brachial pressure indices have been used to objectively assess 94 femoro-distal bypass grafts 4-8 weeks postoperatively. Twenty grafts were occluded. Of the 74 patent grafts, three distinct groups could be identified on the basis of the non-invasive examination. Group 1. Patent grafts with no evidence of haemodynamically significant disease. Group 2. Patent grafts with localised disease. Group 3. Patent: haemodynamically failed grafts. Ankle brachial pressure indices alone could not differentiate between occluded grafts and grafts that were patent: haemodynamically failed (group 3), or adequately separate between grafts in groups 1 and 2. Duplex scanning when combined with pressure indices identified patent grafts "at risk" due to the presence of haemodynamically significant disease. Life table analysis demonstrated appreciable differences in event free survival between group 1 grafts and "at risk" grafts (groups 2 and 3). Duplex scanning is ideal for regular postoperative surveillance and complements the use of ankle brachial pressure indices in the follow-up of femoro-distal grafts.

Actuarial Analysis↗
PubMed1987

Duplex ultrasound assessment of femorodistal grafts: correlation with angiography.

Fifty-eight grafts have been assessed using duplex scanning and ankle brachial pressure indices. This assessment is compared with the findings by angiography. Eighteen grafts were occluded and 40 patent. Duplex scanning defined graft status with a greater accuracy than pressure indices. Pressure indices alone would not differentiate "satisfactory" grafts from those with localised, haemodynamically significant disease. Only 55% of those grafts with localised stenoses demonstrated a fall of greater than 0.2 in ankle brachial pressure index after exercise. When the information obtained using pressure indices and duplex scanning was combined non-invasive assessment had a sensitivity of 86% and specificity of 94% for detection of localised, haemodynamically significant disease in patent grafts. Haemodynamically significant disease, as defined by angiography, can be detected and localised with duplex scanning complementing the use of pressure indices in graft assessment.

Aged↗
PubMed1987

The success of in situ vein grafting: early results in comparison with the reversed vein technique.

In a 6-year retrospective analysis of 341 consecutive femorodistal autogenous vein bypasses, results from 104 in situ veins (IS) were compared with 209 reversed veins (RV). The groups were comparable for age, sex, diabetes, indication for surgery and calf vessel run-off, but a significantly higher proportion of the in situ group had a lower distal anastomosis (16% IS, 6% RV, chi 2 = 7.1 P less than 0.01). Overall, operative mortality was 2% and early graft failure was similar in both groups (11% IS, 12% RV, P = NS). Cumulative graft patency rates were 74% IS, 79% RV at one year and 71% IS, 71% RV (P = NS) at three years. Cumulative limb survival rates were 81% IS, 85% RV at one year and 79% IS, 81% RV [P = NS) at 3 years. These results demonstrate that the in situ technique has been used in a wider variety of patients and yielded similar early and intermediate term results to reversed vein.

Adult↗