Biomedical subjects

B A Perler

Publications and source records attributed to B A Perler.

77 records · Page 5Linked to original sources

PubMed1982

Aortofemoral graft for multilevel occlusive disease. Predictors of success and need for distal bypass.

Results of aortofemoral reconstruction of 181 consecutive patients with multilevel occlusive disease were reviewed and correlated with possible predictors of outcome. Overall, 74% of patients attained satisfactory relief of ischemic symptoms with proximal operation alone. Forty-six patients (26%) had an unsatisfactory result, 31 (17%) of whom underwent distal bypass grafts. Of 42 variables studied, 12 achieved statistical significance as predictors of outcome, and multivariate analysis identified five factors an independent indicators. Factors documenting hemodynamically significant inflow disease were associated most strongly with a good result. Several noninvasive laboratory variables were found helpful, particularly in assessing the hemodynamic compensation of distal disease. While no single variable reliably indicated the definite need for distal grafting, careful consideration of important factors together with the clinical situation will aid the surgeon in selection of the small group of patients best treated by synchronous aortofemoral and femoropopliteal grafts.

Adult↗

PubMedDate not supplied

Cost-efficacy issues in the treatment of peripheral vascular disease: primary amputation or revascularization for limb-threatening ischemia.

Controlling rising health care costs represents a major challenge to our society. Due to the aging of the population and the increasing number of patients with vascular disease, vascular specialists will be under mounting pressure by the managed care industry to provide the most cost-effective care for these patients. One particular controversy is whether to attempt revascularization in the patient with limb-threatening ischemia or to proceed directly with primary amputation. Although it has been assumed that the operative risk for revascularization procedures is high in elderly patients with a severely ischemic limb, mortality rates in the sickest patients are actually higher for amputation. It is also incorrect to assume that the duration of hospitalization is shorter for patients undergoing amputation than for patients undergoing revascularization. For both types of procedures, it is complications that prolong the length of hospital stay, and the rate of secondary amputation following a revascularization attempt is low (8.5%), compared with the rate of operative revision in patients following primary below-knee amputation (23%). The costs for revascularization and primary amputation are similar when the costs of a prosthesis and rehabilitative therapy are included in the calculations for amputation. The rationale for primary amputation assumes that patients will ambulate successfully with a prosthesis; however, many do not, and thus costs for institutionalization must be included in the equation. Long-term costs following revascularization were $28,374 in patients with a viable limb, compared with $56,809 in those undergoing secondary revascularization. The key to minimizing health care costs in this population is careful patient selection for initial revascularization, with aggressive long-term surveillance to ensure graft patency and limb viability.

Activities of Daily Living↗

PubMedDate not supplied

Balloon dilatation versus surgical revision of infra-inguinal autogenous vein graft stenoses: long-term follow-up.

Although infra-inguinal autogenous vein graft stenoses may be treated by balloon dilatation (PTA) or surgical revision, the optimal approach is undefined. Over the last 7 years 24 PTA procedures were performed on 37 vein graft stenoses in 19 grafts. Graft stenoses were diagnosed from 2 to 72 (mean = 17.3) months after implantation. PTA was successfully completed in 23 (96%) of the 24 procedures including 18 (95%) of the primary, and 5 (100%) of the secondary procedures. Recurrent vein graft stenosis or graft thrombosis developed in 12 (67%) grafts from 3 to 47 (mean = 12.5) months after primary PTA. Long-term patency after primary PTA was 69% at 6, 29% at 12, and 22% at 36 months; secondary patency was 81% at 6, 45% at 12, and 27% at 36 months. During the same period vein graft stenosis in 7 fem-pop and 2 fem-tib grafts were surgically revised with an initial success rate of 100%, and 2 (22%) complications. Four (44%) of these grafts occluded from 1-17 (mean 6.2) months after repair, yielding a primary 5-year patency of 62%. Although vein graft stenosis may be safely, effectively, and repeatedly treated with PTA, long-term durability appears to be superior after surgical revision.

Aged↗

PubMedDate not supplied

Immediate post-operative urokinase infusion: extending the limits of limb salvage surgery.

We report the case of a 74-year-old woman with multi-level arterial occlusive disease and severe ischemia of the right lower extremity who underwent a re-operative femoro-femoral and a right femoro-popliteal bypass graft. Her right foot remained non-viable post-operatively despite patent grafts. She then underwent a 12-hour infusion of urokinase through a percutaneously placed popliteal artery catheter during that first post-operative day, with salvage of the right leg.

Aged↗

PubMedDate not supplied

Abdominal aortic replacement with a left-sided inferior vena cava: transperitoneal and left retroperitoneal approaches.

An unsuspected left-sided inferior vena cava (IVC) can present a formidable challenge for the surgeon attempting aortic reconstructive surgery. A 73-year-old man with aorto-iliac occlusive disease and a 64-year-old man with a seven centimeter (cm) abdominal aortic aneurysm (AAA) each underwent an aorto-femoral bypass graft in the setting of a left-sided cava. In the former case the conventional transperitoneal approach was utilized and in the latter case the extended left retroperitoneal incision was employed. The technical details required in performing these procedures and the developmental anatomy of this and other major venous anomalies are discussed.

Aged↗