A new mode of treatment for extensive acute and subacute deep venous thrombosis of the lower extremities combines the beneficial effects of surgical thrombectomy and of thrombolysis with streptokinase during the course of a single surgical intervention. Rapid-flow regional perfusion is the vehicle used to administer streptokinase and probably represents the third arm of this therapeutic approach by adding a hemodynamic washout effect. Because the thrombolytic agent is rinsed out of the circuit at the end of regional perfusion, the usual side effects and contraindications of this drug are avoided. Early and late results of this treatment are assessed clinically and with repeat phlebograms in a group of 6 unselected patients. Highly satisfactory results were achieved by 4 patients, 3 of whom experienced complete anatomic and functional restoration of deep veins along their entire length. Continued use of this method appears to be warranted.

Adult↗

PubMedDate not supplied

The syndrome of Klippel-Trenaunay, a polyvalent angiodysplasia.

The syndrome of Klippel and Trenaunay remains basically a venous angiodysplasia. Newer investigative methods have however allowed us to distinguish a polyvalence of the vascular morphology. The basic clinical triad: vascular nevus, varicosities and limb hypertrophy remains the main clinical diagnostic characteristic.

Angiography↗

PubMedDate not supplied

Prognostic factors in the surgical treatment of aorto-iliac aneurysmal disease. Factors affecting survival and long-term results.

Factors governing the immediate and long-term outcome of surgical treatment of aorto-iliac aneurysmal disease were investigated in 182 elective and 116 ruptured consecutive cases. There was a 3.3% operative mortality for elective procedures and a 46.6% mortality for ruptured aneurysms. Long-term survival of elective resections was significantly reduced by age (0.01 less than p less than 0.025) and concomitant heart disease (0.025 less than p less than 0.05). Compensated renal insufficiency and chronic obstructive pneumopathy were not enough individually to preclude elective resection. In the emergency procedures the correlation of pre-, per- and postoperative factors to mortality was assessed: patient age (p = 0.01) and preoperative duration of symptoms less than 6 hours (p = 0.0076), arterial hypotension at the outset, during and at the end of operation (p = 0.0195; 0.0076 and 0.005 respectively), blood loss (p = 0.003), suprarenal extension of aneurysm (p = 0.0098) and intraperitoneal hemorrhage (p = 0.0094) were significant predictive factors in the univariate analysis. In the multivariate analysis peroperative duration of hypotension greater than 30 minutes was the strongest single independent discriminator (p = 0.0076), death being caused by myocardial ischemia in elderly patients, secondary to poorly tolerated severe hypovolemia.

Age Factors↗