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Biomedical subjects

D J Reddy

Publications and source records attributed to D J Reddy.

At least 19 recordsLinked to original sources
PubMed1991

Management of infected aortoiliac aneurysms.

A 30-year retrospective review identified 13 patients treated for infected aneurysms of the abdominal aorta or iliac arteries, for an overall incidence of 0.65%. A constellation of clinical findings led to the correct preoperative diagnosis in 11 (85%) of 13 patients. Treatment methods included resection and in situ replacement grafting in seven patients, resection and extra-anatomic bypass in five patients, and resection-ligation in one patient. Four (31%) of 13 patients died within 30 days of operation, three of whom died of rupture. Overall, good results were achieved in five patients (38%), while poor results were noted in the remaining eight patients (62%). The determinants of outcome were aneurysm location or rupture, the presence of established infection, and the virulence of the infecting organism. In 10 (77%) of the 13 aneurysms, Salmonella species, Bacteroides fragilis, Staphylococcus aureus, and Pseudomonas aeruginosa accounted for all deaths, ruptures, and suprarenal aneurysm infections. These data suggest that patients with primary infections of the abdominal aorta or iliac arteries continue to present with advanced infections or aneurysm rupture that result in a high mortality.

Adult↗
PubMed1991

Left flank retroperitoneal exposure: a technical aid to complex aortic reconstruction.

Over the last 5 years an extended left flank retroperitoneal approach was used in 85 of 531 (16%) aortic reconstructions deemed technically complex. Abdominal aortic aneurysm repair was performed in 70 patients (82%), bypass of aortoiliac occlusive disease was performed in 11 (13%), and aortic endarterectomy for mesenteric and/or renovascular disease was performed in 4 (5%). Indications for use of this approach included a "hostile" abdomen (43 patients), juxta/suprarenal abdominal aortic aneurysm (35), large (greater than 10 cm) abdominal aortic aneurysm (12), extreme obesity (10), associated renal and/or visceral artery stenosis requiring endarterectomy (9), inflammatory abdominal aortic aneurysm (2), and horseshoe kidney (2). Suprarenal or supraceliac aortic clamping, averaging 31 minutes, was required in 43 patients (50%). Postoperative recovery was rapid (average length of stay, 10.2 days), and morbidity was minimal despite the complex nature of these reconstructions. The perioperative mortality rate in elective operations was 1.2%. This approach facilitated proximal abdominal aortic exposure and anastomosis, especially in large, pararenal aneurysms or in situations unfavorable to a transabdominal approach. Whereas a left flank retroperitoneal approach can be used in most aortic reconstructions, it seems especially suited to those that pose significant technical challenges.

Abdomen↗
PubMed1990

Intraoperative autotransfusion in vascular surgery.

To determine the impact of intraoperative autotransfusion on vascular surgical care, data related to 304 major vascular surgical operations performed over a 42-month period were retrospectively analyzed. Procedures included abdominal aortic aneurysmectomy (N = 152), aortobilateral femoral bypass (N = 60), thoracoabdominal aortic aneurysmectomy (N = 20), and other vascular procedures (N = 68). Fifty percent of the transfusion requirement was met by autotransfusion for the average patient. The per patient average volumes (liters) autotransfused were as follows: elective abdominal aortic aneurysmectomy, 0.87 L and nonelective, 1.45 L; elective aortobilateral femoral bypass, 0.63 L; elective thoracoabdominal aortic aneurysmectomy, 2.47 L, and nonelective, 2.15 L; and elective other, 0.53 L and nonelective, 1.30 L. Results of immediate postoperative and hospital discharge hemoglobin, hematocrit, and coagulation studies (prothrombin time, partial thromboplastin time, and platelets) did not differ from results of preoperative studies in any group. Neither mortality nor morbidity was related to intraoperative autotransfusion. These data suggest that intraoperative autotransfusion is a safe blood replacement method during major vascular surgical operations.

Adult↗
PubMed1990

Ureteral complications and aortoiliac reconstruction.

A 33-year experience with 58 ureteral complications in 50 of 3580 patients undergoing aortoiliac reconstruction was analyzed. Ureteral obstruction was treated before or in conjunction with aneurysm repair in six patients with aneurysmal disease. The remaining 44 patients had 46 ureteral complications after aortic reconstruction; complications included hydronephrosis (42), ureteral leak (3), and ureteral necrosis (1). A high incidence of associated graft complications was noted. Graft thrombosis developed in one of the six patients undergoing prior or simultaneous ureteral procedures, and graft infection developed in another. Thirty-six graft complications developed in 24 (55%) of the 44 patients with postoperative ureteral complications. The complications included 19 anastomotic aneurysms, eight graft limb thromboses, six graft infections, and three aortoenteric fistulas. Twenty-nine of the 44 patients with postoperative ureteral complications underwent ureteral or graft operations or both. These included five patients having ureteral operations alone, seven with a ureteral procedure and subsequent graft operation, eight requiring simultaneous ureteral and graft procedures, and nine undergoing a graft operation with ureteral observation. Six of these 29 patients (21%) died after operation, all from graft complications including aortoenteric fistulas (three), ruptured anastomotic aneurysms (two), and graft infection (one). Graft complications affected 55% of 44 patients with postoperative ureteral complications, compared to 12% of 3536 patients without ureteral complications (p less than 0.0001). Patients with postoperative ureteral complications were 4.4 times as likely to have graft complications compared to those without ureteral complications (p less than 0.0001). These data suggest that such urologic complications may be markers for recognition of or harbingers for graft complications.

Adult↗
PubMed1990

Distal internal carotid exposure: a simplified technique for temporary mandibular subluxation.

Distal internal carotid artery exposure can be technically demanding even for experienced vascular surgeons. Although a variety of techniques have been described to facilitate such exposure, temporary mandibular subluxation has emerged as the simplest and least debilitating approach. Current techniques for maintaining temporary mandibular subluxation during distal internal carotid artery procedures, including maxillomandibular arch bar fixation and circummandibular/transnasal wiring, have been time consuming and associated with complications. Over the last 4 years a new simplified technique of temporary mandibular subluxation fixation has been used in 14 patients requiring distal internal carotid exposure. Indications for operation included extended carotid endarterectomy (8), carotid body tumor excision (2), repair of distal internal carotid artery trauma (2), and repair of postendarterectomy pseudoaneurysm (2). Among patients with healthy teeth, unilateral temporary mandibular subluxation was maintained by interdental wiring from the ipsilateral mandibular bicuspids to the contralateral maxillary bicuspids. In edentulous patients or those with chronic periodontal disease, temporary mandibular subluxation was maintained with diagonal wiring between maxillary and mandibular Steinmann pins. No instances of malocclusion, dental injury, or local infection were observed. Transient postoperative cranial nerve dysfunction was observed in three patients. Transient ipsilateral temporomandibular joint pain occurred in three patients. Two patients developed permanent cranial nerve injuries unrelated to temporary mandibular subluxation. These data suggest that temporary mandibular subluxation by diagonal interdental/Steinmann pin wiring is safe, expeditious, and effective in facilitating exposure of the distal internal carotid artery.

Bone Nails↗
PubMed1988

Recurrent femoral anastomotic aneurysms. A 30-year experience.

Of the 1771 patients who underwent aortofemoral bypass grafting (AFB) during the 30-year period of 1957-1986, 43 noninfected recurrent femoral anastomotic aneurysms (RFAA) developed in 28 patients. Thirty-six RFAAs were treated surgically, with one death and no amputations occurring. Seven small RFAAs (less than 2.0 cm) were treated expectantly without complications. Using univariate and multivariate analyses, clinical characteristics and other factors influencing results in patients with RFAAs were compared to two control groups: patients who had undergone AFB without the development of femoral anastomotic aneurysms (FAAs) and patients who had undergone FAA repairs but without recurrence of FAA. Comparative analyses suggested: 1) local wound complications after initial AFB or FAA repair increased risk of a RFAA (p less than 0.03); 2) development of an FAA within 4.5 years after AFB increased risk of a RFAA (p less than 0.0002); 3) following an FAA repair, risk of a RFAA was almost three times greater for women than for men (p less than 0.05); and 4) patients with arteriosclerotic heart disease (ASHD) were less likely to develop RFAA than those without ASHD (p less than 0.05). Among the 20 additional variables analyzed--including hypertension, smoking, diabetes mellitus, and etiology of primary vascular disease--no statistically significant influence on the development of RFAAs could be detected.

Aged↗
PubMed1988

Surgical treatment of carotid paragangliomas presenting unusual technical difficulties. The value of preoperative embolization.

Although the application of reconstructive vascular surgical procedures to the treatment of carotid paragangliomas has made their resection the method of choice and has produced excellent cure rates, it has not obviated some of the technical problems presented by excessively vascular, adherent, or bulky lesions. Our experience with preoperative trans-catheter embolization for the reduction of the vascularity in six cases of this group of lesions is presented and the conclusion is made that preoperative embolization greatly reduced operative technical difficulties.

Adult↗
PubMed1986

A thirty-year survey of the reconstructive surgical treatment of aortoiliac occlusive disease.

With the view of assessing functional durability and the factors that influence or determine it, we reviewed the clinical course of 1748 reconstructive operations performed between Jan. 1, 1954, and Dec. 31, 1983 in the treatment of 1647 patients with aortoiliac occlusive disease (AIOD). Disabling intermittent claudication (in 65.6%), ischemic rest pain and/ or pregangrene (in 20.7%), and ischemic gangrene (in 13.7%) were the operative indications. Patency proven by angiography was the criterion of success. Follow-up was continuous and endless and 94% successful over a period of 30 years. Twenty-five percent of the patients were followed up for 11 to 30 years. The incidence of severe degree of occlusive involvement increased significantly from the first (9.3%) to the third (17.1%) decade of observation, whereas the perioperative mortality rate improved markedly from the first (7.4%) to the third (2.5%) decade. The aortobifemoral bypass (AF2B) procedure remained the most popular type of repair (with a perioperative patency rate of 91.4%) throughout, but both it and unilateral reconstructions lost some ground to remote (extra-anatomic) bypasses in the third decade. Atherosclerotic heart disease remained the most common cause of perioperative (50%) and late (60.2%) death. Among the early postoperative local complications graft thrombosis improved markedly from the first (8.3%) to the third (3.2%) decade. Graft infection remained rare (1.6% to 0.8%). The incidence of the most common late wound complication, anastomotic aneurysm at the common femoral level, remained relatively constant (5.7% per anastomosis), but it responded very well to surgical correction. The partial or complete secondary repair of all late complications (26.0%) improved the cumulative late patency rate in the AF2B procedures by 2% to 12% during 20 years of observation. The perioperative (97.3%), 5-year (76.6%), 10-year (76.6%), 15-year (72.5%), and 20-year (67.5%) cumulative patency rates of AF2B operations were highly satisfactory. The postoperative late survival rate of patients with AIOD declined rapidly (59% at 5, 33% at 10, 14% at 15 years). The cause of late death in 60.2% of the cases was atherosclerotic heart disease.

Aortic Diseases↗
PubMed1986

Suprarenal mycotic aortic aneurysm: surgical management and follow-up.

A case is reported of a rare 7 cm saccular mycotic aneurysm that developed in the suprarenal abdominal aorta of a severely atherosclerotic 63-year-old man from presumed hematogenous inoculation of an atherosclerotic plaque. At operation a right axillobifemoral artery bypass graft was performed along with autotransplantation of the left kidney to the left common iliac vessels and the suprarenal aorta was ligated, excised, and widely debrided. The patient recovered and was in good health for 6 months when sudden occlusion of his axillofemoral graft required thrombectomy for limb salvage and to preserve renal function. Elective thoracoaortic to bilateral iliac artery bypass was successfully undertaken 8 months after the initial operation. However, the patient suffered a fatal myocardial infarction 2 weeks after operation. At autopsy a well-perfused nephrosclerotic kidney, healed aortic ligation, and no graft infections were found.

Aneurysm, Infected↗
PubMed1986

Infected femoral artery false aneurysms in drug addicts: evolution of selective vascular reconstruction.

Fifty-four infected femoral artery false aneurysms resulting from chronic drug addiction were managed surgically with an 11% amputation rate and no mortality. Angiography localized the arterial segment involved, which in turn influenced the type of operation performed. Twenty-six aneurysms of anatomically isolated femoral artery segments were ligated and excised without resultant amputation. However, of the 28 aneurysms involving the common femoral bifurcation, 18 required triple ligation and excision that led to six amputations. Six of the 28 aneurysms were reconstructed with autogenous saphenous vein grafts, three by prosthetic grafts, and one by primary anastomosis. No amputations followed vascular reconstruction. However, all synthetic grafts eventually developed septic complications that required graft removal. On the basis of this experience we recommend ligation and excision for single artery segment aneurysms and immediate autogenous reconstruction for selected common femoral bifurcation lesions. This approach has proved safe and has reduced our amputation and graft complication rates. Extensive uncontrollable wound sepsis may contraindicate revascularization. Under these circumstances we estimate a 33% risk of amputation when the common femoral bifurcation is excised.

Adult↗
PubMed1986

Limitations of the femoral artery pulsatility index with aortoiliac artery stenosis: an experimental study.

Relationships between femoral artery pulsatility index (PI) (a number calculated from Doppler-derived arterial blood velocity waveforms) and three directly measured physiologic parameters (proximal artery stenosis, blood pressure index (BPI), and blood flow) were studied in a canine model. All combinations of stenoses were constructed, including 0%, 25%, 50%, 75%, and 90% reduction in a cross-sectional area in the infrarenal aorta and/or left common iliac artery of 14 animals. PIs, BPIs, and mean blood flows were measured for each stenosis pattern at both the right (control) and left femoral arteries. Three groups were studied--group I, the left femoral artery remained open; group II, the left femoral artery was ligated; and group III, a left femoral arteriovenous fistula was constructed. Correlations between reductions in femoral artery PI and increasing arterial stenosis as well as decreasing BPI and blood flow were obtained. However, positive correlations were weak and only recognized when high-grade stenoses were present. Moreover, these correlations were further influenced by the multiplicity of stenoses present as well as flow velocity into the distal arterial bed. These data suggest that PI lacks the sensitivity to be a clinically useful diagnostic test.

Animals↗
PubMed1984

Central venous thrombosis and embolism associated with peritoneovenous shunts.

During a five-year period from Aug 1, 1977 through Aug 1, 1982, 36 patients required 47 peritoneovenous shunt procedures (36 initial and 11 revisions) for the management of their intractable ascites. The results at six months showed 23 (63.9%) of 36 patients were dead, but in those living, 12 (92.3%) of 13, the ascites was satisfactorily controlled. Patency was measurably prolonged by appropriate revision of the shunt. The early and late complication rates were surprisingly high, 38.3% and 40.4%, respectively. The most serious complication was central venous thrombosis, 11 (23.4%) of 47 procedures, including one nonfatal and two fatal pulmonary emboli. Treatment included the use of fibrinolytic agents, anticoagulation, and shunt revisions. Careful attention to the details of shunt fabrication, insertion, and patient selection may help to reduce the occurrence of central venous thrombosis associated with peritoneovenous shunts.

Adolescent↗
PubMed1983

Bilharzial portal hypertension.

Schistosomiasis is a major world health problem that is being encountered more frequently in North America as the immigration patterns from endemic areas change. At Henry Ford Hospital in Detroit, only two admissions for active schistosomiasis were recorded before 1970, but since then there have been 43 such cases. Of these 45 patients, six required seven portasystemic shunts, primarily to treat the complication of esophageal variceal hemorrhage, which is associated with portal hypertension secondary to presinusoidal hepatic fibrosis. No operative deaths occurred, and follow-up averaging 6.6 years revealed no late deaths and minimal encephalopathy. These excellent results are attributed to successful portal decompression and the well-preserved liver function that is typical of these patients. Bilharzial portal hypertension should be suspected in immigrants from endemic areas who have bleeding esophageal varices.

Africa↗
PubMed1981

Popliteal arterial aneurysms. Their natural history and management.

Eighty-seven popliteal aneurysms in 62 patients, of which 50 were treated surgically, were reviewed and their clinical characteristics summarized. The need for alertness in the clinical detection of these lesions was stressed. Because complications, namely thrombosis and embolization, were frequent (23% in the total group, 36% in the surgical group), we recommend surgical treatment not only in all symptomatic but also in asymptomatic aneurysms larger than 2 cm in diameter; nonsurgically treated cases must be followed up carefully. With this aggressive approach, no lives and only two limbs were lost (one in a case of irreversible gangrene of the foot). Of the two surgical techniques described, the bypass procedure with autogenous vein graft is, because of its simplicity, given preference over resection with graft.

Aneurysm↗
PubMed1980

Intimal hyperplasia. An experimental study.

Intimal hyperplasia is a common cause of the narrowing and failure of vein grafts in arterial circuits. Various factors may contribute to this. An experimental dog model that isolated the contribution of blood velocity from other possible causes was developed. Intimal hyperplasia was clearly greater in those segments of vein grafts with low-flow velocities.

Angiography↗