Search PubMed⌕ Search

Biomedical subjects

D S Sumner

Publications and source records attributed to D S Sumner.

At least 91 records · Page 5Linked to original sources
PubMed1979

Hemodynamic studies before and after extended bypass grafts to the tibial and personeal arteries.

Thirty-ones limbs of 29 consecutive patients undergoing bypass grafts to the tibial or peroneal arteries were studied. Twenty-five limbs had ischemic rest pain with or without localized gangrene, and six had incapacitating claudication. The mean segmental pressure indices were upper thigh, 1.16 +/- 0.36; above knee, 0.71 +/- 0.30; below knee 0.51 +/- 0.23; and ankle, 0.28 +/- 0.21. Indices at the ankle were significantly lower (P less than 0.005) than those obtained from limbs that were candidates for simple femoropopliteal bypass. Three grafts failed immediately (initial patency rate of 90%). In the surviving grafts, ankle pressures rose from 39 +/- 26 to 145 +/- 29 mm Hg, and the ankle pressure index increased from 0.27 +/- 0.20 to 1.03 +/- 0.15 mm Hg. Consistent with these hemodynamic changes, all patients but one initially were relieved of their symptoms, and all ischemic lesions were treated successfully. Thirteen grafts failed subsequently (21 days to 34 months). Compared with preoperative values, ankle pressures after failure were either increased or unchanged in 75% of these limbs. Early occlusion could not be predicted on the basis of a low preoperative pressure index. During follow-up, impending graft failure was detected by a fall in ankle pressure in three patients and successfully prevented.

Adult↗
PubMed1978

Aortoiliac reconstruction in patients with combined iliac and superficial femoral arterial occlusion.

Despite revascularization of the common femoral--profunda femoris system, many patients fail to obtain satisfactory relief from claudication or rest pain. Clinical observations were compared with objective physiological data in 54 technically successful aortoiliofemoral reconstructions for multilevel disease. Nine of 28 operations (32%) for claudication and five of 26 operations (19%) for ischemia at rest had poor results. While the average ankle pressure index (API = ankle blood pressure/arm blood pressure) rose from 0.52 +/- 0.03 (SEM) to 0.81 +/- 0.03 in limbs treated successfully for claudication, it changed insignificantly in those with an unsuccessful result (0.58 +/- 0.04 to 0.61 +/- 0.04). When ischemic symptoms were relieved, API rose from 0.23 +/- 0.04 to 0.55 +/- 0.03 but increased only from 0.22 +/- 0.09 to 0.40 +/- 0.02 in limbs with insufficient improvement. Preoperative thigh pressure index (TPI) in claudicating limbs with poor results (0.96 +/- 0.05) differed little from that in limbs with good results (0.92 +/- 0.05); nor was the TPI of ischemic limbs with poor results (0.83 +/- 0.13) significantly greater than that in limbs with good results (0.60 +/- 0.05). Neither the TPI nor the thigh to ankle pressure gradient was of value in predicting which extremities would respond poorly to aortoiliofemoral reconstruction.

Adult↗
PubMed1977

Successful revascularization of mesenteric infarction following aortography.

Two cases of bowel infarction following abdominal aortography are presented. In both patients, two of the three major arteries supplying the bowel were occluded before the study. The superior mesenteric artery in one and the inferior mesenteric artery in the other were the only arteries supplying the bowel and their lumens were reduced. After the aortogram, the residual lumen clotted, leading to bowel necrosis. Survival was made possible in these two cases by revascularizing the superior mesenteric artery and resecting the necrotic bowel.

Aorta, Abdominal↗
PubMed1976

Extremity necrosis caused by indwelling arterial catheters.

Four patients sustained tissue due to indwelling catheters, three of which were in radial arteries and one of which was in the dorsalis pedis artery, In one of the patients, septic thrombosis was demonstrated. The risk of such complications can be minimized by precannulation evaluation of the arterial circulation of the extremity, by proper care of the catheter when in place, and by careful observation for clinical evidence of infection, ischemia, and other treatable problems.

Aged↗
PubMed1976

The effects of femoropopliteal vein graft failure on limb function.

Twenty-one patients were followed for an average of 40 months following occlusion of femoropopliteal vein grafts. Serial recordings of the resting ankle pressure index and treadmill walking time were correlated with the patient's clinical status, and compared to the preoperative values. Graft failure resulted in a return to preoperative status in ten of 11 limb salvage patients. There were 5 amputations, 3 died of unrelated causes, and 2 were subsequently improved by further reconstructions. At last followup, 3 of 10 patients who were operated on for claudication were unchanged, 6 were improved, and one became worse. In no case did graft failure result in the development of advanced ischemia. Femoropopliteal graft failure did not have a significantly adverse effect on limb function or survival in patients presenting with claudication, nor did it complicate the subsequent course of patients in whom the initial aim was limb salvage.

Adult↗
PubMed1976

The accuracy of the supraorbital Doppler examination in the diagnosis of hemodynamically significant carotid occlusive disease.

The supraorbital Doppler technique was used to study 102 carotid arteries prior to arteriography. A carotid stenosis was defined as being hemodynamically significant if the diameter of the lumen were reduced by more than 50 percent. The Doppler examination gave a false-positive result in only two of the 61 arteries which did not demonstrate significant stenoses. False-negative Doppler results occurred in 22 percent of the 41 significant carotid lesions. The presence or absence of significant carotid lesions were predicted in 96 percent of 67 arteries for which the results of the supraorbital examination and carotid auscultation were in agreement. False-negative results occurred in association with significant ipsilateral external and common carotid stenoses and in the presence of unusually efficient collateral circulation via the circle of Willis. The supraorbital Doppler examination is a valuable technique for the identification of patients with hemodynamically significant carotid stenoses.

Adult↗
PubMed1975

The transcutaneous measurement of the elastic properties of the human saphenous vein femoropopliteal bypass graft.

The pressure-strain elastic modulus and compliance of 20 reversed saphenous femoropopliteal vein grafts have been measured by a noninvasive, ultrasonic method. The grafts had been in place for an average of 33.6 months, 11 days to 128 months. In this study no correlation was demonstrated between wall stiffness and duration of implantation. It is concluded that the elastic properties of vein grafts may remain stable for considerable periods of time.

Adult↗