Biomedical subjects

F A Weaver

Publications and source records attributed to F A Weaver.

At least 73 records · Page 4Linked to original sources

PubMed1990

Is arterial proximity a valid indication for arteriography in penetrating extremity trauma? A prospective analysis.

Three hundred seventy-three patients with a penetrating extremity injury were studied to assess the yield of arteriography. Patients underwent arteriography if any of the following was present: bruit, history of hemorrhage or hypotension, fracture, hematoma, decreased capillary refill, major soft-tissue injury, or nerve or pulse deficit. In the absence of these findings, arteriography was performed if the injury was in "proximity" to a major neurovascular bundle. In 216 patients, arteriography was performed when an abnormal finding was noted. Sixty-five injuries were identified, 19 requiring intervention. Proximity was the indication for arteriography in 157 patients. Seventeen injuries were identified, of which one required repair. In penetrating extremity trauma, the need for arteriography is based on clinical findings. The use of arteriography to screen for an arterial injury when proximity alone is the indication rarely identifies a significant injury and should be abandoned.

Adolescent↗

PubMed1990

Role of routine arteriography in blunt lower-extremity trauma.

During an 18-month period, 53 patients with unilateral blunt lower-extremity trauma were entered into a prospective study designed to determine how often clinically occult arterial injuries are identified by routine arteriography, and how often these injuries are of sufficient magnitude to warrant therapeutic intervention. Patients underwent diagnostic arteriography if one or more of the following abnormal clinical findings were present: distal pulse deficit, nerve deficit, soft-tissue loss, decreased capillary refill, bruit, or a history of hemorrhage or hypotension. In the absence of these findings, arteriography was performed for significant orthopedic injuries, i.e., knee dislocations or complex long-bone fractures. In 31 patients (58%), arteriography was performed because 1 or more abnormal clinical findings were present and 12 arterial injuries were identified, 4 requiring arterial repair. The presence of a knee dislocation or complex long-bone fracture was the only indication for arteriography in 22 patients (42%) and 3 arterial injuries were identified, none requiring operative intervention. For all patients, two variables, pulse deficit and delayed capillary refill, strongly correlated (p less than 0.05) with arteriographic demonstration of an arterial injury. In the absence of these findings, routine diagnostic arteriography will have a low diagnostic yield and will rarely identify a vascular injury in a major artery that will require operative repair. Arteriography should be selectively performed and guided by examination and noninvasive Doppler indices.

Adolescent↗

PubMed1990

Carbon dioxide digital subtraction arteriography: a pilot study.

To investigate the diagnostic value of carbon dioxide arteriograms in patients with peripheral vascular disease, ten patients in whom standard contrast arteriography was contraindicated underwent carbon dioxide digital subtraction arteriography. Lower extremity ischemia or severe hypertension with renal insufficiency were the indications for arteriography. Standard contrast arteriography was precluded by chronic nondialysis-dependent renal insufficiency, severe congestive heart failure or contrast hypersensitivity. All critical arterial segments were well visualized with the exception of the infrapopliteal arterial tree in three patients. Adequate imaging of this segment required the addition of 20 cc of dilute nonionic contrast. Guided by carbon dioxide digital subtraction arteriography, four percutaneous transluminal angioplasties and three reconstructive procedures were successfully performed. One patient did not have surgically reconstructible disease and two had renal arteries without critical stenoses. Renal function transiently deteriorated in one patient who received 20 cc of nonionic contrast. No adverse events occurred due to carbon dioxide. Clinically useful diagnostic arteriograms are possible using carbon dioxide as the contrast agent.

Aged↗

PubMed1990

An effective treatment protocol for intraarterial drug injection.

Between 1972 and 1988, 48 patients with extremity ischemia after an intraarterial drug injection were treated with the following protocol: heparin, dextran 40, dexamethasone, elevation, and early mobilization of the extremity. A tissue ischemia score, derived by assessing the color, capillary refill, sensory function, and temperature of the extremity, was used to assess the ischemic injury. Each sign was scored either normal = 0 or abnormal = 1; then summed to provide the tissue ischemia score (range, 0 to 4). Twenty-four (50%) patients had an extremity tissue ischemia score less than or equal to 2. After treatment 22 of the 24 patients had a normal extremity, and 2 required limited digital amputations. In this group, outcome was comparable regardless of the time interval from intraarterial drug injection to treatment. Ten of 24 (50%) patients with an extremity tissue ischemia score greater than 2 had a normal extremity, 3 had a functional deficit, and 11 required digital amputations. Twelve of the 24 patients were treated within 24 hours and had a significantly superior outcome when compared to the 12 who were treated more than 24 hours after intraarterial drug injection (p less than 0.001, Fisher's exact test). The tissue ischemia score is a useful predictor of extremity outcome in patients with intraarterial drug injection. The outlined treatment protocol is effective in minimizing tissue injury caused by intraarterial drug injection. Institution of treatment within 24 hours of intraarterial drug injection is particularly important in patients who manifest severe ischemia.

Adult↗

PubMed1990

Surgical procedures in the management of Takayasu's arteritis.

Takayasu's arteritis is an inflammatory arteriopathy that often progresses to obliteration of multiple large arteries. Variable results have been reported after medical and surgical management. Twenty female patients with Takayasu's arteritis were treated from 1973 to 1989. Eleven (55%) patients had hypertension. Upper or lower extremity ischemia was present in 12 (60%) patients and cerebrovascular insufficiency in seven (35%). Nine patients initially managed with corticosteroids had no improvement in signs or symptoms of arterial insufficiency. Eleven patients had 16 vascular procedures for the following indications: renovascular hypertension (6), extremity ischemia (5), cerebrovascular insufficiency (2), dilation ascending aorta with aortic insufficiency (1), thoracic aortic aneurysm (1), abdominal aortic aneurysm (1). Procedures included aortorenal bypass (5), carotid-subclavian, axillary, or brachial bypass (4), aorto-carotid bypass (2), aneurysm resection (2), supra-celiac aorto-femoral bypass (1), ascending aorta/aortic valve replacement (1), and nephrectomy (1). Clinical improvement occurred in all patients. There were no operative deaths. All are alive at a mean follow-up of 5.75 years (6 months to 16 years). Revision of the initial reconstruction has been required for recurrent renovascular hypertension in one patient and extremity ischemia in another. The other nine patients remain symptomatically improved. Symptomatic Takayasu's arteritis frequently requires arterial reconstruction. Symptomatic improvement and excellent long-term graft patency can be expected after arterial reconstruction.

Adolescent↗

PubMed1990

Sinistral (left-sided) portal hypertension.

Between 1953 and 1988, 21 patients with splenic vein thrombosis (SVT), 12 of whom had sinistral portal hypertension (SPH) were treated at our institution. SVT was identified at autopsy in nine patients. Twelve additional patients presented with SPH: bleeding esophageal varices, SVT and normal hepatic function. SVT was caused by pancreatic neoplasm (5), chronic pancreatitis (5), and pancreatic pseudocyst (2). SVT was diagnosed by splanchnic angiography, splenoportography, computerized tomography, and ultrasonography. Gastric varices were diagnosed by endoscopy (10) and barium swallow (2). Splenectomy was performed as primary therapy in 10 patients. Three of these 10 had en block distal pancreatectomy. Two high-risk patients had splenic artery embolization, one as a prelude to splenectomy performed 48 hours later and the other as definitive therapy. One splenectomized patient continued to bleed. No further bleeding occurred in 10 splenectomized patients in follow-up from 1 week to 14 years. Sinistral portal hypertension is a clinical syndrome of splenic vein thrombosis caused by pancreatic pathology and manifests as bleeding gastric varices in patients with a patent portal vein and normal hepatic function. Splanchnic arteriography is necessary for accurate diagnosis. Splenectomy is the effective treatment of choice.

Adult↗

PubMed1989

Selective management of nonocclusive arterial injuries.

Between 1978 and 1988, 50 patients were demonstrated arteriographically to have 61 nonocclusive arterial injuries (44 major arteries, 17 minor arteries). The 61 injuries consisted of 19 intimal defects, 4 intimal flaps, 26 pseudoaneurysms, 2 arterial stenoses, and 10 arteriovenous fistulas. End-organ ischemia or ongoing hemorrhage were not present. All patients were treated nonoperatively. At 1 to 12 weeks after the injury, 30 arterial injuries (24 major, 6 minor) were studied by repeated arteriography. Resolution, improvement, or stabilization of the injury occurred in 21 (87%) major artery injuries. Progression occurred in the remaining 3 injuries, including 1 patient who underwent subsequent successful repair. Twenty-one injuries were followed up without repeated arteriography. Delayed arterial thrombosis, hemorrhage, or ischemia did not develop, and no patient required operative management. Eight of 10 additional arterial injuries had successful percutaneous embolization at the time of repeated arteriography. The overwhelming majority of small arterial injuries or intimal fractures do not lead to vascular complications if managed nonoperatively. A routine policy of operative exploration for all such injuries is therefore unwarranted. These injuries are best managed by observation and serial arteriography to document spontaneous healing or progression.

Adolescent↗

PubMed1989

Trends in the management of traumatic vertebral artery injuries.

From 1975 to 1988, 25 patients with a vertebral artery (VA) injury were treated. Admission neurologic status was intact in 14 patients (56 percent). Eight patients had deficits due to direct nerve or spinal cord injury, two patients had symptoms referable to vertebrobasilar ischemia, and one patient had a contralateral deficit due to an associated carotid artery injury. Twenty-two of 25 patients (88 percent) underwent diagnostic arteriography. Twelve patients (48 percent) with 9 occlusive and 3 minimal injuries were observed. Seven patients (28 percent), three with exsanguinating hemorrhage, were treated by operative exploration and VA ligation. Six patients (24 percent), two with a VA pseudoaneurysm and four with an arteriovenous fistula, were managed by percutaneous transcatheter embolization. The neurologic status was unchanged or improved in 22 patients (88 percent) at discharge. Two patients developed Horner's syndrome after VA ligation. Transient posterior circulation ischemia occurred in a single patient after percutaneous transcatheter embolization. There was no mortality. The majority of VA injuries are best managed by nonoperative methods. Untoward neurologic sequelae are rare. Operative intervention and VA ligation should be reserved for patients with active hemorrhage or large pseudoaneurysms and arteriovenous fistulas which cannot be embolized.

Adolescent↗

PubMed1989

Long-term assessment of a damp-stored, albumin-coated, knitted vascular graft.

In a previous study the authors reported greater endothelialization and thrombus-free surface area in albumin-coated grafts compared with collagen-coated grafts after 1 month's aortic interposition. Another study was undertaken to determine whether these differences persisted after a 6-month implantation period. A 6 cm segment of either an albumin-coated [n = 6] or a collagen-coated [n = 4] graft was implanted into a canine descending thoracic aorta for 6 months. Light micrographs from multiple sections of each explanted graft were scored from 1 to 4, least to most, for tissue ingrowth, perigraft inflammation, and capsular thickness. Using computer planimetry, luminal thrombus free surface area and endothelial coverage were calculated from gross and electron photomicrographs, respectively. The results were averaged and expressed as mean +/- standard error (SEM). After 6 months, no significant differences were noted between the albumin-coated grafts and the collagen-coated grafts, both of which were durable and served equally well as scaffolds for vascular remodeling and tissue incorporation. The authors conclude that the safety, ease of handling, low porosity, low thrombogenicity, and durability of the albuminated grafts warrant their clinical trial.

Albumins↗

PubMed1989

Injuries to the ascending aorta, aortic arch and great vessels.

During the past decade (1977 to 1987), 46 patients with 51 arterial injuries to the ascending aorta, aortic arch and great vessels have been treated at our institution. There were 25 subclavian arterial, 17 common carotid arterial, five innominate arterial and four ascending aortic injuries. Sixteen (35 per cent) patients were hemodynamically unstable at admission and required immediate operative intervention. Two patients arrived in cardiac arrest, necessitating thoracotomy performed in the emergency room. Thirty (65 per cent) patients were hemodynamically stable and underwent emergent diagnostic angiography prior to arterial repair. Lateral or end to end arterial repairs were used in the majority. Two ascending aortic injuries required cardiopulmonary bypass. Forty-three of 46 patients survived. Prompt exploration in the unstable patient, diagnostic angiography in the stable patient and a systematic but flexible operative approach are the keys to the management of these potentially lethal injuries.

Adolescent↗

PubMed1989

Monocular blindness after penetrating trauma to the carotid artery.

Near-total or total blindness caused by chronic ocular ischemia is a well-recognized complication of severe atherosclerotic occlusive disease of the carotid artery (CA) but has not been previously reported in the English-language literature as a sequela of an occlusive CA injury. This report describes a patient who sustained a gunshot wound to the neck, which injured the ipsilateral internal CA, external CA, and vertebral artery. The location of the injuries precluded arterial repair. The patient was neurologically intact after operative exploration. Twenty months after the injury a marked loss of vision in the ipsilateral eye was detected. Chronic ocular ischemia was diagnosed from clinical findings and ophthalmoscopic examination results. Knowledge that chronic ocular ischemia and blindness can occur after an occlusive CA injury supports the use of primary arterial repair for all CA injuries. In those instances in which repair is not technically possible, frequent ophthalmoscopic examinations and testing of visual acuity should be used postoperatively to diagnose ocular ischemia; thus treatment to prevent the loss of sight can be carried out.

Adolescent↗

PubMed1988

The role of arterial reconstruction in penetrating carotid injuries.

The outcome of 80 patients with 85 penetrating injuries to the extracranial carotid artery (CA) were analyzed after three types of treatment: (1) 54 patients, 17 with a neurologic deficit, who underwent arterial reconstruction; (2) 18 patients, eight with a neurologic deficit, who had CA ligation or non-operative management of a CA occlusion; and (3) eight patients, two with a deficit, who had minimal nonocclusive injuries managed nonoperatively. Outcome was analyzed using a Carotid Neurologic Score (CNS). The CNS is a quantitative measure of neurologic outcome and survival and ranges from -1 to +3. The higher the CNS, the more favorable the outcome. The conditions of nine patients in group 1 neurologically improved after treatment, 41 were the same, and four were worse. Forty-four patients were neurologically intact and three died. The mean (+/- SD) CNS was 1.9 +/- 0.8. In group 2, one patient's condition improved, 13 stayed the same, and four deteriorated. Ten patients were intact and two died. The mean CNS was 1.3 +/- 1.13. In group 3, two patients' conditions improved and six stayed the same. All eight patients were intact; there were no deaths. The mean CNS was 2.3 +/- 0.35. There was a significantly higher CNS for groups 1 and 3 compared with group 2. The CNSs of groups 1 and 3 were not significantly different. Arterial reconstruction provides the best outcome for all penetrating CA injuries except nonocclusive limited intimal injuries that require only observation.

Adolescent↗

PubMed1988

Blunt popliteal artery trauma: one hundred consecutive injuries.

An institutional experience with 100 consecutive blunt popliteal artery injuries over a 20-year period was reviewed. The overall amputation rate was 15%; however, during the past 7 years this has declined from 23% to 6%. Minimizing delay in the revascularization of ischemic limbs, routine systemic heparinization, primary arterial repair when possible, repair of popliteal venous injuries, aggressive wound debridement, and early soft tissue coverage have contributed to improved limb salvage during the 1980s.

Adolescent↗

PubMed1988

Phlegmasia cerulea dolens: therapeutic considerations.

Phlegmasia cerulea dolens (PCD) is a rare venous disorder that continues to be a major therapeutic challenge. We reviewed 16 cases of PCD treated during the past 15 years; 11 of the patients were male, and the average age of all the patients was 59 years. Malignant disease was the most common underlying condition (seven patients). Venous gangrene (VG) was present in seven extremities. Three treatment methods were used alone or in combination--intravenous heparin, venous thrombectomy, and thrombolytic therapy. Heparin was used initially in 13 patients; it yielded a successful result in seven (53%) patients, none of whom had VG. Venous thrombectomy was done in six patients; in three it was the primary procedure, in two it followed failure of heparin, and in one it followed failure of both heparin and thrombolytic therapy. Venous thrombectomy was successful in three (50%) patients, one of whom had early VG. Thrombolytic therapy was used on one occasion in conjunction with both heparin and venous thrombectomy, without benefit. Five patients died, all with VG, three after heparin only, one after heparin and venous thrombectomy, and one after all three treatment methods. Review of the 38 cases reported in the recent literature shows comparable results. These data suggest that nongangrenous forms of PCD respond well to systemic anticoagulation. Combination therapy using venous thrombectomy and heparin is indicated for severe ischemia, early VG, or failure of PCD to improve after six to 12 hours of heparin therapy. Phlegmasia cerulea dolens with VG is the lethal form of the entity and responds poorly to established therapy. Future therapeutic trials need to consider aggressive use of thrombolysis with or without thrombectomy.

Adult↗

PubMed1988

Femoropopliteal percutaneous transluminal angioplasty for limb salvage.

The role of balloon catheter femoropopliteal percutaneous transluminal angioplasty (FP PTA) continues to be controversial 14 years after its initial description. In high-risk patients with limb-threatening ischemia, the role of FP PTA is unknown. We reviewed the cases of 27 patients in whom high operative risk and advanced ischemia resulted in referral for PTA of the femoropopliteal segment. Technical and hemodynamic success rates were 74% and 52%, respectively. Patient follow-up was 3 to 84 months after PTA (mean 24 months). Nine patients (33%) had successful limb salvage for more than 12 months. The cumulative limb salvage rate was 47% at 2 years. Established prognostic criteria did not predict this subset of patients. Hemodynamic improvement after PTA did correlate closely with both early and late successful limb salvage. There were two periprocedural deaths. Morbidity included an acute arterial occlusion necessitating an emergency FP bypass and two minor complications. FP PTA is useful in selected high-risk patients with limb-threatening ischemia. Protocols to facilitate successful long-term limb salvage must include close liaison between the vascular surgeon and interventional radiologist, intensive periprocedural monitoring, and serial noninvasive hemodynamic assessment.

Adult↗

PubMed1988

Chronic ocular ischemia and neovascular glaucoma: a result of extracranial carotid artery disease.

Severe occlusive disease of the carotid artery may produce a rare syndrome of chronic ocular ischemia. Prolonged retinal hypoxia is associated with characteristic funduscopic changes and neovascularization of the iris, with subsequent obstruction of aqueous humor resorption. A case of neovascular glaucoma as a result of severe bilateral carotid occlusive disease and the pathophysiology involved are discussed. Definitive treatment consisted of carotid endarterectomy and aggressive control of intraocular pressure, including operative placement of a drainage implant in the anterior chamber of the eye. Seizure activity and an exacerbation of glaucoma developed after successful revascularization, exemplifying the derangements in cerebral and ocular function that may result from chronic hypoperfusion.

Arterial Occlusive Diseases↗

PubMed1988

Anastomotic false aneurysms of the abdominal aorta and the iliac arteries.

Anastomotic false aneurysm (AFA) of the aorta or iliac artery is a potentially lethal complication of prosthetic grafts. To study this complication, the records of 18 patients with 22 noninfected AFAs (15 aortic and seven iliac) were reviewed. Patients with an intact AFA had a pulsatile abdominal mass, abdominal pain, an occluded graft, peripheral emboli, or a femoral anastomotic false aneurysm. All patients with a ruptured AFA were in shock, but 67% (four of six) had symptoms before hemorrhage. For diagnosis, single-plane angiography was 69% accurate (11 of 16), computed tomography was 100% accurate (six of six), and ultrasound was used once and suggested an AFA. Three patients with an AFA less than 5 cm diameter were initially observed; however, all three aneurysms rapidly enlarged and one ruptured. The operative mortality rate was 8% (1 of 12) for patients with an intact aneurysm and 67% (four of six) for patients with a ruptured aneurysm. Treatment was resection of the AFA and replacement with a new graft. Retroperitoneal AFAs often appear years after the initial operation, and life-long follow-up is required for patients with an aortic or iliac graft. All retroperitoneal AFAs should be resected since the outcome of patients with a ruptured AFA is poor.

Aged↗

PubMed1987

The lesser saphenous vein: autogenous tissue for lower extremity revascularization.

From December 1980 to December 1985, 54 patients underwent 56 lower extremity arterial procedures with the use of lesser saphenous vein (LSV) as graft material. LSV was used in all cases because a satisfactory greater saphenous vein (GSV) was unavailable to accomplish the proposed revascularization. Indications for operation were rest pain, ulceration, and gangrene (74%), and 26% had claudication alone. Fifty of the 56 procedures were femorotibial and femoroperoneal bypasses. Three graft combinations were used: LSV alone (29), lesser saphenous vein and other autogenous vein composites (LSV/AUTO) (14), and lesser saphenous vein with synthetic composite grafts (LSV/SYN) (13). Graft patency rates were determined by life-table analysis. The 3-year patency rate for LSV was 60% and for LSV/AUTO was 38%. LSV/SYN graft composites had a graft patency rate at 18 months of 21%. These data suggest that the LSV may function as an autogenous venous graft for lower extremity revascularization when sufficient GSV is not available.

Arteriovenous Shunt, Surgical↗