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Biomedical subjects

G B Agus

Publications and source records attributed to G B Agus.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

[Pararenal aortic aneurysms: definition, classification, directions for surgery].

The formidable impact derived by the endovascular correction (Evar) of abdominal aorta aneurysms (AAA), has risen its classification aspects. The topographical criteria has assumed importance in decisional diagnostic-therapeutic strategy especially in cases of so called pararenal aneurysms (PRAA). DEFINITION: PRAA defines aneurysm being involved underenal juxtarenal aorta (JRA), or more rarely, suprarenal aorta with normal aortic diameter at level of celiac (JRA), or more rarely, suprarenal aorta with normal aortic diameter at level of celiac trunk. CLASSIFICATION: The morphologic-topographic aspect is considered in function of selection or eligibility of patients to Evar or standard open surgery, in the need of a suprarenal clamping for the tailoring of proximal anastomosis or anchorage of endoprotesis. Various specific classifications for these aneurysms have been proposed (Schumacher, 1997; Wolf, 2000; Ayari, 2001) that considers: 1. Aneurysm collar: short/long/tortuous, 2. Relations with renal arteries, 3. Relations with the left renal vein. DIRECTIONS FOR SURGICAL TREATMENT: The choice between the technical solution to prefer either open or endovascular surgery will have to consider a series of additional variables to the standard direction common to every AAA based on dimensions and morphology. Priority will have to be given to evaluating, using shared morphologic-topographical classification criteria, real incidence of PRAA-JRA (3%-20% in literature review); greater post opening mortality (1.3%-15.3%); dimensions (AAA with diameter > or = 5.5 cm in operating risk assessment of single patient, in clinical evolution and increase in the time of the lesion); in common occurrence in AAA of steno-obstructive lesions of renal arteries and involvement of same ones in the aneurysm collar in need of reconstruction and suprarenal aortic clamping.

Aortic Aneurysm, Abdominal↗
PubMedDate not supplied

Femoral noninfected anastomotic aneurysms. A report of 56 cases.

Fifty-six femoral non infected anastomotic false aneurysms (FAAs) were observed in 49 patients admitted to the Institute of Vascular Surgery, University of Milan, from 1975 to 1988; in 6 patients they were bilateral. These aneurysms developed after primary revascularization procedures at a mean interval of 66 months (range 12 to 156 months); one recurred after reparative surgery. Forty-four FAAs (78.6%) were asymptomatic, whereas 3 (5.3%) were complicated by acute expansion and 9 (16.1%) by thrombosis. Host vessel degeneration was the cause of aneurysm formation in most cases. A history of hypertension was present in 30% of the patients. All anastomotic aneurysms were operated upon except for one small aneurysm that was asymptomatic. In 5 patients aneurysm resection was carried out on both sides. The surgical technique was endoaneurysmectomy in all the cases with insertion of an interposition graft in 48 cases, a fabric patch in 2 cases and prosthesis re-anastomosis in 5 cases. One case of peripheral embolization occurring in the early postoperative period was successfully treated and there was no operative mortality. In our opinion elective repair of these aneurysms should be recommended whenever possible because of their propensity to develop serious complications and the operative morbidity is low.

Aged↗
PubMedDate not supplied

Thrombectomy for late graft limb occlusion: our experience in 182 consecutive cases.

Late occlusion of an aortofemoral bypass graft is usually caused by fibrointimal hyperplasia or progressive atherosclerosis. Several surgical approaches have been advocated in order to minimize the operative risk, to correct the impaired inflow and to provide a satisfactory outflow. In the last 16 years, in the Institute of Vascular Surgery and Angiology of the University of Milan, we have operated upon 182 consecutive thrombosed grafts. Inflow was restored by performing a graft limb thrombectomy using a Fogarty balloon catheter and simultaneously employing an endarterectomy ring stripper to dislodge tenaciously adherent fibrinous material and thrombotic plug. As the superficial femoral artery was generally occluded, usually a good outflow was achieved by profundaplasty in 101 cases (55.5%) or direct bypass (interposition graft), to a more distal segment of the profunda femoris artery in 55 cases (30.2%). Concomitant popliteal or tibial revascularization was done in the remaining 26 cases (14.3%) when pre-operative or intra-operative findings suggested an inadequate collateral network through the profunda femoris artery. Early re-occlusion, which occurred in 14 cases (7.6%), generally due to insufficient outflow, was corrected by additional intervention in 7 cases (3.8%), while 7 legs were amputated for extensive atherosclerotic disease. Six patients died giving a mortality rate of 3.3%. This low rate in a high risk population is probably related to our policy of operating under loco-regional anaesthesia. Long term results, with a patency rate of 62.0% at 3 years and 60.2% at 5 years (life table method), prove that this operation is a durable procedure for correction of graft limb thrombosis.

Aorta, Abdominal↗
PubMedDate not supplied

Slow release nifedipine in the treatment of Raynaud's phenomenon.

An ever increasing interest is shown towards calcium-antagonist drugs and in particular to nifedipine in the treatment of Raynaud's Phenomenon (R.P.) On this matter a randomized double-blind study with 40 mg/die slow release nifedipine versus placebo was carried out for 30 days on 24 patients affected by R.P.-idiopathic in 16 cases and secondary in the remaining 8 cases. The evaluation of the clinical situation (hand ischemic attacks, pain, skin trophism) and the structural one (capillaroscopy of the finger nail bed and strain-gauge digital plethysmography) could be performed on 17 patients since 7 dropped out. From the clinical point of view an improvement was observed especially in the reduction of the ischemic attacks (88.8% of patients treated with nifedipine vs. 25.0% treated with placebo). Capillaroscopic results showed an improvement in 100% of the cases treated with nifedipine vs. 12.5% with placebo (p less than 0.001), as well as an improvement of the basal digit blood pressure values and after cold test in 88.8% of patients treated with nifedipine vs. 12.5% treated with placebo (p less than 0.005) and (p less than 0.0025) respectively.

Adult↗
PubMedDate not supplied

The role of regional nerve block anesthesia for carotid endarterectomy: an experimental comparison with previous series with the use of general anesthesia and barbiturates for cerebral protection.

A retrospective analysis was performed on a consecutive series of 60 cases divided into two groups given carotid endarterectomy (C.E.) for atherosclerotic disease. In the first group general anesthesia and barbiturate cerebral protection were employed; in group two, loco-regional anesthesia. Indications and risk factors were similar in the two groups; the surgical procedure was identical. The differences in the results are reported and factors contributing to cerebral protection or reduction in the risk of stroke are analyzed. The analysis indicates that loco-regional anesthesia for C.E. is a reliable method for detecting cerebral ischemia and guaranteeing cerebral protection by means of a temporary shunt when strictly necessary.

Anesthesia, General↗
PubMedDate not supplied

Thrombosis prevention with ticlopidine after femoropopliteal thromboendarterectomy.

Fifty patients submitted to thromboendarterectomy in the femoropopliteal district for obstructive arterial disease of the lower limbs, documented angiographically, were randomly allocated to treatment with ticlopidine (500 mg/day) (T) or a placebo (P) in double-blind conditions. The treatment was started as soon as possible after the surgical intervention and was continued for six months or until a clinically evident reocclusion occurred. There were 46 patients available for assessment, 23 in each treatment group both of which were comparable in preoperative characteristics and type of surgery. Doppler ultrasonography at the end of treatment showed three cases of reocclusion of the operated segment in the T group versus six occlusions and seven significant stenoses in the P group (p = 0.003). Clinically, the active treatment significantly reduced the incidence of both acute ischemia during the treatment (four cases, all in the P group) and residual claudication at the end of treatment: in the T group five patients presented persistent or recurrent symptoms versus 16 in the P group (p = 0.001). Hemostatic function tests showed a marked inhibition of platelet activation in the T group. The treatment was well tolerated.

Aged↗
PubMedDate not supplied

Bypass procedures in the management of juxtarenal aortic occlusion.

Juxtarenal aortic occlusion is one of the most important though less frequent atherosclerotic lesions. The indications for surgical treatment using bypass techniques, are well known. However, controversy remains about the pathogenesis of the lesion; from either a thrombosis developing on an atherosclerotic lesion of the terminal aorta, or a primary atherosclerosis of the subrenal aorta. In our series of 1,180 patients submitted to surgery for aorto-iliac occlusive disease, we encountered 91 cases (7.7%) of juxtarenal occlusion. Apart from the different angiographic pictures, the patients were grouped on the operative finding of either thrombosis or atheroma. An aortobifemoral bypass graft was implanted on all but three of the cases; in these three we performed an axillo-bifemoral bypass. A different technique was used, for juxtarenal disobliteration, using a different (end-to-end, or end-to-side) suture of the proximal anastomosis. The operative indications and results are discussed.

Adult↗