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Biomedical subjects

J F Reidy

Publications and source records attributed to J F Reidy.

At least 37 records · Page 2Linked to original sources
PubMed1997

The concept of knee salvage: why does a failed femorocrural/pedal arterial bypass not affect the amputation level?

OBJECTIVES: There is continued controversy over whether a failed distal bypass influences the level of amputation. This issue is important as the number of arterial bypass grafts undertaken for critical ischaemia is increasing, followed by an increasing number of failed grafts. SETTING: Teaching hospital. STUDY DESIGN AND MATERIALS: A prospective analysis of 109 consecutive femorocrural/pedal bypass grafts performed between June 1991 and January 1995 on patients presenting with severe critical lower limb ischaemia (CLI) to a single vascular unit. A further 43 amputations for non-reconstructible distal disease were also analysed. CHIEF OUTCOME MEASURES: Mortality, amputation, rehabilitation, survival and knee salvage rates. The Kaplan-Meier method was used for comparison of factors associated with knee preservation. RESULTS: Primary amputees had a higher in-hospital mortality (18% vs. 10%) but similar 3 year survival rates (30%) compared with secondary amputees (36.6%). Patients with successful grafts showed a trend towards better survival (61.9% at 3 years) compared to amputees (38.6% at 42 months, p = 0.061). Below- to above-knee amputation ratio was similar in the two groups (0.85 in secondary vs. 0.95 in primary amputees). Factors significantly associated with knee salvage at 3 years were shown to be: the condition of the inflow (81.9% for good vs. 43.1% for impaired, p = 0.000) the state of the profunda femoris artery (good 93%, impaired 71%, occluded 37% p = 0.0001) and the graft material (vein 81.8% vs. PTFE 59.8%, p = 0.033). The presence of tissue loss (p = 0.0523) and secondary procedures (p = 0.0879) showed a trend to become significant. Multivariate and Cox regression analysis showed that the most important factors were the inflow (p = 0.001), the state of the profunda (p = 0.001), the graft material (p = 0.034) and previous revascularisation attempts (p = 0.019). CONCLUSIONS: The factors which determine knee loss are a compromised inflow state, the presence of an inadequate profunda femoris, previous revascularisation attempts and the use of synthetic graft material. Most of these factors (with the exception of infection related to revascularisation) are present before reconstructive arterial surgery is performed and this study shows that failure of a distal graft does not affect the final amputation level.

Aged↗
PubMed1997

Percutaneous angioplasty for infrainguinal graft-related stenoses.

OBJECTIVE: To assess the success of percutaneous transluminal angioplasty (PTA) in treating infrainguinal graft-related stenoses. DESIGN: Retrospective analysis of stenoses undergoing PTA over 6 years. MATERIALS: Fifty-seven stenoses in 42 grafts. METHODS: Site, length and type of stenoses recorded. Follow-up till discharge, graft occlusion or death. RESULTS: PTA was successful in 48/57 stenoses in 36 grafts (G), with a poor result in seven. Further PTA was required in seven stenoses (7 G). One graft occluded at PTA and one stenosis was inaccessible. Overall graft (G) patency (median 13 months) was 82% (1 year patency 84%). Of 48 successful PTAs (37 G), 36 remained patent (28 G), eight (4 G) occluded and four were lost to follow-up (4 G). Fourteen of thirty-six stenoses which remained patent required further intervention (seven PTA, six jump grafts, one vein patch). The four occlusions were associated with small veins (two), multiple stenoses (one) and a PTFE graft which occluded 10 days following PTA. Of the seven PTAs with a poor angiographic result, five remained patent, three after further intervention. CONCLUSION: PTA is the best treatment for localised stenoses. Stenoses > 2 cm or multiple (three or more) stenoses are best treated surgically. Follow-up is essential, as 20% require further intervention.

Angiography↗
PubMed1997

Outcome and cost analysis after femorocrural and femoropedal grafting for critical limb ischaemia.

BACKGROUND: The past decade has seen an increase in the use of distal arterial bypass grafts for treating critical lower limb ischaemia. However, this surgical policy is associated with variable results. The aims of this study were to identify factors that affect outcome and to calculate the cost of such surgical interventions. METHODS: A prospective analysis of femorocrural and femoropedal bypass grafts and primary amputations was performed between June 1991 and January 1995. A consecutive series of 109 limbs with critical lower limb ischaemia underwent a bypass graft to a single crural or pedal vessel shown on either preoperative intra-arterial digital subtraction angiography or at surgical exploration. Complete data were available for all patients during follow-up which ranged from 0 to 42 (median 12) months. The factors assessed were age, sex, diabetes, pedal arch, graft material, outflow vessel, number of calf vessels, number of vessels crossing the ankle, inflow state, previous revascularization procedures and foot gangrene and tissue necrosis. Chief outcome measures were survival, knee and limb salvage, patency rates and hospital cost. The Kaplan-Meier method was used to construct life tables and the log rank test for comparison of factors. Cost was measured according to National Health Service criteria, and comparisons were made by the Mann-Whitney U test. RESULTS: At 36 months primary patency was 27 per cent, primary assisted patency 31 per cent and secondary patency 45 per cent; limb salvage was 54 per cent, knee salvage 73 per cent and survival 58 per cent. Significant factors in predicting outcome were graft material (P = 0.004), inflow state (P = 0.0001), number of calf vessels (P = 0.039), number of vessels crossing the ankle (P < 0.0001) and the condition of pedal vessels (P < 0.0001). Cost analysis showed that the median price for a successful bypass was 4320 pounds, that of a failed bypass leading to amputation 17,066 pounds and that of primary amputation in patients with non-reconstructable distal disease 12,730 pounds. CONCLUSION: The patency rate of femorotibial and peroneal bypass depends on the inflow state, the availability of a venous conduit, the number of calf vessels, the presence of straight flow to the foot and the presence of patent pedal vessels. These factors can help in the selection of patients for femorodistal reconstruction and may explain the wide variation in published results. The low cost of revascularization compared with amputation justifies attempted reconstruction. However, repeated attempts to reconstruct patients with severe distal disease who may benefit more from primary amputation will significantly increase the cost.

Aged↗
PubMed1996

Endovascular repair of residual iliac artery aneurysms following surgery for ruptured abdominal aortic aneurysm.

Emergency repair of ruptured abdominal aortic aneurysm continues to have a high mortality. Such patients require expeditious operations to repair the ruptured segment rather than attempts to deal with all coexisting disease. The use of endovascular techniques obviates the need for open surgery to repair iliac aneurysms. We report two patients who, after successful repair of ruptured abdominal aortic aneurysms, had three iliac artery aneurysms treated successfully by embolisation in one case and percutaneous insertion of a self expandable stent graft in two cases. The issues that arise from such an approach are discussed with a review of the literature.

Aged↗
PubMed1996

Short communication: tunnelled central venous catheter insertion via the internal jugular vein using a dedicated portable ultrasound device.

We describe the use of a purpose-built portable ultrasound device to assist puncture of the internal jugular vein during percutaneous insertion of tunnelled central venous catheters such as Hickman lines. In many situations the internal jugular route is safer, faster and less costly in comparison with the subclavian approach. The use of ultrasound allows an accurate initial venous puncture with fewer complications, in the hands of both experienced operators and those less familiar with the internal jugular vein approach.

Ambulatory Care↗
PubMed1996

Non-invasive assessment of arterial disease: a comparison of Quickscan with intra-arterial digital subtraction angiography.

The ability of Quickscan to identify haemodynamically significant lesions in the arteries of the lower limb was studied. Quickscan was prospectively compared with intra-arterial digital subtraction angiography (IADSA) of the iliac, femoral and popliteal arteries. In 155 patients, 631 arterial segments were evaluated. A Quickscan frequency ratio of 1:3 or greater had a sensitivity of 93 per cent and a specificity of 85 per cent in detecting a stenosis of more than 50 per cent diameter reduction (67 per cent area reduction) in the iliac artery, as shown on IADSA. The sensitivity and specificity in the femoral artery were 85 and 96 per cent respectively, and in the popliteal artery 82 and 98 per cent respectively. In the detection of occlusion, Quickscan had a sensitivity and specificity of 84 and 98 per cent respectively in the iliac artery, 94 and 97 per cent respectively in the femoral artery, and 94 and 85 per cent respectively in the popliteal artery. Quickscan is an inexpensive, quick and non-invasive method of screening for peripheral vascular disease in the lower limb.

Adult↗
PubMed1996

Mid-aortic syndrome presenting in childhood.

Mid-aortic syndrome (MAS) is an uncommon condition characterized by segmental narrowing of the proximal abdominal aorta and ostial stenosis of its major branches. It is usually diagnosed in young adults, but may present in childhood as a challenging problem. Over the past 20 years 13 patients with MAS have presented to this institution. All had hypertension, four had associated neurofibromatosis, three persistent eosinophilia and three had Williams syndrome. In all cases arteriography showed a smooth segmental narrowing of the abdominal aorta with concomitant stenosis at the origins of the renal arteries. Six children were successfully treated with antihypertensive medication alone. Percutaneous transluminal angioplasty was attempted in two cases with poor result. Surgery was indicated in seven children with refractory hypertension and progressive renal impairment. Techniques used to revascularize the kidneys included thoracoabdominal to infrarenal aortic bypass with renal artery reimplantation, splenorenal bypass, gastroduodenal to renal bypass, aortorenal bypass and autotransplantation.

Adolescent↗
PubMed1995

Impedance analysis compared with Quickscan in the detection of graft-related stenoses.

OBJECTIVE: To compare two methods of detecting graft stenoses after infrainguinal bypass. DESIGN: Prospective study. SETTING: Vascular Laboratory, University Hospital. MATERIALS: 110 infrainguinal graft studies (60 vein, 50 PTFE) in 74 patients were performed prospectively to detect graft-related stenoses. CHIEF OUTCOME MEASURES: The diagnostic accuracy of computer assisted impedance analysis was assessed using Quickscan (QS) as the gold standard in the detection of graft-related stenoses. CHIEF RESULTS: QS showed occlusion in 4 grafts (two vein and two PTFE), no stenosis in 86 graft studies and stenoses in 20 studies. All 12 stenoses with a frequency ratio > or = 1.4, were confirmed with intraarterial digital subtraction angiography (IADSA). Eight stenoses with a frequency ratio of 1:3 continued graft surveillance. The median thigh impedance score of vein grafts with QS confirmed stenoses was 0.51 (0.36-0.70) compared with 0.44 (0.30-0.60) for non-stenosed vein grafts (p = 0.015, Mann-Whitney U test). The median thigh impedance score in PTFE graft with QS confirmed stenosis was 0.58 (0.53-0.76) compared with 0.42 (0.28-0.73 for non-stenosed grafts (p = 0.0001). An impedance score > 0.45 has been suggested for detection of "at risk" grafts. Using QS as the gold standard, impedance assessment gave 90% sensitivity, 63% specificity in the thigh; 80%, 52% in the calf and 90%, 46% taking the higher score on calf for thigh data. Taking a QS frequency ratio of 1:4 as indicating a significant stenosis (50% diameter reduction), 11% (12/106) of surveillance studies went on to intervention, that is 12/74 (16%) grafts. CONCLUSIONS: If the higher impedance score derived from either the calf or thigh was used to detect stenoses, 60% (64/106) of graft studies would have been referred for intervention. We believe this high level of intervention is unrealistic and cannot therefore recommend impedance analysis for graft surveillance.

Angiography, Digital Subtraction↗
PubMed1993

Radiographic patterns of intrathoracic disease in breast carcinoma: prognostic implications.

The chest radiographic appearances of patients with intrathoracic metastases from breast cancer are variable and their relationship to patient outcome is unknown. This study aimed to classify and determine the frequency of various radiographic patterns and, in addition, to establish whether these patterns can be used to predict patient prognosis. A retrospective study was made of the patients of a major breast unit who over a 3 year period were found to have developed intrathoracic metastases. In each case, the earliest plain chest X-ray showing signs of metastasis was reviewed and the frequency of the different radiographic patterns determined. Comparison was made between these patterns and patient mortality. The chest radiographs of 92 patients who developed intrathoracic metastases during a 3 year period were analysed. Pulmonary nodules were found in 66%, pleural effusions in 41% (bilateral in 18%), lymphadenopathy in 25%, lymphangitis in 18% and pleurally-based nodules in 11%. Median survival of the whole group was 13.5 months. Patients with bilateral, but not unilateral, effusions had a significantly poorer prognosis (median survival 3 months). Although the median survival of patients with lymphangitis seemed poor (5.5 months), this difference was not statistically significant. Multivariate analysis showed bilateral effusions to be the only independent predictor of worse outcome. We have found that of the plain radiographic patterns seen in intrathoracic metastasis from breast cancer, only bilateral pleural effusions can be used to predict a worse prognosis than that associated with intrathoracic metastasis as a whole.

Adult↗