Search PubMed⌕ Search

Biomedical subjects

J M Edwards

Publications and source records attributed to J M Edwards.

At least 37 records · Page 2Linked to original sources
PubMed1999

Raynaud's syndrome in workers who use vibrating pneumatic air knives.

PURPOSE: The use of vibrating tools has been shown to cause Raynaud's syndrome (RS) in a variety of workers, including those who use chain saws, chippers, and grinders. The diagnosis of RS in workers who use vibrating tools is difficult to document objectively. We studied a patient cohort with RS caused by the use of a vibrating pneumatic air knife (PAK) for removal of automobile windshields and determined our ability to document RS in these workers by means of digital hypothermic challenge testing (DHCT), a vascular laboratory study that evaluates digital blood pressure response to cooling. METHODS: Sixteen male autoglass workers (mean age, 36 years) with RS were examined by means of history, physical examination, arm blood pressures, digital photoplethysmography, screening serologic studies for underlying connective tissue disorder, and DHCT. RESULTS: No patient had RS before they used a PAK. The mean onset of RS (color changes, 100%; pain, 93%; parathesias, 75%) with cold exposure was 3 years (range, 1.5 to 5 years) after initial PAK use (mean estimated PAK use, 2450 hours). Fifty-six percent of workers smoked cigarettes. The findings of the physical examination, arm blood pressures, digital photoplethysmography, and serologic testing were normal in all patients. At 10 degrees C cooling with digital cuff and patient cooling blanket, a significant decrease in digital blood pressure was shown by means of DHCT in 100% of test fingers versus normothermic control fingers (mean decrease, 75%; range, 25% to 100%; normal response, less than 17%; P <.001). The mean follow-up period was 18 months (range, 1 to 47 months). No patient continued to use the PAK, but symptoms of RS were unchanged in 69% and worse in 31%. CONCLUSION: PAK use is a possible cause of vibration-induced RS. The presence of RS in workers who use the PAK was objectively confirmed by means of DHCT. Cessation of PAK use in the short term did not result in symptomatic improvement.

Adult↗
PubMed1999

Improved results with conventional management of infrarenal aortic infection.

PURPOSE: Interest in alternative methods, such as autogenous vein grafts and aortic allografts, for the management of infrarenal aortic infection (IRAI) has been stimulated by the historically disappointing results with conventional surgical management. Recently, there have been dramatic improvements in the results of axillofemoral bypass grafting (AXFB) followed by excision of the IRAI that have gone relatively unrecognized. The purpose of this report is the presentation of modern-day results in the treatment of IRAI with conventional surgical methods. METHODS: From January 1, 1983, through June 30, 1998, patients with IRAI underwent treatment with AXFB and complete excision of the IRAI. The patients were followed for survival, limb salvage, and AXFB graft patency. The results were tabulated with life-table methods. RESULTS: During the 15-year study period, 60 patients (51 men, nine women; mean age, 68 years) underwent treatment for IRAI (50 graft infections, including 16 graft-enteric fistulae, and 10 primary aortic infections). The mean follow-up period was 41 months. The perioperative mortality rate was 13% (12% for graft infection, and 20% for primary infection). The overall 2-year and 5-year survival rates were 67% and 47%, respectively. The limb salvage rates at 2 and 5 years were 93% and 82%, respectively. The 5-year primary AXFB graft patency rate was 73%. CONCLUSION: These results show an improvement with the conventional management of IRAI equal or superior to those results reported with alternative methods, including femoral vein grafts or aortic allografts. These results should be regarded as the modern standard with which alternative therapies can be compared.

Aged↗
PubMed1999

Vascular surgery and the Internet: a poor source of patient-oriented information.

OBJECTIVE: Increasing numbers of patients use the Internet to obtain medical information. The Internet is easily accessible, but available information is under no guidelines or regulations. We sought to evaluate the type, quality, and focus of vascular disease information presented on the Internet and the role in patient education with simple search techniques. METHODS: The arbitrarily chosen search phrases "abdominal aortic aneurysm (AAA)," "carotid surgery (CEA)," "claudication surgery," and "leg gangrene surgery" were entered into five common Internet search engines. No attempt was made to refine searches. As indicated by the search engines, the 50 most commonly encountered web sites for both AAA and CEA were reviewed. The first 25 claudication sites and the first 25 gangrene sites were combined for a total of 50 leg ischemia (LIS) sites. An information score (IS) was developed as a weighted score ranging from 0 (poor) to 100 (outstanding) and was designed to assess how well the web page educated the patient about the disease, the treatment options, and the medical and surgical complications. Each vascular surgery web site was classified according to the author, the referenced information source, and the therapeutic recommendations. This was followed by an evaluation of each web site with the IS independently scored by two observers. RESULTS: Of the 150 web sites, 146 were accessible. Ninety-six sites (65.8%) had no useful patient-oriented information (IS < 10). The mean IS and the ranges were: AAA, 14.9 (0 to 72.0); CEA, 17.5 (0 to 77.0); and LIS, 12.2 (0 to 44.5; P =.9). The mean IS of the 59 sites with scores of more than 10 were: AAA, 39.8 (n = 17); CEA, 44.8 (n = 19); and LIS, 24.8 (n = 23; P <.01, as compared with LIS scores). Differences in IS between observers were not significant (P =.9). Misleading or unconventional care recommendations were recognized in one AAA site (1 of 47, 2.1%), two CEA sites (2 of 49, 4.1%), and 13 LIS sites (13 of 50, 26.0%). The Joint Vascular Societies web page was identified only as a tertiary link. CONCLUSION: Patient-oriented vascular surgery information, for common vascular diseases, is difficult to find on the Internet. The overall quality is poor, and information is difficult to obtain in part because of the large number of irrelevant sites. Of the sites that were relevant to patient education (33%), one third presented information that was classified by the authors as misleading or unconventional. This was most apparent in the leg ischemia sites. The Internet is a poor overall source of patient-oriented vascular surgery information and education. Focused and refined searches and improvements in search engines and educational web sites may yield improved information. Public and medical community awareness needs to be improved regarding the severe limitations of the Internet as an information resource.

Aortic Aneurysm, Abdominal↗
PubMed1999

Duplex scanning alone is not sufficient imaging before secondary procedures after lower extremity reversed vein bypass graft.

PURPOSE: Duplex surveillance of lower extremity reversed vein bypass grafts (LERVG) is a means of identifying patients at risk for occlusion. The perceived accuracy of duplex scan as a means of identifying stenoses has led many surgeons to perform graft revision on the basis of duplex scan alone. This may result in missing additional lesions that are threatening patency. To assess the role of duplex scan as the sole imaging method before revision of LERVGs, we reviewed consecutive patients undergoing revisions who underwent preoperative arteriography after identification of duplex scan abnormalities. METHODS: Duplex scan results, operative reports, and preoperative arteriograms for patients undergoing LERVG revision from January 1990 to December 1997 were reviewed. A standard duplex scan surveillance protocol was followed, and attempts were made to survey the entire graft, including inflow and outflow. Duplex scan results were compared with the results of preoperative arteriograms and the operation performed to determine if all significant lesions were identified by means of duplex scan alone. RESULTS: Two hundred five LERVG revisions were performed. The 5-year assisted primary patency rate was 91%. In 119 cases (58%), arteriography did not contribute significantly to duplex scan findings. Arteriography significantly contributed to operative planning in 86 cases (42%). In 38 cases (19%), only a low-flow state was identified by means of duplex scan, and a correctable stenosis was identified by means of arteriography. In 48 cases (23%), additional significant lesions corrected at operation were identified by means of arteriography. These included 26 inflow, 16 graft, and 8 outflow lesions. Arteriography was most useful as a means of determining the revision procedure performed when there were inflow lesions (P <.05) or when the proximal anastomosis was to the profunda or superficial femoral arteries (P <.05). All frequently performed bypass graft configurations had some discrepancy between arteriographic and duplex scan findings. CONCLUSION: Available data do not permit prediction of which LERVG are immune from missed lesions in a duplex scan surveillance protocol. This suggests to us that arteriography is mandatory before LERVG revisions.

Aged↗
PubMed1999

Non-heart-beating organ donation: process and review.

To combat the national shortage of donor organs and meet the needs of more than 60,000 patients awaiting transplant, many organ procurement organizations have reevaluated non-heart-beating organ donation (NHBD) as one solution. Non-heart-beating donation is the process by which organs are recovered from patients after the pronouncement of death by cardiopulmonary criteria. Recent media reports have misled health care providers to believe that this is a new donation procedure; however, NHBD provided the foundation for modern clinical transplantation. This article describes non-heart-beating donor evaluation criteria, the donation process, associated ethical considerations and the role of the advance practice nurse in assisting families with this end-of-life decision. A case study will be presented followed by a summary of transplant recipient patient and graft survival outcomes.

Adolescent↗
PubMed1998

Predictors of outcome of forefoot surgery for ulceration and gangrene.

BACKGROUND: Surprisingly little is known about the long-term outcome of forefoot surgery for limb salvage. METHODS: From January 1, 1992 through December 31, 1996, patients requiring toe amputation or forefoot surgery were prospectively entered into a computerized database and followed up for healing, need for repeat foot surgery, or major amputation (below or above knee). RESULTS: A total of 162 patients (mean age 65 years), 72% diabetic, 10% with end-stage renal disease (ESRD), and 73% without palpable pulses, were entered into the study. Mean follow-up was 25 months. Of patients without palpable pulses (n = 98), 83% underwent concomitant or subsequent limb revascularization. Eleven of 98 revascularization procedures (11%) were hemodynamically unsuccessful. Nonhealing of the initial forefoot procedure occurred in 14%, and late repeat foot surgery (following initial healing) was required in an additional 14%. Major amputation was eventually required in 30 (18.5%) patients. Multivariate analysis indicated that unsuccessful revascularization, but not diabetes or ESRD, predicted nonhealing and major amputation (P <0.0001). Patients presenting with palpable pulses and neuropathic ulcers were at risk for late, repeat foot surgery, but not major amputation (P = 0.0015). CONCLUSIONS: In patients requiring toe or partial forefoot amputation, success of revascularization is the primary predictor of initial healing and freedom from major amputation. Neuropathic ulceration predicts need for repeat foot surgery following healing.

Adult↗
PubMed1998

Surgical treatment of infected aortic aneurysm.

BACKGROUND: We report results of infected aortic aneurysms treated by a single group over 20 years. METHODS: Retrospective review. RESULTS: Seventeen patients were treated, 10 with infrarenal and 7 suprarenal infections. All had abdominal/back pain, 88% were febrile, 71% had leukocytosis, and 24% were hemodynamically unstable. The most common responsible organism was Staphylococcus aureus (29%) followed by Salmonella organisms (24%). All suprarenal infections were gram-positive organisms. Infrarenal infections were treated with preliminary axillofemoral bypass followed by aortic resection. Suprarenal infections were treated with either in situ prosthetic graft or patch repairs. Operative survival was 90% for infrarenal and 57% for suprarenal infections. Operative deaths occurred in the setting of overwhelming sepsis and/or severe preoperative hemodynamic instability. There was no limb loss, renal failure, or intestinal ischemia. Late deaths occurred in 4 patients at 1.3 to 6.3 years postoperatively and were unrelated to their aortic repairs. Nine patients remain alive with a median follow-up of 2 years. There have been no late aortic or graft infections. CONCLUSIONS: In the absence of hemodynamic instability and uncontrolled sepsis, infected aortic aneurysms can be successfully repaired with durable results.

Adult↗
PubMed1998

Inferior epigastric artery pseudoaneurysm: a complication of paracentesis.

Two patients had inferior epigastric artery pseudoaneurysms after therapeutic paracentesis for ascites caused by portal hypertension. The first patient, a 62-year-old man, had a two-week history of left lower quadrant pain, tenderness, and nonpulsatile mass after a paracentesis for ascites. A left inferior epigastric artery pseudoaneurysm measuring 10 cm in diameter and 20 cm in length was diagnosed by means of Duplex ultrasound and arteriography. The patient was treated with percutaneous embolization, with successful thrombosis of the pseudoaneurysm. The second patient, a 33-year-old woman, had a six-week history of left lower quadrant pain, tenderness, and nonpulsatile mass after a paracentesis for ascites. Computerized tomography and arteriography showed a left inferior epigastric artery pseudoaneurysm, measuring 7 cm in diameter and 9 cm in length. The patient was treated with percutaneous embolization with successful thrombosis of the pseudoaneurysm. Both patients were discharged in good condition 2 days after embolization. Inferior epigastric artery pseudoaneurysm is a complication of paracentesis, and percutaneous embolization may be preferable to surgical repair in patients with chronic liver failure and portal hypertension.

Adult↗
PubMed1998

Prophylactic repair of renal artery stenosis is not justified in patients who require infrarenal aortic reconstruction.

PURPOSE: Simultaneous prophylactic repair of asymptomatic renal artery stenosis (ARAS) in patients who require infrarenal aortoiliac reconstruction is controversial. This study documents the natural history of ARAS in patients who require aortic reconstruction. METHODS: Two hundred patients who required aortic reconstruction from 1985 to 1990 for indications other than hypertension or renal salvage were identified. ARAS was not repaired. Preoperative angiograms were available for 171 of 200 patients and were reviewed for renal artery stenosis. Patients were assessed for atherosclerotic risk factors, survival, preoperative and follow-up blood pressure, serum creatinine level, antihypertensive medication usage, and need for dialysis. RESULTS: The mean duration of follow-up was 6.3 years. Twenty-four of 171 patients (14%) had preoperative unilateral 70% to 99% diameter reduction ARAS, and eight (5%) had bilateral 70% to 99% ARAS. Clinical features associated with > or =70% ARAS included coronary artery disease, increased age, and a diagnosis of hypertension (p < 0.05). Patients with > or =70% ARAS did not have a decreased 7-year survival rate (66% vs 84%; p = 0.10) but had higher systolic blood pressures (153 +/- 25 vs 138 +/- 30 mm Hg; p < 0.05) as well as increased numbers of antihypertensive medications at follow-up (1.1 +/- 0.2 vs 0.7 +/- 1; p < 0.05). The mean serum creatinine level (1.1 +/- 0.3 preoperative vs 1.4 +/- 0.8 mg/dl; p = NS) was not increased. One patient (0.58%) with polycystic kidney disease and minimal renal artery stenosis required dialysis. CONCLUSIONS: High-grade ARAS in patients who are undergoing infrarenal aortic reconstruction is associated at late follow-up with increased systolic blood pressure and a need for increased numbers of antihypertensive medications, but not decreased survival rate, dialysis dependence, or an increase in serum creatinine level. These data do not support renal artery repair in patients with ARAS who undergo infrarenal aortic reconstruction.

Aorta, Abdominal↗
PubMed1998

Upper extremity arterial disease: etiologic considerations and differential diagnosis.

Upper extremity ischemia is an unusual clinical entity. Using a careful history and physical examination, detailed vascular laboratory testing, serological tests, and occasionally arteriography, it is possible to determine the cause in most patients. Most patients presenting with upper extremity ischemia have small vessel disease that is not amenable to surgical treatment. The primary treatment of upper extremity ischemia remains cold avoidance, with pharmacological treatment added in a limited number of patients. A patient's long-term prognosis can be determined based on initial serological studies and the presence or absence of arterial obstruction. Patients with no serological or arterial abnormalities usually continue to have upper extremity ischemic symptoms, but these remain only a nuisance. Patients with either serological abnormalities or arterial obstruction have a mild to moderate risk of progressive symptoms. Those patients with combined serological abnormalities and arterial obstruction at presentation are most likely to have continued difficulties. A significant number of these patients, approximately 50%, are most symptomatic at the time of initial presentation and improve under follow-up.

Angiography↗
PubMed1997

Pulmonary embolism is associated with the combination of isolated calf vein thrombosis and respiratory symptoms.

PURPOSE: Overall prevalence of pulmonary embolism (PE) in patients with deep venous thrombosis (DVT) isolated to calf veins is low. However, the prevalence of PE in the subgroup of patients with respiratory symptoms and isolated calf vein thrombosis (CVT) is unknown. Such information is important in determining whether patients with CVT only and respiratory symptoms should undergo evaluation for PE. The purpose of this study was to determine the prevalence of PE in patients with respiratory symptoms and isolated CVT. METHODS: From 1992 through 1994, all patients assessed by duplex scanning for lower extremity DVT were reviewed, and those found to have isolated CVT and lower extremity or respiratory symptoms were identified. Patients who had respiratory symptoms or later developed respiratory symptoms in addition to lower extremity symptoms underwent pulmonary angiography or ventilation/perfusion (V/Q) scanning. Positive results on pulmonary arteriograms or "high probability" V/Q scans were considered diagnostic of PE. RESULTS: There were 105 patients with isolated CVT and symptoms. Twenty-six patients had respiratory symptoms; nine (35%) had PE and two died. Seventy-nine patients had only lower extremity complaints; five later developed respiratory symptoms. All five had PE and none had progression of CVT on repeat duplex scanning. Neither age, gender, prior DVT/PE, obesity, pregnancy, medication, known malignancy, smoking, recent surgery, or trauma predicted PE. CONCLUSIONS: Patients with respiratory symptoms and duplex diagnosed isolated CVT have a high prevalence of PE and require pulmonary angiographic or V/Q scanning to rule out PE.

Adult↗
PubMed1996

Upper extremity thromboembolism after axillary-axillary bypass grafting.

Two patients experienced upper extremity thromboembolism after axillary-axillary bypass grafting (AxAG) for symptomatic subclavian artery stenosis. The first patient, a 67-year-old male, presented with left upper extremity thromboembolism 3 years after AxAG with 8 mm externally support PTFE. An arteriogram revealed a patent AxAG, thrombus in the proximal left subclavian arterial stump just distal to its occlusion, and multiple digital artery emboli. The patient was treated with warfarin for 8 months, with resolution of symptoms. The second patient, a 57-year-old male, occluded his AxAG (8 mm knitted Dacron) with minimal return of symptoms. Non-operative treatment was elected and 4 years later the patient presented with right upper extremity (donor side) thromboembolism. Arteriography revealed occlusion of the AxAG, radial artery, and digital arteries of the index, long and ring fingers. Thrombolytic therapy of the right arm was undertaken with minimal improvement. Subsequent detachment of the AxAG and placement of an interposition reversed saphenous vein graft was performed. Both patients continue to be asymptomatic during follow-up of 4.7 and 2.0 years, respectively.

Aged↗
PubMed1996

"Just in time" decision making for ICU care after carotid endarterectomy.

BACKGROUND: Many patients undergoing carotid endarterectomy (CE) do not require active intensive care unit (ICU) care (AIC). Until recently, all patients spent 24 hours postoperatively in an ICU, but many of these patients were simply monitored and did not need unique ICU services. METHODS: To aid in developing a selective policy for ICU admission following CE, we reviewed preoperative risk factors, recovery room course, and total hospital stay of 126 patients for 2 years when postoperative ICU admission was routine. Preoperative assessment included presence or absence of cardiac disease, hypertension, severe respiratory disease, diabetes, arrhythmia, renal failure, and a Goldman cardiac risk score. The operative, recovery room, and ward records were reviewed for conditions requiring AIC. Requirement for AIC was defined as need for infusion of vasoactive, bronchodilator, or antiarrhythmic medication beyond the recovery room period. In addition, treatment for coronary ischemia or MI, need for active diuresis, perioperative neurological event, or requirement for mechanical ventilation were indications for AIC. RESULTS: There were 132 CEs in 126 patients; 37% required AIC as defined above. When patients who required AIC were compared with patients not requiring AIC, the only significant difference was the number of risk factors per patient. Goldman cardiac risk class I patients were at less risk for cardiac morbidity than the combined Class II and III patients. CONCLUSIONS: In an individual patient, preoperative risk assessment does not aid in predicting the need for AIC following CE. Selection of patients for ICU admission following CE can be accurately determined by a short period of recovery room observation.

Aged↗
PubMed1996

Long-term outcome of Raynaud's syndrome in a prospectively analyzed patient cohort.

PURPOSE: Knowledge of the long-term clinical outcome of Raynaud's syndrome (RS), essential both for patient counselling and formulation of optimal therapeutic recommendations, is conspicuously deficient in current medical literature. We have prospectively monitored 1039 patients with RS, 118 (11.4%) for more than 10 years to determine whether initial characterization was able to predict outcome. METHODS: At initial presentation, patients were divided into four groups on the basis of vascular laboratory and serologic testing results: vasospastic, serologically positive (spast,sero+) and negative (spast,sero-) and obstructive, serologically positive (obst,sero+) and negative (obst,sero-). RESULTS: Connective tissue disease (CTD) was present initially in 48.6% of patients with spast,sero+ results and 72.9% of patients with obst,sero+ results. Of the remaining patients in these groups, progression to CTD during follow-up occurred in 16.4% of patients with spast,sero+ results and 30.4% of patients with obst,sero+ results. In the > 10-year follow-up group, progression to CTD occurred in 81.8% of patients in the obst,sero+ group. Progression to CTD occurred in 2.0% of patients in the spast,sero-group and 8.5% of patients in the obst,sero- group. Digital ulcers occurred in 15.5% of patients in the spast,sero+ group, 5.2% of patients in the spast,sero- group, 55.6% of patients in the obst,sero+ group, and 48.2% of patients in the obst,sero- group. Digital or phalangeal amputations were required in 1.4%, 1.6%, 11.6%, and 19.0% of these patients, respectively. CONCLUSIONS: The long-term outcome of patients with RS can be predicted by initial serologic studies and separation into vasospastic and obstructive categories. Initial serologic positivity strongly predicts the development of CTD. Initial vascular laboratory classification of obstructive RS strongly predicts digital ulcerations, which occurred in half of these patients regardless of initial serologic study results. Amputations were required in 10% to 20% of patients with obstructive RS. These occurrences did not increase with increased duration of disease. Ulcerations and amputations were rare in patients initially with vasospastic RS.

Adult↗
PubMed1996

Prospective comparison of infrainguinal bypass grafting in patients with and without antiphospholipid antibodies.

PURPOSE: The antiphospholipid antibodies (APL)-anticardiolipin antibodies (ACL) and lupus anticoagulant (LA)-are widely believed to be associated with decreased lower extremity bypass graft patency rates. To date, no prospective cohort study has confirmed this assumption. A prospective comparison of the result of infrainguinal revascularization procedures performed since 1990 in patients with and without APL forms the basis of this report. METHODS: Patients who underwent elective infrainguinal bypass procedures from 1990 to 1994 were evaluated for hypercoagulable states (ACL, LA, protein C, protein S, and antithrombin III). Patient data were prospectively entered in a computerized vascular registry, and postoperative follow-up was maintained for life. Graft patency, limb salvage, and patient survival rates were calculated by life-table methods. RESULTS: Three hundred twenty-seven lower extremity bypass grafting procedures were performed in 262 patients. APLs were present in 83 patients (32%); 70 patients (84%) had ACLs only, 11 patients (13%) had LA only, and two patients (3%) had both ACLs and LA. There was no significant difference between APL-positive and APL-negative patients with respect to demographics, associated medical conditions, indication for operations, and type of procedures performed. More patients who had APLs had warfarin treatment after surgery (43% vs 24%, p = 0.002). Life table 4-year primary patency rates showed minimal difference (APL-positive, 43%; APL-negative, 59%; p = 0.087), and no significant difference was noted in assisted primary patency rates (APL positive, 72%; APL negative, 73%; p = NS), limb salvage rates (APL positive, 79%; APL negative, 88%; p = NS), and patient survival rates (APL positive, 67%; APL negative, 66%; p = NS). CONCLUSIONS: APLs were found in a surprising one third of the patients who underwent leg bypass grafting procedures. The majority of APLs identified were ACLs (87%). There was minimal difference in graft primary patency rates, and no difference in assisted primary patency, limb salvage, and survival rates between patients with and without APLs who underwent leg bypass grafting procedures. The extreme morbidity rate associated with APLs in previous reports is not confirmed by this prospective study. APLs should not be regarded as a contraindication to indicated leg bypass grafting procedures.

Aged↗
PubMed1996

Improving selection of patients with less than 60% asymptomatic internal carotid artery stenosis for follow-up carotid artery duplex scanning.

PURPOSE: The Asymptomatic Carotid Atherosclerosis Study (ACAS) indicated significant benefit from endarterectomy compared with medical therapy for patients with 60% to 99% asymptomatic internal carotid artery (ICA) stenoses. To date, optimal selection of patients for vascular laboratory follow-up to determine progression from < 60% to > or = 60% asymptomatic ICA stenosis is unknown. To determine which patients with < 60% asymptomatic ICA stenoses are at greatest risk for short-term progression to > or = 60% without symptoms, we reviewed vascular laboratory results and clinical risk factors of consecutive patients who were prospectively observed in a study of atherosclerosis progression. METHODS: Carotid duplex studies were obtained every 6 months and were reviewed for progression from < 60% to > or = 60% asymptomatic ICA stenosis by using criteria that were developed and reported by our laboratory. Clinical risk factors and velocities from initial duplex scans were analyzed for association with progression from < 60% to > or = 60% ICA stenoses without symptoms. RESULTS: Two hundred sixty-three patients (mean age, 66 years) with 434 asymptomatic < 60% ICA stenoses were prospectively observed for a mean of 20 months, with a mean of four examinations per patient. Seventeen patients (6.5%) and 18 ICAs (4%) progressed without symptoms to > or = 60% ICA stenoses at a mean of 18 months. Clinical risk factors associated with progression to > or = 60% asymptomatic ICA stenosis included elevated systolic blood pressure and decreased ankle-brachial index (p = 0.05). The mean initial ICA peak systolic velocity (PSV) in ICAs that progressed to > or = 60% asymptomatic stenoses was 180 cm/sec, compared with 104 cm/sec in asymptomatic ICAs that did not progress to > or = 60% (p = 0.0003). Thirty-one percent of asymptomatic ICAs that had initial PSVs of 175 cm/sec or greater progressed to > or = 60% stenosis, whereas only 1.8% that had initial PSVs less than 175 cm/sec progressed to > or = 60% asymptomatic stenoses (p < 0.001). The life-table-determined rate of freedom from progression to > or = 60% stenosis was 94% at 4 years for asymptomatic ICA lesions that had initial PSVs less than 175 cm/sec, compared with 14% at 3 years for lesions that had initial PSVs > or = 175 cm/sec. CONCLUSIONS: Early progression from < 60% asymptomatic ICA stenoses to > or = 60% asymptomatic ICA stenoses occurs infrequently. Patients who are at the greatest risk of early progression without symptoms to an ACAS-positive lesion can be identified from the ICA PSV at their initial duplex examination. Early vascular laboratory follow-up of asymptomatic ICA stenoses may be limited to a relatively small group.

Aged↗
PubMed1996

Comparison of axillofemoral and aortofemoral bypass for aortoiliac occlusive disease.

PURPOSE: A comparison of aortofemoral bypass grafting (AOFBG) and axillofemoral bypass grafting (AXFBG) for occlusive disease performed by the same surgeons during a defined interval forms the basis for this report. METHODS: Data regarding all patients who underwent AOFBG of AXFBG for lower-extremity ischemia caused by aortoiliac occlusive disease were prospectively entered into a computerized vascular registry. The decision to perform AOFBG rather than AXFBG was based on assessment of surgical risk and the surgeon's preference. This report describes results for surgical morbidity, mortality, patency, limb salvage, and patient survival for procedures performed from January 1988 through December 1993. RESULTS: We performed 108 AXFBGs and 139 AOFBGs. AXFBG patients were older (mean age, 68 years compared with 58 years for AOFBG, p<0.001), more often had heart disease (84% compared with 38%, p<0.001), more often underwent surgery for limb-salvage indications (80% compared with 42%, p<0.001). No significant differences were found in operative mortality (AXFBG, 3.4%; AOFBG, <1.0%, p=NS), but major postoperative complications occurred more frequently after AOFBG (AXFBG, 9.2%; AOFBG, 19.4%; p<0.05). Follow-up ranged from 1 to 83 months (mean, 27 months). Five-year life-table primary patency, limb salvage, and survival rates were 74%, 89%, and 45% for AXFBG and 80%, 79%, and 72% for AOFBG, respectively. Although the patient survival rate was statistically lower with AXFBG, primary patency and limb salvage rates did not differ when compared with AOFBG. CONCLUSION: When reserved for high-risk patients with limited life expectancy, the patency and limb salvage results of AXFBG are equivalent to those of AOFBG.

Adult↗