Biomedical subjects
Publications and source records attributed to K Kasirajan.
A 65-year-old male was found to have hepatic portal venous gas (HPVG) by computed tomogram secondary to ischemic bowel. Despite aggressive surgical and antibiotic treatment, the patient died within 12 hours. Portal pyelophlebitis, when identified by air in the portal venous system, is a grave indicator of ischemic bowel with a very high mortality rate, except in patients with inflammatory bowel disease.
The purpose of this study was to compare the early results and complication rates of commercially available endoluminal grafts (ELG) for abdominal aortic aneurysm (AAA) by a team of vascular surgeons at a nontrial center with those of published results from trial centers. A retrospective chart review of all patients undergoing endoluminal graft repair of AAA was made at the medical center. From October 1, 1999, to December 31, 2000, a team of vascular surgeons electively repaired AAAs in 100 patients at a regional referral center. Of these patients, 49 underwent repair with a commercially available ELG (35 AneuRx, 14 Ancure) whereas the remaining were repaired with an open operation. In the ELG group, the primary technical success rate was 100% with a 30-day mortality rate of 2.0%. The average hospital length of stay was 3.28 days with ICU stay of 1.20 days. The average operative estimated blood loss was 501 mL (100-2,500) with average transfusions of 0.49 unit packed red blood cells (prbc) (0-6). Eighty-eight percent of ELG patients left the hospital without complication. Seven patients (14%) required 11 follow-up procedures for complications including endoleak, limb or graft thrombosis, graft stenosis, distal embolization, or wound complications. Three of 26 patients (11%) with 6-month computed tomography follow-up had evidence of endoleak (2 have subsequently undergone lumbar embolization). Only 1 6-month follow-up patient had shown increased aneurysm size before endoleak treatment. A team of board-certified vascular surgeons at a nonclinical trial center can safely perform ELG for AAA with results similar to those of published series from trial centers.
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