Biomedical subjects

Kenneth J Cherry

Publications and source records attributed to Kenneth J Cherry.

40 records · Page 3Linked to original sources

PubMed2002

Abdominal aortic reconstruction in infected fields: early results of the United States cryopreserved aortic allograft registry.

OBJECTIVE: Aortic reconstructions for primary graft infection (PGI), mycotic aneurysm (MA), and aortic graft-enteric erosion (AEE) bear high morbidity and mortality rates, and current treatment options are not ideal. Cryopreserved grafts have been implanted successfully in infected fields and may be suitable for abdominal aortic reconstructions. Registry data from several institutions were compiled to examine results of cryopreserved aortic allograft (CAA) placement. METHODS: The experience of 31 institutions was reviewed for CAAs inserted from March 4, 1999, to August 23, 2001. Indications for CAA, organisms, mortality, and complications were identified. RESULTS: Fifty-six patients, 43 men and 13 women, with a mean age of 66 years (range, 44 to 90 years) had in situ aortic replacement with CAA. Indications for CAA placement were PGI in 43 patients (77%), MA in seven (14%), AEE in four (7%), and aortic reconstruction with concomitant bowel resection in two (4%). Infectious organisms were identified in 33 patients (59%); the most frequent organism was Staphylococcus aureus in 17 (52%). Thirty-one patients (55%) needed an additional cryopreserved segment for reconstruction. The mean follow-up period was 5.3 months (range, 1 to 22 months). One patient died in the operating room, and the 30-day surgical mortality rate was 13% (7/56). Seven additional patients died during the follow-up period, yielding an overall mortality rate of 25% (14 patients). Two patients (4%) had graft-related mortality as the result of hemorrhage from the CAA and persistent infection. Graft-related complications included persistent infection with perianastomotic hemorrhage in five patients (9%), graft limb occlusion in five (9%), and pseudoaneurysm in one (2%). Three patients (5%) needed amputation. CONCLUSION: In situ aortic reconstruction with CAA in infected fields carries a high mortality rate, but most deaths are not the result of allograft failure. However, CAA infection and lethal hemorrhage caused by graft rupture occurs and is concerning. Early reinfection was not reported. Late graft-related complications, such as reinfection, thrombosis, or aneurysmal changes, are unknown. Preliminary data from this registry fail to justify the preferential use of CAA for PGI, MA, or AEE. A multicenter, randomized study is needed to compare results with established techniques.

Adult↗

PubMed2002

Superior mesenteric artery aneurysms: is presence an indication for intervention?

INTRODUCTION: Although rare, superior mesenteric artery (SMA) aneurysms have a definite rupture risk. Past reports have suggested that this risk is low, yet most investigators recommend repair in selected patients. We reviewed our experience with 21 patients to try to determine when intervention was indicated. METHODS: A retrospective review of the medical records of all patients with SMA aneurysms at our institutions from January 1980 through December 1998 was undertaken. Only patients with true aneurysms of the SMA were included. RESULTS: Twenty-one patients with true SMA aneurysms were identified and included 14 males (67%) and seven females (33%). This represents a 6.9% incidence rate of all visceral aneurysms seen at our institutions. Eight patients (38%) had rupture at presentation, including seven of the 14 males (50%). In contrast to previous reports, only one patient (4.7%) had an infectious etiology. Five patients were on beta-blocker therapy, but none were seen with rupture. However, eight of the remaining 16 patients (50%) without beta-blockade had rupture. Thirteen patients (62%) had calcified aneurysms, but all ruptures were seen in noncalcified aneurysms. Operative intervention occurred in 11 of the 21 patients (52%). All eight patients with rupture underwent operation, including six ligations and one successful embolization, and one patient died before completion of repair. The operative mortality rate was 37.5% for ruptured aneurysms. Elective repair included one prosthetic graft, one excision and patch angioplasty, and one embolization, with no mortality. Ten of the 21 patients (48%) with SMA aneurysms were observed, and all were alive and well at a mean of 67 months' follow-up (range, 2 to 148 months). CONCLUSION: SMA aneurysms are rare but appear to have a higher risk of rupture than previously reported. Male patients and patients with noncalcified aneurysms appear to have a greater risk of rupture. beta-Blockade may have some protective effect against aneurysm rupture. Intervention is reasonable in all patients at good operative risk with SMA aneurysms, considering the high rupture rate in our series.

Adrenergic beta-Antagonists↗

PubMed2002

Obstructive external iliac arteriopathy in avid bicyclists: new and variable histopathologic features in four women.

OBJECTIVE: Avid competition bicycling may be associated with the development of external iliac artery stenosis. European studies have documented endofibrosis that primarily has affected young men. Our objective was to review the histopathologic features of obstructed external iliac arteries resected from avid competition bicyclists at a single institution. METHOD: Medical records and microscopic slides were reviewed from all competitive bicyclists who had undergone resection and graft placement for segmental external iliac artery disease at Mayo Clinic (Rochester, Minn) between 1991 and 2001. RESULTS: Of seven patients (five female, two male) seen with external iliac obstructive disease, four underwent resection and graft placement and thus had specimens available for histopathologic review. Ages of these four patients, all of whom were women, ranged from 31-40 years (mean, 36 years). Claudication was the primary symptom in all four women. There were five iliac arteries involved in the four women, and pre-operative arteriography showed stenotic disease in these arteries, ranging from subtle stenosis to occlusion. Gross examination of the five resected arteries showed wall thickening and luminal narrowing, without aneurysm formation. Microscopically, luminal thrombus was observed in two arteries (one old and one recent). Intimal thickening affected four specimens (symmetric in three and asymmetric in one). Thickening was the result of smooth muscle hyperplasia, with only mild collagen or elastin deposition. Medial hypertrophy was present in three specimens (symmetric in two and asymmetric in one), one of which also contained focal calcification. Adventitial thickening was prominent in four (symmetric in two and asymmetric in two) and was due to smooth muscle hyperplasia. There was no intimal, medial, or adventitial inflammation. CONCLUSIONS: In contrast to previous reports, iliac arteriopathy among competition bicyclists may occur in women. The microscopic lesions responsible for stenosis are more varied than the "endofibrosis" that has been previously documented. In addition to the intimal fibrosis and luminal thrombosis noted by others, we describe medial and adventitial responses to repetitive trauma. Accordingly, we favor the term "external iliac arteriopathy" for this disease entity.

Adult↗

PubMedDate not supplied

Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts.

Strict morphologic criteria must be used for patient selection to achieve durable success with endovascular aortic aneurysm repair (EVAR). The goal of this study was to assess morphologic suitability (MS) of abdominal aortic aneurysms (AAAs) for 2 currently approved bifurcated stent grafts and identify reasons for exclusion from EVAR. The authors reviewed the electronic charts of 1,795 consecutive patients who were diagnosed as having AAA between January 1999 and July 2001 at their institution. Three hundred and twenty patients had an AAA with a diameter of > or = 5.0 cm, measured on computed tomography (CT). The records of 301 patients, 254 men, 47 women, with a mean age of 74 years were available for review, and these patients constituted the study cohort. Criteria used for MS included a proximal neck length > or = 15 mm; neck diameter between 18 and 26 mm; neck angulation < or = 60 degrees ; common or external iliac artery (CIA or EIA) diameters of 7-16 mm and 8-13 mm, respectively, for AneuRx (Medtronic Ave, Santa Rosa, CA) and Ancure (Guidant Cardiac and Vascular Division, Menlo Park, CA) bifurcated grafts. AAAs were suitable for AneuRx device in 14% of patients (43 of 301; 95% CI = 11-19%) and for Ancure in 5% (16 of 301; 95% CI = 3.1-9%). The main reason for exclusion was an inadequate proximal aortic neck (73%). The neck was too short in 49.5%, too wide in 64% and badly angulated in 12% of the patients. Iliac artery morphology precluded EVAR with AneuRx and Ancure devices in 52% and 80%. Both CIAs were too wide for EVAR in 43% and 77%, respectively. When iliac artery diameter < or = 20 mm was accepted, iliac suitability for AneuRx increased from 49% to 70% and overall suitability increased from 14% to 20%. When more permissive criteria were used for MS (neck length > or = 10 mm, neck diameter < or = 30 mm, CIA < or = 20), 39% of patients became candidates for EVAR. More than three fourths of the patients with an AAA > or = 5.0 cm in size, seen in a tertiary referral center, are morphologically not suitable for EVAR using 2 currently approved bifurcated endografts. The main reasons for exclusion are a short or wide proximal aortic neck. Considerable changes in size of the devices and in proximal attachment techniques have to occur before most AAAs will be suitable for EVAR.

Aged↗