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Biomedical subjects

R A McCready

Publications and source records attributed to R A McCready.

At least 37 records · Page 2Linked to original sources
PubMed1984

Renal revascularization by extra-anatomic bypass.

Patients who suddenly become anuric and in whom no urinary obstruction is found should undergo arteriography both to confirm acute renal arterial occlusion and to plan surgical treatment. In acute renal arterial occlusion collateral circulation is often sufficient to maintain kidney viability and subsequent successful revascularization. Because there are no clinical or radiologic criteria to determine salvageability of the kidney, surgical exploration is advised in these patients. Such individuals who undergo successful renal revascularization often have gratifying return of renal function. Axillofemoral-renal bypass is suggested as a method to accomplish this objective.

Adult↗
PubMed1984

Brachial artery puncture: a definite risk to the hand.

We have described a patient who had an acutely ischemic hand after brachial artery puncture in the antecubital fossa. Because of the anatomy of the forearm, hematoma formation and compression of the brachial artery and median nerve are poorly tolerated and predispose to irreversible ischemia or neuropathy. We recommend that brachial artery puncture in the antecubital fossa be avoided.

Acute Disease↗
PubMed1984

Superior mesenteric artery embolus.

We have presented a case of SMA embolization with early diagnosis and successful embolectomy. A high index of suspicion is necessary, since the relative paucity of early signs and symptoms often belies the gravity of the situation. Prompt angiography can corroborate the diagnosis and allow expeditious laparotomy. Although some authors have advocated nonoperative management of this problem, we believe a surgical approach offers the best chance for a successful resolution and for preventing devastating sequelae.

Aged↗
PubMed1984

Atherosclerosis in the young: a virulent disease.

To learn more about the prognosis of young patients with atherosclerotic cardiovascular disease we reviewed our experience with patients 40 years of age or younger who required surgical intervention for cardiovascular occlusive disease. We identified 47 patients, 25 of whom required peripheral vascular reconstruction and 22 of whom underwent coronary artery bypass grafting. All but one patient were extremely heavy cigarette smokers. Of the 11 women with peripheral vascular disease, eight required operations for limb salvage and three for renovascular hypertension. Four of the 11 women required a total of 11 subsequent operations because of recurrent or progressive disease. Of the 14 men, 13 required intervention for limb salvage and one for renovascular hypertension. Forty-five additional operations, including 15 amputations, were required in these 14 male patients because of recurrent or progressive disease. Of the 22 patients (21 men and one woman) who underwent coronary artery bypass operations, there was one postoperative death. Five patients (23.8%) required a second bypass operation and one patient (4.8%) required a third procedure bypass because of recurrent symptoms and occluded grafts. One patient has occluded grafts and inoperable disease. Atherosclerotic cardiovascular disease in young patients appears to be a virulent disease process and is associated with a high rate of recurrent or progressive disease. There is a striking association between the premature development of atherosclerotic cardiovascular disease and cigarette smoking.

Adult↗
PubMed1984

A ten year follow-up study of the Mobin-Uddin filter for vena cava interruption.

Forty-seven Mobin-Uddin interruption filters were successfully placed and observed for an average of four years. One patient had a recurrent nonfatal pulmonary embolus. One patient died as a direct result of filter placement, secondary to retroperitoneal hemorrhage. Postoperative venous sequellae were evident in 17 of 33 patients observed for long term follow-up study, eight of whom required symptomatic therapy. Ultimate venous sequellae correlate primarily with preoperative venous conditions.

Adult↗
PubMed1983

Uncommon visceral artery aneurysms.

Aneurysms of the hepatic, celiac, and superior mesenteric arteries are uncommon visceral artery aneurysms. They are often difficult to diagnose, and symptoms of expansion or rupture may easily be misinterpreted as suggestive of primary gastrointestinal disease. These aneurysms appear to have a significant propensity toward rupture. Indications for surgery include an aneurysm three to four times the original size of the vessel, x-ray evidence of increasing size of the aneurysm, or a calcified aneurysm larger than 3 cm. We believe that in all patients who are acceptable surgical candidates, a diagnosed visceral artery aneurysm should be resected.

Aged↗
PubMed1983

Radiation-induced arterial injuries.

In a 20-year period from 1961 to 1981 at the University of Kentucky Medical Center, there were 20 patients with vascular lesions directly attributable to irradiation. Two distinct patterns of arterial injury attributable to radiotherapy were identified--arterial disruption and occlusion. Arterial disruption occurred in 12 patients--11 carotid blowouts and 1 iliac artery rupture. Two patients underwent prophylactic carotid artery ligation for impending rupture. In the 11 carotid artery ruptures, ligation of the artery in nine patients resulted in stroke or death in five patients. Iliac artery disruption necessitated ligation, which eventually led to severe ischemia requiring hip disarticulation. Unusual arterial stenosis or occlusion occurred in six patients 7 to 24 years after irradiation. Three patients had severe stenosis or occlusion of the common, internal, or external carotid arteries leading to cerebrovascular insufficiency. Three other patients with focal stenosis of the iliofemoral region were successfully treated with bypass grafting.

Adult↗
PubMed1983

Isolated iliac artery aneurysms.

The records of 50 patients with isolated iliac artery aneurysms seen between January 1970 and January 1982 were reviewed. Forty-seven were men and three were women. Their ages ranged from 41 to 92 years (mean 69.7 years). Aneurysm diameter ranged from 2 to 20 cm (mean 4.7 cm). Seventeen patients had multiple aneurysms. Sixty-two percent of aneurysms were on the right side. Eighty-nine percent were located in the common iliac artery, 10% in the internal iliac artery, and 1% in the external iliac artery. Twelve patients had symptoms; all presented with sudden pain. Rupture occurred in seven patients; only three patients survived. Twenty-four patients had surgical treatment. Aneurysmorrhaphy with graft interposition was the most common procedure. There were no deaths during elective operation. Nineteen patients who did not undergo operation were followed from 0.25 to 11 years (mean 4.9 years). Enlargement occurred in nine patients and rupture in one. We conclude that the natural history of isolated iliac artery aneurysms is similar to that of other atherosclerotic aneurysms. Elective resection and arterial reconstruction are recommended.

Adult↗
PubMed1982

Recurrence and rupture of an axillary artery aneurysm.

Aneurysm of the axillary is an uncommon type of peripheral artery aneurysm. most of these aneurysms are symptomatic and present with signs and symptoms of thromboembolism. Rupture of an axillary artery aneurysm is uncommon. We present a patient who ruptured a recurrent true axillary artery aneurysm four years after surgical treatment by exclusion and bypass of the aneurysm. We believe that the preferred treatment of an axillary artery aneurysm is resection and insertion of an end-to-end interposition graft.

Aged↗
PubMed1981

Abdominal aortic aneurysm and coronary artery disease.

To delineate the role of routine preoperative coronary angiography in patients undergoing elective abdominal aortic aneurysm resection, we reviewed the records of 422 such patients at the Mayo Clinic, Rochester, Minn. One hundred seventy-three patients (41%) had a history of either myocardial infarction or angina pectoris; 146 (35%) had a previous myocardial infarction; 111 (26%) had a history of stable angina. Six patients underwent coronary artery bypass grafting prior to aneurysmorrhaphy. Ten patients (2.4%) died within the first 30 postoperative days. Seven deaths (1.7%) were secondary to myocardial infarction. Mortality from myocardial infarction was 0.8% in patients who had no history of coronary artery disease and 2.9% in patients with a history. Mortality was not increased in elderly patients. Coronary angiography should be selectively obtained prior to elective aneurysmorrhaphy. A 0.8% mortality from myocardial infarction in patients without a history of coronary artery disease and an overall mortality of 1.7% do not justify routine coronary angiography prior to elective resection of an abdominal aortic aneurysm.

Adult↗
PubMed1980

Adult Hirschsprung's disease: results of surgical treatment at Mayo Clinic.

Fifty adult patients with Hirschsprung's disease were operated on at the Mayo Clinic between 1950 and 1978. Six different operations were used. Of the three patients treated by the Soave endorectal pull-through procedure, two suffered anastomotic leaks and required diverting colostomies; all three had excellent long-term results, however. All four patients who underwent the Duhamel procedure had excellent results, with only one minor complication. Of the 17 patients undergoing the Swenson procedure, 6 had major postoperative complications, including 2 with impotence; 3 (17.6 per cent) patients who underwent rectal myectomy, there was one minor complication, although 5 (38.5 per cent) had unsatisfactory results. Six patients had anterior resection, one of whom died of generalized peritonitis from an anastomotic leak, and one patient suffered recurrent megacolon that required resection of an additional segment of colon. Four of the five survivors had excellent results. Of the seven patients who underwent left hemicolectomy or total abdominal colectomy, two had serious postoperative complications, and two required resection of an additional segment of colon because of recurrent symptoms. All seven patients eventually had excellent results.

Adolescent↗
PubMed1979

Surgical treatment of ascending aortic aneurysms associated with aortic valve insufficiency.

From 1965 to 1978, 111 patients underwent combined operation for ascending aortic aneurysms and aortic valve insufficiency. Fifteen patients had direct coronary implantation (Group 1). In 25 patients operated on between 1972 and 1977, the aortic root was retained (Group 2). An additional 71 patients operated on between 1965 and 1972 were included (Group 3): 40 who had synthetic graft replacement and retention of the aortic root and 31 who had aortoplasty and associated aortic valve repair. In 8 patients in Group 3, recurrent aneurysms were detected an average of 6.5 years after operation. The mortality rate for repaiajor complication after incomplete resection of the aortic root. Total exclusion of the aneurysm should be considered.

Adolescent↗
PubMed1979

The surgical treatment of incapacitating constipation associated with idiopathic megacolon.

Results of the surgical treatment of idiopathic megacolon with incapacitating constipation in 23 patients are reviewed. The Swenson endorectal pull-through procedure, although it gave satisfactory results, was associated with high morbidity and resulted in the only death in this series. Anterior resection gave good results in six of eight patients. This procedure should give good results when the dilatation as seen on barium enema studies is confined to the rectosigmoid. However, for patients who have more extensive dilatation of the colon, extensive left hemicolectomy or total abdominal colectomy should be strongly considered, for these procedures have been associated with uniformly good results and little morbidity. There is little to recommend bilateral lumbar sympathectomy.

Adolescent↗