PURPOSE: To evaluate the role of metallic stents in treating stenoses involving prosthetic arterial bypass grafts. METHODS: Patients undergoing stent placement within a failing prosthetic bypass graft, during a 41-month period, were reviewed for treatment outcome and complications. The indications for stent placement in 15 patients included severe claudication (n = 3), rest pain (n = 9), and minor or major tissue loss (n = 3). Lesions were at the proximal anastomosis (n = 6), the distal anastomosis (n = 3), or within the graft (n = 6). RESULTS: Treatment with metallic stents was successful in all patients. There was one acute stent thrombosis, successfully treated with thrombolytic therapy. Follow-up data are available for a mean duration of 12.3 months. The mean duration of primary patency was 9.4 months with 6- and 12-month primary patency rates of 51.9% and 37.0%, respectively. The mean duration of secondary patency was 12.1 months with 6- and 12-month secondary patency rates of 80.0% and 72.7%, respectively. Two patients with discontinuous runoff and preexisting gangrene required a below-knee amputation. Six patients were revised surgically after stent placement (at a mean of 10.8 months). Three late deaths occurred during follow-up. CONCLUSION: Given the mortality risks of surgical revision and the reduced life expectancy of this patient population, metallic stent placement represents a viable, short-term treatment option for stenoses within or at the anastomoses of prosthetic grafts. Further evaluation is warranted to compare intragraft stent placement with surgical graft revision.

Adult↗

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Instrumentation and examination procedures for a clinical vascular laboratory.

Instrumentation and examination procedures used in the clinical vascular Laboratory of the Massachusetts General Hospital are outlined and recommended for use in other similar laboratories. The arterial system is studied by the analysis of blood flow direction, segmental plethysmography, and systolic pressure measurements obtained at rest and following a measured exercise stress. The effect of induced reactive hyperemia on systolic pressure, obtained by direct intra-arterial measurement, is used to demonstrate the hemodynamic importance of stenotic lesions within the aorto-iliac system. Maximum venous outflow studies are combined with analyses of venous Doppler signals for purposes of screening patients with suspected deep venous thrombosis. The laboratory contributes important objective physiologic information to the examination of the arterial and venous systems. Experience obtained through the evaluationof more than 2500 patients resulted in the development of this recommended program.

Clinical Laboratory Techniques↗

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Decreased morbidity associated with retroperitoneal exclusion treatment for abdominal aortic aneurysm.

A prospective randomized study has been carried out to compare the retroperitoneal (RP) and the transperitoneal (TP) approaches to infrarenal abdominal aortic aneurysms (AAA). From November 1988 to July 1989, 27 patients were randomized to one or the other group. Twelve patients underwent TP resection of their AAA; 11 of these were performed using the open aneurysmorrhaphy technique. The RP approach was used in 15 patients, 12 of whom had the exclusion technique performed. Enteral feeding was resumed on the second postoperative day in the RP group compared to the fourth postoperative day in the TP group; the difference was statistically significant (p less than 0.02). Statistically significant differences were also present in the estimated blood loss (516 cc in the RP group versus 1127 cc in the TP group) in the blood transfusion requirement (p less than 0.05). This prospective randomized study comparing TP and RP approaches to AAA showed that the RPE approach had less blood loss, less transfusion requirement, and earlier resumption of enteral feeding than the TP approach. We feel the RPE technique is safe and efficient in the treatment of infrarenal abdominal aortic aneurysm.

Aged↗

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The management of infected arterial aneurysms.

Infected aneurysms involve the aorta, visceral and peripheral arteries and are associated with a high morbidity and mortality. Prompt confirmation of the suspicion of infection, resection of all infected tissue, and prolonged antibiotic therapy based on appropriate sensitivity studies are crucial to successful management. Patients whose aortic aneurysms grew Gram negative organisms were more likely to suffer early rupture of an aortic aneurysm, and had a higher mortality. Superior mesenteric aneurysms are preferably treated by resection. Upper extremity aneurysms can often be excised without distal ischemia. Lower extremity aneurysms were more likely to require reconstruction which can be accomplished through non-infected tissue planes, preferably with autogenous tissue.

Adult↗

PubMedDate not supplied

Proceeding: Experience with mycotic aneurysms of the abdominal aorta.

Explore the source record for details and available documents.

Adult↗