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Biomedical subjects

R D Sayers

Publications and source records attributed to R D Sayers.

At least 91 records · Page 5Linked to original sources
PubMed1995

Management of lower limb ischaemia associated with the use of intra-aortic balloon pumps during cardiac surgery.

OBJECTIVE: To audit the lower limb vascular complications associated with the use of an intraaortic balloon pump (IABP) on a cardiothoracic unit over a 12 month period. DESIGN: Retrospective analysis. SETTING: Regional university cardiothoracic unit. PATIENTS: Fifty four IABPs inserted into 51 patients. RESULTS: Seventeen patients (33%) died from cardiogenic shock in the immediate postoperative period. Of the remaining 34 patients (37 IABPs), lower limb vascular complications occurred in nine patients (26%) who underwent 11 IABP insertions (30%). Vascular complications included groin haematomas (n = 2 insertions), compartment syndrome (n = 2 insertions), femoral artery trauma (n = 7 insertions). CONCLUSIONS: Prompt management by peripheral vascular surgeons resulted in limb salvage in 10 legs and only one death from a pulmonary embolus.

Acute Disease↗
PubMed1995

The additional value of intraoperative angiography in infragenicular reconstruction.

OBJECTIVE: To evaluate the ability of preoperative intraarterial digital subtraction angiography (IADSA) to predict the feasibility of infragenicular reconstruction and site of the distal anastomosis. DESIGN: Prospective study. SETTING: University Hospital MATERIALS: 45 patients with 50 ischaemic limbs, considered potential candidates for infragenicular reconstruction. CHIEF OUTCOME MEASURES: Pre-reconstruction intraoperative angiography (IOA) was used as the gold standard. Analysis of angiograms was performed blindly and independently by a single observer. In patients who ultimately underwent primary amputation, exploration and attempted angiography of the crural and ankle vessels was performed to verify the IADSA findings. MAIN RESULTS: There was 87% accuracy (kappa = 0.66) between IADSA and IOA in differentiating between a normal, stenosed and occluded tibial artery and there was 86% accuracy (kappa = 0.67) in determining the adequacy of run-off into the pedal arch. IADSA had a positive predictive value of 100% to determine the feasibility of reconstruction but a negative predictive value of only 73%. After excluding those patients tha IADSA deemed non-reconstructable, IADSA had a positive predictive value of 97% to determine the correct artery and 92% to determine the correct segment of artery for distal anastomosis. CONCLUSIONS: IADSA could not determine when reconstruction was not possible, but in those deemed reconstructable by IADSA, the surgeon can confidently expose the appropriate artery at the appropriate level knowing the pedal run-off status in 86% of patients. IADSA should not be used to exclude reconstruction (i.e. pre-reconstruction IOA is still required in these patients) but for the remainder, IADSA can be used to plan surgical strategy without recourse to IOA.

Amputation, Surgical↗
PubMed1995

Trends in abdominal aortic aneurysms: a 13 year review.

AIM: To assess changing trends of abdominal aortic aneurysms 1979-1991. DESIGN: Retrospective study from the Leicestershire Health Authority. RESULTS: 727 patients with abdominal aortic aneurysm were treated. Of these 56.4% were admitted for elective repair and 43.6% presented with rupture. There was a significant increase in the number of ruptured aortic aneurysms over this period despite an increase in the number of elective repairs. The overall 30-day mortality of elective repair (including patients with symptomatic but non-ruptured aneurysms) was 8.8%. The overall 30-day mortality of ruptured aneurysms (including patients who were deemed medically too unfit for surgery) was 57.7%. There has been no significant change in elective and ruptured mortality over the study period. There was a significant increase in the median age of patients (69.5 yrs in 1979 to 74 yrs in 1991). CONCLUSION: The increasing incidence of abdominal aortic aneurysms may reflect better diagnostic methods, greater clinical awareness of the condition and increase in the proportion of elderly people in the population.

Adult↗
PubMed1995

Quality of life following infragenicular bypass and lower limb amputation.

AIMS: To objectively assess the quality of life after femorodistal bypass and compare this to quality of life achieved following primary limb amputation. DESIGN: Retrospective review. SETTING: Leicester Royal Infirmary, U.K., 1988-1993. METHODS: A self-assessment postal questionnaire containing scales measuring emotional disorder, social functioning and mobility was sent to 112 patients who had previously undergone femorodistal bypass (n = 86) or primary limb amputation (n = 26). RESULTS: Further analysis demonstrated that a secondary procedure (PTA or graft revision) to maintain graft patency did not adversely affect quality of life. Additionally, patients undergoing secondary amputation after graft failure had an identical quality of life to those undergoing primary amputation. CONCLUSIONS: These data illustrate that the quality of life after successful femorodistal bypass is higher than after primary or secondary amputation. To attain the maximum quality of life in patients with critical ischaemia, femorodistal bypass should be performed wherever feasible.

Aged↗
PubMed1994

Treatment and outcome of severe lower-limb ischaemia.

The overall outcome of severe lower-limb ischaemia in terms of limb salvage and mortality is poorly documented. A consecutive series of 232 severely ischaemic legs in 209 patients was therefore studied. An aggressive policy of revascularization has been pursued; this was attempted in 89 per cent of legs, with a primary amputation rate of 8 per cent. The perioperative 30-day limb salvage rate was 79 per cent with a patient mortality rate of 20 per cent. At 12 and 24 months the limb salvage rates were 74 and 71 per cent and patient survival rates 75 and 73 per cent respectively. To identify high-risk groups the effects on limb salvage and mortality of age, sex, presentation, diabetes and ankle systolic pressure of 50 mmHg or less were studied. Using life-table analysis, none of the preoperative risk factors had an effect on limb salvage and mortality. An aggressive policy of revascularization provides excellent results in the treatment of patients with severe leg ischaemia.

Adult↗
PubMed1994

Influence of Losartan, an angiotensin receptor antagonist, on neointimal proliferation in cultured human saphenous vein.

An organ culture of human saphenous vein was used as a model of vein graft intimal hyperplasia and the potential of Losartan, an angiotensin II receptor antagonist, to inhibit neointimal proliferation was investigated. Median (range) neointimal thickness was reduced from 17 (16-19) to 11 (8-18) microns in veins cultured with Losartan (median difference 5 (95 per cent confidence interval 2-8) microns). A similar decrease in the median neointimal proliferation index was seen from 21 (range 14-47) to 15 (range 5-31) per cent (median difference 8 per cent (95 per cent confidence interval 5-11 per cent)). These results demonstrate that angiotensin II receptor antagonists may be of therapeutic value for the modulation of vein graft intimal hyperplasia.

Angiotensin Receptor Antagonists↗
PubMed1994

Endovascular repair of abdominal aortic aneurysm: limitations of the single proximal stent technique.

Endovascular repair of abdominal aortic aneurysm (AAA) has been performed using both a single proximal stent technique and a double (proximal and distal) stent method to anchor a graft in the aneurysm lumen. This study examined the effect of the single proximal stent technique on femoral artery blood flow, renal function and the occurrence of back-bleeding into the aneurysm sac in a canine model; eight dogs were used. Femoral artery blood flow and glomerular filtration rate were not affected by graft-stent insertion. Two graft-stent combinations failed to deploy in the correct position and led to graft thrombosis in one case. The six correctly positioned grafts all showed back-bleeding from around the distal end into the aneurysm sac. The single proximal stent technique for endovascular repair of AAA is inadequate and attention should continue to focus on a double (proximal and distal) stent method or a bifurcated system.

Animals↗
PubMed1994

Surgical management of major thoracic injuries.

Major thoracic injuries are uncommon in the United Kingdom and wide experience of their management by centres in this country has not been reported. Between 1985 and 1990, 23 patients have undergone urgent thoracotomy at Birmingham Accident Hospital for suspected intrathoracic injury. The majority of these injuries were caused by penetrating trauma (13 patients). The commonest indications for thoracotomy were suspected intrathoracic haemorrhage in 13 patients and suspected cardiac tamponade in four patients. In three of the four patients with suspected cardiac tamponade, the diagnosis was correct, the tamponade successfully relieved together with repair of the lesion, and all three patients survived. Of the 13 patients with intrathoracic haemorrhage, 10 survived after control of haemorrhage and repair of the lesion but three died: one from uncontrollable haemorrhage from a right middle lobe vessel laceration, one from associated multiple injuries and one from post-operative complications. The TRISS methodology was applied to audit our results. Two patients who died after a penetrating injury had a greater than 50 per cent probability of death by the TRISS method. Two patients who died after a blunt injury had a less than 50 per cent probability of death by the TRISS method although one of these patients died from postoperative complications. This series illustrates the point that prompt recognition of a suspected intrathoracic injury and appropriate urgent surgical intervention to relieve cardiac tamponade and control intrathoracic haemorrhage in these patients can produce a successful outcome. In addition it it is essential that all units audit their own results in order to highlight areas where improvements in trauma care can be made.

Adolescent↗
PubMed1994

Human venous endothelium can promote intimal hyperplasia in a paracrine manner.

PURPOSE: Vein graft stenoses resulting from the development of intimal hyperplasia are the major cause of graft failure in the first postoperative year. This study uses an organ culture of human saphenous vein to model vein graft intimal hyperplasia and assess the involvement of the endothelium in its development. METHODS: Organ cultures of saphenous vein were established comprised of intact vein, vein denuded of endothelium, or cocultures of intact plus denuded vein for 14 days in serum-supplemented medium. At the end of the culture period, veins were processed and sections prepared for immunostaining with monoclonal alpha-smooth muscle actin, Millers elastin, QB END.10, and bromodeoxyuridine. RESULTS: After culture, a cellular neointima developed in the intact veins that was significantly thicker than in those denuded of endothelium (24.5 vs 2.5 microns; p = 0.0001). Denuded veins in coculture with intact veins developed a thicker neointima than did denuded veins alone (12 vs 0 microns; p = 0.01) but less than that of intact veins (12 vs 28 microns; p < 0.01). Proliferation indexes followed the same trend (i.e., intimal smooth muscle cell proliferation was greatest in intact and least in denuded veins). CONCLUSION: The endothelium can promote neointimal formation in cultured human saphenous vein through a paracrine action on the vascular smooth muscle cell.

Endothelium, Vascular↗