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Biomedical subjects

T C Bower

Publications and source records attributed to T C Bower.

At least 19 recordsLinked to original sources
PubMed1996

Aortic reconstruction in kidney transplant recipients.

Renal transplantation has increased the longevity of patients with uremia. An increasing number undergo aortic reconstruction, which exposes the transplanted kidney to ischemic injury. To evaluate the risk for renal failure, loss of the transplant, and methods of renal protection, we reviewed our experience. Clinical data were reviewed for 10 consecutive patients (7 men, 3 women; mean age 52.7 years [range 32 to 75 years]) with a transplanted kidney who underwent aortic reconstruction between 1977 and 1994 at our institution. Mean interval between renal transplantation and aortic reconstruction was 5.9 years (range 1 month to 12.7 years). Seven patients required emergency repair because of dissection (2 patients), aneurysm rupture (4 patients), or symptomatic aneurysm (1 patient); three underwent elective repair. Reasons for reconstruction included aortic dissection (2 patients), aneurysm of the descending thoracic (2 patients), thoracoabdominal (1 patient), or abdominal aorta (3 patients), and aortoiliac occlusive disease (2 patients). Patients with thoracic or thoracoabdominal reconstructions underwent repair with atriofemoral, aortofemoral, or femorofemoral shunt placement or bypass. Of the five abdominal aortic reconstructions, the kidney was protected with aortofemoral shunt placement in one patient and cold renal perfusion in three. In two of them, topical cooling of the kidney also was used. One patient with acute aortic dissection died at 39 days as a result of respiratory failure. Loss of the recently transplanted kidney was caused by acute rejection. One patient had a transient increase in serum creatinine concentration. Eight no worsening of renal function, and none of the nine survivors lost the transplanted kidney. We concluded that aortic reconstruction can be safely performed in kidney transplant recipients. Patients in whom thoracic or thoracoabdominal aortic reconstruction was required were protected with an atriofemoral or aortofemoral bypass or shunt. Patients undergoing abdominal aortic reconstruction did well when cold renal perfusion with or without local cooling of the transplant was used for renal protection. Transplanted kidneys appeared to tolerate ischemic injury similarly to native kidneys.

Adult↗
PubMed1996

Inflammatory abdominal aortic aneurysms: a case-control study.

PURPOSE: This study was designed to identify significant differences in the clinical and radiologic characteristics and outcome between patients with inflammatory and noninflammatory abdominal aortic aneurysms (AAAs). METHODS: We reviewed 29 consecutive patients who underwent repair of an inflammatory AAA between 1985 and 1994. This group was matched in a case-control fashion by date of surgery and by the performing surgeon to a group of 58 patients who underwent repair of noninflammatory AAAs. RESULTS: The two groups had comparable characteristics of age, gender, and cardiovascular risk factors. Patients with inflammatory AAAs were significantly more symptomatic than those with noninflammatory AAAs (93% vs 9%, p < 0.001), were more likely to have a family history of aneurysms (17% vs 1.5%, p = 0.007), and tended to be current smokers (45% vs 24%, p = 0.049). The most significant laboratory difference was an elevated sedimentation rate in patients with inflammatory AAAs (mean, 53 mm/hr vs 12 mm/hr, p < 0.00001). Inflammatory AAAs also were significantly larger than noninflammatory AAAs at presentation (6.8 cm vs 5.9 cm, p < 0.05). Although operative mortality was low in both groups, patients with an inflammatory AAA tended to have higher morbidity, including sepsis (p < 0.01) and renal failure (p = 0.04). Five-year survival rates, however, were similar for the two groups (79% for inflammatory and 83% for noninflammatory AAAs). On follow-up computed tomographic scans, the retroperitoneal inflammatory process resolved completely in 53% of the patients, but 47% of patients had persistent inflammation that involved the ureters in 32% and resulted in long-term solitary or bilateral renal atrophy in 47%. CONCLUSIONS: This case-control study provides preliminary evidence that inflammatory AAAs may have a relatively strong familial connection and that current smoking may play an important role in the inflammatory response. The study also documents that persistent retroperitoneal inflammation may be more prevalent than has been previously reported, and stresses the need for an improved understanding of the pathogenesis and long-term management of inflammatory AAAs.

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PubMed1996

Aneurysms of the great vessels and their branches.

Aneurysms of the innominate, carotid, subclavian, and vertebral arteries are rare and have a variety of etiologies. Although few contemporary natural history data are available, numerous reports through the years highlight their propensity to cause life-and limb-threatening problems. To lessen the risk of complications from rupture, embolization or thrombosis of the aneurysms, elective repair in good risk patients is recommended. The perioperative morbidity and mortality from these operations can be minimized with careful and thorough preoperative evaluation and meticulous intraoperative techniques.

Aneurysm↗
PubMed1995

Renal endarterectomy vs. bypass for combined aortic and renal reconstruction: is there a difference in clinical outcome?

Are there differences in the patient characteristics and clinical outcome for transaortic renal endarterectomy vs. bypass grafting when either technique is combined with infrarenal aortic replacement for occlusive or aneurysmal disease? Two common perceptions persist: (1) combined aortic and renal procedures have a high risk and (2) bypass is easier and safer than endarterectomy. To address these controversies we compared 52 consecutive patients undergoing concomitant aortic and renal reconstruction between 1987 and 1991: 26 with bypass and 26 with endarterectomy. Bypass patients were older (70 vs. 64 years, p = 0.001), had more extensive plaque extending into the distal renal artery and more severe baseline azotemia (creatinine = 2.6 vs 1.7 mg/dl, p = 0.01), more clinically evident coronary heart disease (89% vs. 56%, p = 0.001), and a greater need for nephrectomy of a small nonfunctional pressor kidney (23% vs. 0%) than endarterectomy patients. In contrast, endarterectomy patients more commonly required aortic replacement for occlusive disease than for an aortic aneurysm (endarterectomy: 65% vs. 35%; bypass: 19% vs 81%, p = 0.002) and tended to require more intraoperative technical revisions (12% vs. 4%) than bypass patients. Both groups, however, experienced no operative mortality, had similar cardiorespiratory morbidity, and achieved equal improvement in hypertension (69% vs. 65%). Bypass patients, who already had more severe preoperative azotemia than endarterectomy patients, showed less improvement in the creatinine level (Cr = 2.1 vs. 1.4 mg/dl, p = 0.01) and had greater need for late dialysis (30% vs. 4%, p = 0.01). Only one patient on dialysis had graft occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1995

Intracardiac extension of an intracaval sarcoma of endometrial origin.

A 52-year-old woman was diagnosed with a cardiac tumor by transesophageal echocardiography and magnetic resonance imaging. An intraoperative biopsy indicated the mass was low-grade endometrial stromal sarcoma. Successful tumor removal from the heart and inferior vena cava was accomplished with the use of hypothermic circulatory arrest. The chronically occluded infrarenal portion of the inferior vena cava was transected. The patient has no evidence of recurrent disease after a follow-up of 18 months and has no significant restriction in her daily activities.

Biopsy↗
PubMed1995

Renal artery anomalies in patients with horseshoe or ectopic kidneys: the challenge of aortic reconstruction.

Renal fusion or ectopia can present formidable challenges during aortic surgery. To evaluate morbidity and define optimal management, the clinical histories of 20 patients with renal fusion or ectopia who underwent 21 aortic procedures at the authors' institution over a 37-year period were reviewed. Indications for surgery included aortic aneurysm in 16 patients (infrarenal in 15 and thoracoabdominal in one) and aortoiliac occlusive disease in five (with renovascular hypertension in two). The abnormal kidney was detected before surgery in 13 patients (65%) by excretory urography, arteriography, computed tomography, or ultrasonography. Arteriography revealed multiple and/or anomalous renal arteries in nine of 12 patients studied. At surgery, 15 patients (75%) were found to have multiple or anomalous renal arteries. Six required renal revascularization (reimplantation four, endarterectomy one, aortorenal bypass one). The renal symphysis was divided in two patients. There were no operative deaths. Six major complications included bleeding requiring reoperation, renal failure requiring short-term dialysis, pancreatitis, gastrointestinal bleeding, pneumonia and thrombophlebitis. Preoperative aortography is recommended in patients with renal fusion or ectopia because of the high incidence of associated renal artery anomalies. The surgeon must be prepared to preserve or revascularize these anomalous renal arteries. Division of the renal symphysis is rarely required. Although perioperative morbidity is raised, aortic reconstruction in patients with renal fusion or ectopia can be safely performed without increased mortality.

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PubMed1995

Outcome and expansion rate of 57 thoracoabdominal aortic aneurysms managed nonoperatively.

BACKGROUND: The prognosis of thoracoabdominal aortic aneurysms (TAAAs) managed nonoperatively is unknown. PATIENTS AND METHODS: To determine the risk of rupture and survival, we retrospectively reviewed the clinical course and computed tomographic data of 57 patients who were evaluated for degenerative, nondissecting TAAAs. Nonoperative management was decided initially for all patients. Data of aneurysm expansion rate were available in 29 patients who underwent 2 or more scans. Follow-up was complete in 52 (91%) patients and averaged 37 months (range 1 to 82). RESULTS: Thirty-four of the 57 (60%) patients died during follow-up, including 3 of 15 patients who underwent subsequent repair of their aneurysm. Two- and 5-year survival rates for the entire group were 69% and 39%, with repair-free survival rates of 52% and 17%, respectively. Eight (14%) aneurysms ruptured, accounting for 24% (8/34) of the deaths. Two- and 4-year risks of rupture were 12% and 32%, respectively. The median expansion rate was 0.2 cm/y and was greater in patients with chronic obstructive pulmonary disease (P < 0.05). All ruptured aneurysms were > 5 cm in diameter. Aneurysms with a diameter > 5 cm at diagnosis had a higher rupture rate than those with a diameter < or = 5 cm (P < 0.05). Expansion rate did not predict rupture. CONCLUSIONS: Mortality of patients with TAAAs preselected for nonoperative management is high, with an overall survival rate of 39% and repair-free survival rate of only 17% at 5 years. Expansion rate of TAAAs (0.2 cm/y) is similar to that of abdominal aortic aneurysms. Our data that support nonoperative management for patients with TAAAs < 5 cm in diameter, but confirm the increase rate of rupture for aneurysms > 5 cm.

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PubMed1995

Advanced renovascular hypertension and renal insufficiency: trends in medical comorbidity and surgical approach from 1970 to 1993.

PURPOSE: The primary aims of this study were to delineate trends in medical comorbidity and surgical approach in patients with renal atherosclerosis and azotemia. METHODS: We reviewed 1643 patients undergoing renovascular surgery between 1970 and 1993. We focused on those with the most advanced kidney disease (serum creatinine > 2 mg/dl) (n = 402). Attention was focused specifically on trends in sex, age, medical risk factors, surgical technique (bypass vs endarterectomy), and outcome including eventual need for long-term dialysis. RESULTS: From 1970 to 1980, 652 patients underwent renovascular surgery, with 98 (15%) having a serum creatinine > 2 mg/dl. From 1980 to 1993, the percentage of patients with renal insufficiency increased to 31% (304 of 991) (p < 0.001). Gender distribution did not change, but median age rose from 63.5 years in the first decade to 68.0 in the past 13 years. A remarkable increase in all serious medical risk factors also occurred (first vs second decade). Another significant trend was a shift toward bilateral simultaneous transaortic endarterectomy (18% from 1980 to 1985 vs 53% from 1986 to 1993; p < 0.01), which simplified and achieved complete renal revascularization, especially in patients having multiple renal artery stenoses and those needing aortic grafting for occlusive or aneurysmal disease (56% from 1970 to 1980 vs 75% from 1980 to 1993). Patients at low risk (0 to 1 comorbid medical conditions) had a 30-day mortality rate of 5.6% compared with patients at high risk (2 to 3 comorbid conditions) (15.5%) (p = 0.016). The eventual need for long-term dialysis remained low (9%) for patients with a preoperative serum creatinine of 2 to 2.9 mg/dl compared with those with a serum creatinine greater than 3 mg/dl (35%, p < 0.01). CONCLUSIONS: In the past 20 years, there has been a remarkable increase in the medical comorbidity and extent of aortic disease in patients undergoing surgical revascularization for advanced renovascular hypertension and renal insufficiency. However, the surgical approach can be simplified and expedited by bilateral transaortic endarterectomy, and the risk of late dialysis can be reduced significantly by operating before the serum creatinine exceeds 3 mg/dl.

Adult↗
PubMed1994

Symptomatic, nonruptured abdominal aortic aneurysms: are emergent operations necessary?

To evaluate current morbidity and mortality and to define the best strategy of management, we retrospectively reviewed the clinical histories of 36 patients (24 males and 12 females) who underwent repair of symptomatic, nonruptured abdominal aortic aneurysms (AAAs) between April 1, 1987, and April 30, 1992, at the Mayo Clinic (3.2% of 1111 patients with AAA repair). Ages ranged from 54 to 94 years (mean 75 years). All patients were hemodynamically stable and presented with abdominal and/or back pain of 1 to 60 days' duration (mean 11.6 days). The diagnosis of AAA was confirmed by CT scan in 26 patients, ultrasonogram in seven, and plain abdominal films in three. Fourteen patients (38.9%) were operated on emergently within 4 hours of admission, 11 (30.5%) between 4 and 24 hours, and 11 between 24 hours and 7 days following presentation (mean 28.9 hours). Eight (22.2%) had inflammatory aneurysm. AAAs were repaired with a straight graft in 17 patients and a bifurcated graft in 19. Complications occurred in 24 patients (66.7%). Mortality was 11.1% (4/36). The association between emergency repair (< 4 hours) and 60-day mortality was significant (p < 0.05). There were no deaths among those patients whose operation was delayed. Comparison to a matched control group of 72 patients who underwent elective AAA repair revealed an increased incidence of inflammatory aneurysm and female gender among our study group. The symptomatic patients had larger aneurysms (6.5 vs. 5.6 cm, p < 0.05) and required more intraoperative transfusions. Intensive care unit and hospital stay was longer in the symptomatic patients (p < 0.001); morbidity was markedly increased (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Popliteal artery aneurysms: the risk of nonoperative management.

To evaluate the risk of nonoperative management of popliteal artery aneurysms (PAAs), a retrospective cohort study of 106 consecutive patients (103 males and 3 females) with PAAs seen between January 1, 1980, and December 31, 1985, was performed. The mean age was 70.5 years (range 50 to 90 years). The 106 patients with 161 PAAs were followed for a mean of 6.7 years (range 3 days to 12.1 years). Follow-up was complete in 91.5% (97/106) of the patients. PAA was confirmed by ultrasonography in 124 limbs (77%), arteriography only in 7 (4.3%), and physical examination only in 32 (19.9%). Fifteen limbs presented with acute symptoms, 52 with chronic symptoms, and 94 were asymptomatic. Five of the 15 limbs with acute symptoms (33%) underwent amputation (4 primary, 1 secondary). PAAs in 23 of the 52 limbs with chronic symptoms were repaired; 2 limbs required amputation (8.7%). Twenty-seven of the 94 asymptomatic limbs were repaired initially; 1 required amputation (3.7%). The remaining 67 asymptomatic limbs were initially managed nonoperatively. Amputation was required in 3 of 67 limbs (4.4%), 1 with acute symptoms and 2 with chronic symptoms, all of which had undergone attempted repair. Symptoms (3 acute, 9 chronic) eventually developed in 12 (17.9%). At least one of three risk factors (size > 2 cm, thrombus, and poor runoff) was initially present in 11 of 12 limbs (91.7%) compared with 9 of 24 control limbs (37.5%) that remained asymptomatic (p < 0.05). Amputation rates in symptomatic patients with PAAs continues to be high. In patients with asymptomatic PAAs, aneurysm size > 2 cm, thrombus, or poor runoff predicted the development of symptoms. PAA patients with any of these factors should undergo elective repair, even asymptomatic patients who have a reasonable chance for long-term survival.

Aged↗
PubMed1994

Microscope-aided pedal bypass is an effective and low-risk operation to salvage the ischemic foot.

BACKGROUND: The aim of this study was to determine the current operative risks of the pedal bypass procedure, its durability, and the factors affecting long-term outcome. METHODS: We prospectively observed 96 patients who consecutively underwent 100 pedal bypasses using autogenous vein grafts for chronic critical ischemia. Of the 100 limbs, 91 had ischemic ulcers or gangrene, and 9 produced rest pain only. Sixty-four patients were diabetic, 21 had renal failure, and 36 had coronary artery disease. Nonreversed saphenous vein grafts were used most frequently (68 translocated, 13 in situ), followed by composite (13) and reversed vein grafts (6). Fifty-two long grafts originated from the iliac or femoral arteries, and 48 short grafts originated from the popliteal or tibial arteries. For the 100 procedures, 102 distal anastomoses were performed--68 to the dorsalis pedis, 8 to the distal posterior tibial, 10 to the common plantar, 2 to the medial plantar, 9 to the lateral plantar, 4 to the lateral tarsal, and 1 to the first dorsal metatarsal arteries--with the aid of an operating microscope. RESULTS: No patient died during the perioperative period. Two had hemodynamically insignificant myocardial infarctions. Wound complications developed in 12 patients--infection in 7 and hematoma in 5. There were 10 early graft failures, 6 of which could be salvaged, and 96 grafts were patent at dismissal. Mean follow-up was 2.1 years (range 1 month to 6.4 years). Postoperative surveillance identified 33 failed or failing grafts, 16 of which were successfully revised. At 3 years, cumulative primary and secondary patency rates were 60% and 69%, respectively. Factors correlating with increased secondary patency were intraoperative flow rate > or = 50 mL/min (P = 0.004) and diabetes (P < 0.05). Major amputations were performed on 17 limbs. The cumulative foot salvage rate at 3 years was 79%. CONCLUSION: Pedal bypass is a safe, effective, and durable procedure. It should be considered even for high-risk patients with critical limb ischemia before major amputation is contemplated.

Adult↗
PubMed1994

Iliocaval complications of retroperitoneal fibrosis.

BACKGROUND: Retroperitoneal fibrosis can compress ureters, nerves, and blood vessels in the abdomen. However, clinically significant large-vein obstruction secondary to this process is rare. METHODS: Three hundred forty patients with retroperitoneal fibrosis were treated at our institution between 1976 and 1993. The clinical data from seven of these patients, who were treated for iliocaval complications of retroperitoneal fibrosis, were reviewed. RESULTS: Six patients had signs and symptoms of chronic obstruction, and one patient presented with acute iliocaval thrombosis and underwent attempt at venous thrombectomy in the referring hospital. All patients exhibited extremity edema and three had venous claudication. Iliocaval occlusion was confirmed in all patients by venography, computed tomography, or magnetic resonance imaging. The obstructive process involved the iliocaval tree (four patients), the inferior vena cava alone (two patients), and the iliac vein alone (one patient). Five patients were managed conservatively with leg elevation, compression stockings, and anticoagulation. Two patients received prednisone. One patient underwent an iliocaval bypass from the external iliac vein to the juxtarenal cava using a ringed polytetrafluoroethylene graft with a femoral arteriovenous fistula. A second patient with an isolated left common iliac vein obstruction underwent a left-to-right femorofemoral saphenous vein bypass. Four patients treated conservatively continued to have extremity edema. The two patients managed surgically remain asymptomatic from venous insufficiency, with patent grafts at 25 and 12 months after surgery, respectively. CONCLUSION: Iliocaval obstruction is an unusual complication of retroperitoneal fibrosis. Although most cases can be managed conservatively, reconstruction is an option for patients who have failed medical treatment and are symptomatic secondary to chronic venous obstruction. Lifelong anticoagulation should be considered for all patients with progressive iliocaval obstruction secondary to retroperitoneal fibrosis.

Acute Disease↗
PubMed1994

Selection and preparation of high-risk patients for repair of abdominal aortic aneurysms.

OBJECTIVE: To discuss the most important risk factors in patients who undergo surgical repair of an abdominal aortic aneurysm (AAA). DESIGN: This update in vascular surgical repair highlights the criteria that identify high-risk patients, the useful preoperative tests, and the perioperative measures that can aid surgical recovery. MATERIAL AND METHODS: In elective repair of AAAs, high-risk patients are those with severe coronary or valvular heart disease, decompensated chronic obstructive pulmonary disease, severe cerebrovascular disease, chronic renal failure, hepatic cirrhosis with portal hypertension, and chronic hematologic disorders associated with bleeding dysfunction. Patients with unstable or severely symptomatic heart disease should undergo preoperative coronary angiography and ventriculography. Pharmacologic stress testing is recommended for patients with clinical markers of serious coronary artery disease and other medical or physical factors that prevent any type of standard exercise stress testing. RESULTS: Our experience with high-risk patients supports conventional repair of AAAs. Our preference for the midline abdominal incision in high-risk patients is substantiated by an operative mortality rate of 5.7% in comparison with a reported 7% mortality rate for nonresective therapy. Approximately one in three high-risk patients will have a serious postoperative complication, the most common of which is a cardiac event. Most patients recover after a slightly prolonged hospital stay. CONCLUSION: Despite an increased operative risk, patients with a stable medical condition and an AAA larger than 6 cm in diameter should be considered for elective repair. High-risk patients with smaller aneurysms (5 to 6 cm in diameter) should undergo efforts to stabilize or to improve their general medical condition before elective operation.

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PubMed1994

Mesenteric venous thrombosis: still a lethal disease in the 1990s.

PURPOSE: This study was designed to evaluate progress in diagnosis, management, and clinical outcome of mesenteric venous thrombosis (MVT). METHODS: We retrospectively reviewed the clinical course of 72 patients treated for mesenteric venous thrombosis between 1972 and 1993. RESULTS: Fifty-three patients had acute and 19 had chronic mesenteric venous thrombosis. Fifty-seven patients had secondary mesenteric venous thrombosis; previous abdominal surgical procedure and hypercoagulable states were the most prevalent associated conditions. Computed tomography was abnormal in all patients who underwent this test for acute mesenteric venous thrombosis and in 93% of those who had chronic disease. Angiography diagnosed acute mesenteric venous thrombosis in five (72%) of seven patients. Acute mesenteric venous thrombosis presented most frequently as abdominal pain (83%), anorexia (53%), and diarrhea (43%). Thirty-three (75%) had symptoms longer than 48 hours. Thirty-four (64%) patients with acute mesenteric venous thrombosis underwent a surgical procedure. Bowel resection was necessary in 31 patients. One patient had unsuccessful mesenteric venous thrombectomy. Seven patients with acute mesenteric venous thrombosis underwent anticoagulation without a surgical procedure, and 12 were observed. All patients with chronic mesenteric venous thrombosis were observed; nine of the 19 underwent anticoagulation. The median delay in diagnosis for patients with acute mesenteric venous thrombosis was 48 hours and did not decrease during the last decade. Mesenteric venous thrombosis recurred in 19 (36%) patients. The 30-day mortality was 27%. Long-term survival of patients with acute mesenteric venous thrombosis was significantly worse than that of those with chronic disease (36% vs 83% survival at 3 years). The patients with acute mesenteric venous thrombosis who underwent anticoagulation with and without surgical procedure had improved survival when compared with the observed group. CONCLUSION: Acute mesenteric venous thrombosis remains a lethal disease. Mortality has not improved in the last 22 years. Computed tomography is the most sensitive diagnostic test. Anticoagulation and surgical procedure enhanced survival in the acute subgroup. The underlying disease determined survival in chronic disease.

Acute Disease↗
PubMed1993

Vena cava replacement for malignant disease: is there a role?

Resection and graft replacement of the vena cava for malignant disease is rarely performed, often because of the advanced tumor stage. Since August 1987 we have selectively performed caval replacement in conjunction with tumor resection in 11 patients. Three patients had superior vena cava reconstruction (SVCR) and eight had inferior vena cava replacement (IVCR). There were six males and five females whose mean age was 59.3 years (range 24 to 75 years). Two patients, each with superior vena cava obstruction, presented with symptoms from venous compression. Malignancies involving the superior vena cava were thyroid carcinoma in two patients and lymphoma in one. Cancers requiring IVCR were leiomyosarcoma in three patients, cholangiocarcinoma in two, and malignant fibrous histiocytoma, hepatocellular carcinoma, and colon carcinoma metastatic to the liver in one each. All IVCRs and two SVCRs were performed with expanded polytetrafluoroethylene grafts. The remaining SVCR was constructed with spiral saphenous vein. Six IVCRs involved replacement of the retrohepatic inferior vena cava in conjunction with major liver resection. Mean intraoperative blood transfusions were 5.3 units (range 0 to 10 units). There were no operative deaths. Complications occurred in four patients and included postoperative bleeding in two, myocardial infarction in one, and wound infection in one. There were no perioperative graft occlusions, but one patient developed graft occlusion 2 months after SVCR. All IVCR grafts have remained patent (mean follow-up of 8.8 months). Two patients with SVCRs have died from recurrent cancer at 3.2 and 3.4 years postoperatively. Six patients with IVCRs have developed tumor recurrence either locally (n = 1), at a distant site (n = 2), or both (n = 3). Importantly, eight of nine survivors have an excellent performance status. We conclude that vena cava reconstruction for malignancy can be performed safely, has few graft-related complications, and in some patients may offer the only possibility for tumor control.

Adult↗
PubMed1993

Effects of cerebrospinal fluid drainage in patients undergoing thoracic and thoracoabdominal aortic surgery.

Cerebrospinal fluid (CSF) drainage has been reported to protect the spinal cord during surgical procedures requiring thoracic aortic cross-clamping. In 1986, CSF pressure monitoring and drainage was begun in an attempt to reduce the incidence of paraplegia associated with surgical repair of descending thoracic and thoracoabdominal aortic aneurysms (TAAA). These Group II patients (n = 50) were retrospectively compared to Group I patients (n = 49) who had undergone similar surgical procedures in the previous 3 years before CSF monitoring was introduced into this practice. Group II patients had intrathecal catheters placed for monitoring of CSF pressure and drainage of CSF to maintain the pressure < or = 15 mmHg. Seven patients (four in Group I, three in Group II) died before recovering from the anesthetic. Of the 47 patients in Group II who survived, none had clinically apparent complications such as an epidural hematoma or meningitis from the intrathecal catheter. The mean aortic cross-clamp time was 58.6 +/- 30.5 minutes (mean +/- SD) in Group I versus 65 +/- 42.6 minutes in Group II. Twenty-three patients in Group I and 16 patients in Group II had a shunt to the distal aorta. To maintain a CSF pressure of < or = 15 mmHg in Group II, an average of 46.9 +/- 6.9 mL of CSF was withdrawn. Of the 45 survivors in Group I, 4 developed a spinal cord deficit; the number of patients with spinal cord deficit in Group II was 4 out of the 47 who survived.(ABSTRACT TRUNCATED AT 250 WORDS)

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