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PubMed2000

A novel technique for intraaortic balloon pump placement via the left axillary artery in patients awaiting cardiac transplantation.

In order to circumvent the problems associated with long-term femoral intraaortic balloon pump (IABP) placement we have developed and used a new technique of IABP placement. Over the past three years 13 patients awaiting cardiac transplantation have had placement of IABP via a vein cuff sewn to the left axillary artery. Thirteen patients have undergone IABP placement using this technique. The average duration of IABP support was 37 days (range 10-86 days). Ten patients were successfully transplanted. All patients were allowed to sit, stand and ambulate with assistance. No neurologic complications occurred. There were no episodes of sepsis related to balloon or insertion site. No patient had limb ischemia during IABP counterpulsation. Left axillary artery IABP insertion via a vein cuff portal is a straightforward technique with minimal complications. This method serves as a bridge to cardiac transplantation in a gravely ill group of patients while preserving patient mobility during the waiting period for a donor heart.

Antibiotic Prophylaxis↗

PubMed1989

Recent experience with benign biliary strictures.

The management of benign biliary strictures continues to represent one of the most difficult problems in the practice of general surgery. Twenty-eight consecutive patients with benign strictures treated between 1972 and 1987 are reviewed in this report. Stricture etiology was iatrogenic in 13 patients, pancreatitic in 11, idiopathic in three, and traumatic in one. The authors performed 27 operations and three percutaneous transhepatic balloon dilatations in the treatment of these patients. Operative morbidity was 18 per cent; there were no operative deaths. Treatment was successful in 23 of 28 patients with a mean followup of four years, and four of the five patients with initially unsuccessful results have undergone successful remedial operations. Roux-en-Y biliary enteric diversion procedures have been most successful in these patients: seven patients with Roux-en-Y choledochojejunostomy without recurrence (mean followup of 62 months) and eight patients with Roux-en-Y hepaticojejunostomy with a success rate of 87.5 per cent (mean followup of 50 months). Two patients underwent three percutaneous transhepatic balloon dilatations; one has had a good result with short followup and the other failed on two occasions and has required a remedial operation. Benign biliary strictures have multiple etiologies. Therapeutic approaches, which now include nonoperative procedures, must be tailored to the needs of individual patients. The potential for recurrence is always present. Longterm followup remains essential in the management of patients with this disorder.

Adult↗