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At least 19 recordsLinked to original sources
PubMed2001

Antibiotic prophylaxis in clean surgery: vascular surgery.

The commonest and most dangerous infective complication in vascular surgery is prosthetic graft infection. Despite the use of routine systemic antibiotic prophylaxis, graft infection occurs after 3-5% of all prosthetic vascular reconstructions. Infection is associated with a high rate of major morbidity and mortality, with significant time and cost implications. Management can be difficult and the outcome is often disappointing. Data from Italian Registry of Prosthetic Graft Infections show that the commonest site of infection is the aorto-femoral district and that involved bacteria are usually gram-positive in early and low-grade infections and gram-negative in late and high-grade infections. Results are poor, with a mortality rate of 15% for elective surgery and of 60% for emergency interventions. We report the results of a multicenter randomized controlled trial of rifampicin-bonded Dacron grafts in aorto-femoral surgery, in which our Department was involved. Data demonstrate a reduction in total early wound and graft infection rates, and 2-year results show a small, non-significant reduction in graft infection (1.7% in study group, 2.3% in control group). The same results were obtained in two other multicenter trials.

Antibiotic Prophylaxis↗
PubMed1988

[Abdominal surgery and vascular surgery].

Vascular surgery itself developed for the surgical treatment for the vascular lesions such as occlusion and/or aneurysm. But recently the fine vascular surgical technique has been applied also to the treatment of malignancy affected the abdominal visceral organs. For instance, it is for the curative operation, when the malignant lesion such as bile duct carcinoma involves the main portal system because the resection with reconstruction of the portal vein is nowadays feasible. In this paper I would like to describe the technique of vascular reconstruction for the general surgeons and to report the current status of introduction of vascular surgery into the abdominal surgery in Japan.

Abdomen↗
PubMed1991

[Progress in current vascular surgery].

Vascular surgery, one of the main fundamental parts of angiology, is an important rapidly developing clinical specialty. The author discusses the experience in many thousand operations in injuries, atherosclerosis, and thrombosis of arteries and veins in the light of new advancements in plastic microsurgery and the use of laser, ultrasound, glue, and various types of vascular sutures. He suggests organizing adequately equipped vascular surgery departments and teams of emergency vascular surgery, wider training of vascular surgeons++, and discusses new methods for the reconstruction of vessels and use of vascular prostheses.

Blood Vessel Prosthesis↗
PubMed1994

[Antibiotic prophylaxis in vascular surgery].

Vascular surgery includes various surgical procedures and sites. Infectious risk is low but with a high functional risk and a high mortality rate. Infection risk factors are numerous. Among them the incision in the Scarpa's triangle is at the first place. Antimicrobial prophylaxis in vascular surgery has shown its efficacy whatever the agent. The second generation cephalosporins are the most logical, with a duration of administration of less than 24 hours. In case of re-operation glycopeptides have shown their efficacy.

Anti-Bacterial Agents↗
PubMed2002

Gelatin-thrombin-based hemostatic sealant for intraoperative bleeding in vascular surgery.

Vascular surgical procedures may be prolonged because of intraoperative bleeding that is not easily controlled by cautery or suture ligation. This trial compared the ability of a new hemostat, FloSealTM Matrix (FM), with a known hemostat, Gelfoam(R) plus thrombin (GT), to control intraoperative bleeding. Patients undergoing vascular surgery procedures at four institutions were entered in the trial. After a bleeding site was identified, patients were randomized to one of the study agents: (1) FM, a cross-linked gelatin of bovine origin combined with thrombin, or (2) GT. The assigned agent was applied and the site observed for bleeding at 1, 2, 3, 6, and 10 min. The primary end point was cessation of bleeding within 10 min for the first identified site treated. Secondary end points were cessation of bleeding within 10 min for all sites and time to cessation of bleeding. Patients were assessed for morbidity at 30 days and 6-8 weeks after the operation. Analysis was performed on an intent-to-treat basis for analysis of hemostasis at 10 min and on protocol-valid patients for analysis of time to hemostasis. From our results we concluded that for patients undergoing vascular surgery procedures, the new topical hemostat, FloSeal Matrix, provides more rapid and effective hemostasis than Gelfoam plus thrombin.

Aged↗
PubMed1998

[Complications of vascular surgery].

Vascular surgery, which in certain life-threatening situations is the only possible therapeutic option, has progressed considerably since its beginning in the 1950s. Because of the constant progression of vascular diseases, this surgery will present, in the forthcoming years, a major public health problem. Because of advances in medico-surgical management, evermore elderly and frail patients can be treated. Perioperative mortality is constantly decreasing, but much progress remains to be accomplished to prevent, avoid or treat, postoperative complications. They are common and serious in these typical patients with cardiovascular diseases (men over 50 years of age, heavy smokers, atheromatous ...). The AA divide these complications into 3 main groups depending on the surgical procedure: abdominal aortic surgery, carotid surgery and arterial and venous surgery of the lower limbs. There is much data on abdominal aortic surgery because these long and complex procedures produce repercussions often involving many systems. The postoperative complications are treated according to the system they involve: cardiovascular, the most serious, respiratory, the commonest, alimentary, neurological, renal, others, as well as combined systems. The AA do not deal with the specific problems associated with cardiac and cardio-thoracic surgery. The AA discuss the different epidemiological findings of the large surgical series published in the 1970s and 1980s. The more recent literature analyses the relationship between preoperative risk factors (atheroma, COAD, hypertension ...), peroperative problems (surgical difficulties, emergencies, massive transfusions, others) and the corresponding postoperative morbidity. Thus a few general outlines of the physiopathology of these different complications emerge. In the light of these notions the few proposed methods will be evaluated in order to improve the preoperative condition of the vascular patient. The AA also review the relevance of the preoperative investigation in patients for vascular surgery. All these measures aim at reducing the incidence and severity of perioperative morbidity.

Aorta, Abdominal↗
PubMedDate not supplied

Economics of vascular surgery.

Vascular surgery is a relatively young specialty and its separation from general surgery has raised many questions about its cost and effectiveness. In this article the evidence for the treatment of common vascular conditions is evaluated. The reasons for conflicting results and opinions, together with possible solutions for the future, are also discussed.

Aortic Aneurysm↗
PubMed1989

[Quality of life after surgical interventions--vascular surgery].

Vascular surgery is primarily a reconstructive discipline that contributes appreciably to the patient's quality of life (QL) by improving many organ and system functions. The definition of QL includes a variety of specific and very individual aspects. The postoperative evaluation of QL must be based on the one hand on hard data and common clinical parameters, and, on the other, on the individual feeling of the patient, who compares preoperative sequelae and postoperative functional improvement.

Activities of Daily Living↗
PubMedDate not supplied

Antibiotic prophylaxis in clean surgery: peripheral vascular surgery, noncardiovascular thoracic surgery, herniorrhaphy, and mastectomy.

Studies published in the English-language literature on the use of prophylactic systemic antibiotics in vascular surgery, noncardiovascular thoracic surgery, mastectomy, and herniorrhaphy were reviewed. The effectiveness of antibiotic prophylaxis in preventing deep and superficial wound infections in peripheral vascular surgery appears to be well documented, especially if prophylaxis is directed against Staphylococcus aureus. In clean thoracic surgery the evidence is equivocal, and no studies have sufficient statistical power to eliminate the possibility even of a 50% reduction in incidence. In herniorrhaphy and mastectomy some evidence from a much more powerful study suggests that antibiotic prophylaxis may result in a decrease of up to 50% in wound infections, but whether these data can be generalized uncritically to all clean wounds is still a matter of debate. Accordingly, only guarded recommendations can be made regarding the use of prophylactic antibiotics in procedures associated with a very low risk of serious infection.

Anti-Bacterial Agents↗
PubMed1994

[Antibiotic prevention and occurrence of wound infections in heart surgery and vascular surgery].

Post-operative wound infections are serious complications in cardiovascular surgery. In order to examine the routines for prophylactic antibiotics and frequency of wound infections, questionnaires were sent to heart and vascular surgery units in Norway. In heart surgery, the sternal wound infection rate registered during stay in hospital varied between 0-1.2%. Seven clinics used cephalothin prophylaxis and one cloxacillin and penicillin. One clinic added vancomycin in the case of valvular surgery. The duration of prophylaxis varied from six hours to four days. In vascular surgery, superficial wound infection rates of 1.5-4.0%, and deep infection rates of 0.8-2.0%, were reported. Seven clinics used cephalothin and three cefuroxime as prophylaxis. The duration of prophylaxis varied from one single dose to several days. In conclusion, the reported infection rates indicate that the antibiotic prophylaxis regimens used help to provide satisfactory protection against wound infections.

Anti-Bacterial Agents↗
PubMed1994

Heparin and protamine use in peripheral vascular surgery: a comparison between surgeons of the Society for Vascular Surgery and the European Society for Vascular Surgery.

It was the intent of this study to document, in general, the patterns and complications of heparin and protamine usage during carotid endarterectomy, aortic and femoral-popliteal-tibial reconstructions for occlusive disease, elective and emergent abdominal aortic aneurysmectomy, thromboembolectomy, and dialysis arteriovenous (AV) fistula placement by surgeons from North America and Europe. All vascular surgeons from the Society for Vascular Surgery (SVS) and the European Society for Vascular Surgery (ESVS) were surveyed by a voluntary, self-reported questionnaire. Six hundred and forty-six completed questionnaires (284 from SVS and 362 from ESVS), representing a 62% response rate, were returned for evaluation. Systemic and regional administration of heparin was common during vascular procedures performed by both SVS and ESVS surgeons. Use of protamine to reverse heparin anticoagulation varied among SVS and ESVS surgeons, respectively, during: carotid endarterectomy (54% vs. 26%, p < 0.01), elective aortic reconstruction for occlusive disease (58% vs. 23%, p < 0.001), elective aortic reconstruction for abdominal aortic aneurysm (63% vs. 27%, p < 0.001), and femoral-popliteal-tibial reconstruction (44% vs. 15%, p < 0.001). Adverse reactions to protamine among the 25,219 and 12,902 cases reported from SVS and ESVS surgeons, respectively, included: hypotension (1209 and 495 cases), pulmonary artery hypertension (65 and eight cases), anaphylaxis (52 and 10 cases), and death (seven and two cases). These adverse responses accounted for 5.3% and 4.0% of the SVS and ESVS cases, respectively. Although this study is subject to the known limitations of a retrospective survey, it is clear that heparin use is common. Protamine reversal of heparin anticoagulation is more common in North America.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗
PubMed2003

Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery.

Decision-making in regard to elective repair of abdominal aortic aneurysms (AAA) requires careful assessment of factors that influence rupture risk, operative mortality, and life expectancy. Individualized consideration of these factors in each patient is essential, and the role of patient preference is of increasing importance. It is not possible or appropriate to recommend a single threshold diameter for intervention which can be generalized to all patients. Based upon the best available current evidence, 5.5 cm is the best threshold for repair in an "average" patient. However, subsets of younger, good-risk patients or aneurysms at higher rupture risk may be identified in whom repair at smaller sizes is justified. Conversely, delay in repair until larger diameter may be best for older, higher-risk patients, especially if endovascular repair is not possible. Intervention at diameter <5.5 cm appears indicated in women with AAA. If a patient has suitable anatomy, endovascular repair may be considered, and it is most advantageous for older, higher-risk patients or patients with a hostile abdomen or other technical factors that may complicate standard open repair. With endovascular repair, perioperative morbidity and recovery time are clearly reduced; however, there is a higher reintervention rate, increased surveillance burden, and a small but ongoing risk of AAA rupture. There is no justification at present for different indications for endovascular repair, such as earlier treatment of smaller AAA. Until long-term outcome of endoluminal repair is better defined and results of randomized trials available, the choice between endovascular and open repair will continue to rely heavily on patient preference.

Aortic Aneurysm, Abdominal↗
PubMed1987

Vascular surgery in the United States. Report of the Joint Society for Vascular Surgery--International Society for Cardiovascular Surgery Committee on Vascular Surgical Manpower.

The Joint Committee on Vascular Surgical Manpower was established in 1985 by the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery. It was charged to provide recommendations regarding vascular surgical manpower requirements for the next 15 years. Analysis of National Center for Health Statistics vascular operative rate data and 1690 questionnaire responses from vascular surgeons documented that vascular surgeons performed 235,400 (41%) of the total of 571,000 vascular operations undertaken in 1985. Vascular surgeons performed 87% of 30,000 aortoiliofemoral reconstructions, 77% of 72,000 peripheral vessel bypasses, 75% of 33,000 abdominal aortic aneurysm repairs, 59% of 55,000 angioaccess procedures, and 50% of 107,000 carotid endarterectomies. However, lack of accurate data on caseloads of surgeons who were not vascular specialists precludes precise prediction of manpower requirements for vascular surgery. It is important that surgical leaders and policy makers define the types of vascular surgical procedures that may be undertaken by vascular and other surgeons. Ongoing analyses must include such determinations to establish accurate data for the prediction of future manpower needs for vascular surgery. Furthermore, future manpower studies should be linked to outcome studies to assess not only numbers of surgeons and operations but quality of care as well.

Forecasting↗