Peripheral arterial surgery

Trends in reconstruction for atherosclerotic renal vascular disease

Twenty-eight patients underwent renal vascular reconstruction for atherosclerotic renal vascular stenosis. Ten patients had therapeutic renal artery reconstruction for isolated renal artery stenosis causing severe hypertension, nine patients had therapeutic renal artery reconstruction for severe hypertension combined with simultaneous aortic reconstruction, and nine patients had prophylactic renal artery reconstruction for renal artery stenosis combined with simultaneous aortic reconstruction. Ninety percent of patients undergoing therapeutic renal revascularization procedures for hypertension were cured or improved. The 10 patients undergoing prophylactic renal artery reconstruction combined with aortic reconstruction had an average 72 percent reduction in the diameter of the vessel. Dacron side grafts sutured to the aortic graft were used for revascularization in each of the patients with prophylactic revascularization and was found to be an expedient means of reconstruction with good patency rates. No increased morbidity or mortality rate was noted in the prophylactic group. We believe that prophylactic revascularization should be carried out in patients with atherosclerotic high-grade stenosis of the renal arteries to prevent hypertension and preserve renal function.

Routine aortography before abdominal aortic aneurysmectomy. A prospective study

Routine preoperative arteriography was studied prospectively in 104 patients with abdominal aortic aneurysms. The patients were from the private practice of 11 vascular surgeons. Information regarding patient clinical status was gathered and compared with aortographic and intraoperative findings. Special attention was focused on the question of operation modification as dictated by aortographic findings. The surgeons were further asked whether the information gained from surgical exploration was equal to that obtained from arteriography. It is concluded that because of low yield of benefit, economic considerations, time delay, and minor but distinct risks of the procedure, arteriography should be used selectively rather than routinely in such patients.

Surgical treatment of aorto-iliac artery disease

In a period of 6 years, up to January, 1980, the author has treated 248 cases of aorto-iliac artery disease. There were 109 cases of abdominal aortic aneurysm, and the remainder was obstructive aorto-iliac artery disease. All but 20% of elective abdominal aortic aneurysms were asymptomatic. There were 100 cases of elective abdominal aortic aneurysm resection with operative mortality of 2%. There were 19 cases of ruptured aortic aneurysm with hospital mortality of 47%. There were 49 cases of aorto-femoral artery bypasses with 6th year cumulative patency rate of 89% in aorto-femoral bypass with Dacron graft, and 69% in aorto-iliac artery bypass with Dacron graft, and 2 year cumulative patency rate of 75% in descending thoracic aorto-femoral artery bypass with Poly Tetra Fluoro Ethylene graft. There were 32 cases of axillo-femoral artery bypasses and 48 cases of femoral-femoral artery bypasses. The 3 year cumulative patency rate of axillo-femoral artery bypass with PTFE graft was 89%, and that of femoral-femoral artery bypass with PTFE was 85%. However, axillo-femoral artery bypass with Dacron graft had 3-year patency rate of 67% and femoral-femoral artery bypass with Dacron graft was 62%. The 4 year cumulative patency rate of axillo-femoral artery bypass with Dacron graft was 39%. The 5 year cumulative patency rate of femoral-femoral artery bypass with Dacron graft was 62%

Aneurysms of the abdominal aorta: whether or not, when, and whom?

Recently, those who profess conservative views concerning management of aneurysms of the abdominal aorta argued against operative treatment, saying that the mere presence of an aneurysm is an indication that a patient often suffers from an advanced, terminal stage of diffuse arteriosclerosis and that operation in this patient is futile because it does not prolong life. The experience reported here represents a contrary view. Four hundred and eighty consecutive patients were followed from three to ten years postoperatively. Although the survival rate of these patients was lower than that of the general population of comparable age, it remained significantly higher than that of patients with known aneurysms who did not have the benefit of surgical treatment.

Arterial embolus to the upper limb

Seven cases of arterial embolus to the upper limb are presented. The cases support the current trend to management by embolectomy and the restoration of normal hand function as an important feature.