Peripheral Vascular Disease
Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson in Health Care Needs Assessment, 2018
The clinical course of patients with intermittent claudication is very variable. Most patients either improve or stay about the same; deterioration leading to amputation is uncommon.12,13 In mild claudication, ‘stop smoking and keep walking’ is standard advice;14 drug therapy is of limited value.15 Interventional treatment may be warranted when patients perceive the handicap as severely limiting their quality of life. In such cases, balloon angioplasty or bypass surgery may be carried out, although there have been few controlled trials examining the cost-effectiveness of these procedures. Balloon angioplasty involves passing a catheter through the skin into the artery and inflating a balloon to crack and obliterate the atheromatous plaque. Bypass operations, which are the main type of reconstructive surgery, involve the insertion of a graft comprising vein or synthetic material, such as Dacron. This graft allows blood to bypass the narrowed or obstructed artery. In most cases of intermittent claudication, risk factor management and antiplatelet therapy is also warranted.
Complications of upper extremity bypass grafting for occlusive and aneurysmal disease
Sachinder Singh Hans, Mark F. Conrad in Vascular and Endovascular Complications, 2021
Bypass infection requires removal of the graft material and a plan to re-establish arterial flow outside of the infected field. The standard teaching is that all infected material should be removed, and it is rare that portions of an infected graft can be salvaged. These are extensive operations and it can seem prudent to try to avoid re-operative areas, but it is rare to get away with this approach, especially if a prosthetic conduit was used. This is especially true if either anastomosis is involved as these patients will experience exsanguinating hemorrhage if surgery is delayed.31 Because there are little data specific to the treatment of upper extremity bypass infections, these recommendations are extrapolations of graft infections from other arterial beds.
History-taking model
Kaji Sritharan, Vivian A Elwell, Sachi Sivananthan in Essential OSCE Topics for Medical and Surgical Finals, 2007
RisksThese depend on the patient’s age and on the severity of cardiac disease (e.g. previous coronary artery bypass graft, myocardial infarction, heart failure and comorbidity).They include:arrhythmias (1 in 100 cases)bleeding with or without haematomapseudoaneurysm of the femoral arteryradiation damage to the skinstroke (long-term disability)myocardial infarctioncontrast reaction leading to an asthma attack, convulsions, renal failure or death (rare)lower limb ischaemia (compromised blood supply to the leg) that requires surgeryemergency coronary artery bypass grafting.
Comparing treatment options for large vessel vasculitis
Published in Expert Review of Clinical Immunology, 2022
Federica Macaluso, Chiara Marvisi, Paola Castrignanò, Nicolò Pipitone, Carlo Salvarani
However, the evidence for biological agents in TAK is very limited and mostly derived from uncontrolled observations. In refractory cases, we prefer to use TNFi over TCZ because of the more robust evidence in their favor. Surgical procedures are needed in cases of cerebrovascular disease due to cervical vessel stenosis, coronary artery disease, moderate-to-severe aortic regurgitation, severe coarctation of the aorta, renovascular hypertension, limb claudication, or progressive aneurysm enlargement with risk of rupture or dissection. Bypass graft surgeries are associated with a better long-term outcome. Percutaneous transluminal angioplasty provides better results for short lesions than conventional stents. Surgical procedures should be performed whenever possible when the disease is adequately controlled by medications. A multidisciplinary approach is required to best manage large vessel vasculitis.
Is type 1 tympanoplasty effective in elderly patients? Comparison of fascia and perichondrium grafts
Published in Acta Oto-Laryngologica, 2019
Serkan Cayir, Serkan Kayabasi, Omer Hizli
Forty-nine elderly patients undergone tympanoplasty were eligible for the study. The characteristics of the fascia and perichondrium groups were presented in Table 1. Tympanoplasty operations were performed in 22 (44.9%) right ears and 27 (55.1%) left ears. The overall mean air and bone conduction thresholds were 44.8 ± 12.2 dB and 17.9 ± 12.8 dB, respectively. Overall graft success rate was 85.7% (42 out of 49 patients). After a mean follow-up period of 23.3 ± 8.32 months, the overall mean ABG gain was 11.33 ± 8.42 dB. The overall functional success rate was 65.3% (32 out of 49 patients). The overall median postoperative ABG (9 dB) was significantly lower compared to the overall median preoperative ABG (24 dB) (p < .001). Thus, we found that type 1 tympanoplasty was an effective surgical procedure in elderly patients.
Anterior cruciate ligament reconstruction complicated by Propionibacterium acnes infection: case series
Published in The Physician and Sportsmedicine, 2018
Alex C. DiBartola, Katherine R. Swank, David C. Flanigan
Failure rates vary depending on the type of graft used. In a study of 12,967 primary elective ACL reconstruction procedures overall, the revision rate was 2.6% [5]. A recent registry study of over 60,000 patients demonstrate an ACL failure rate of approximately 2.8–3.7% depending on the type of graft used [6]. A 2003 meta-analysis reported failure rates of 1.9% for patellar tendon autografts and 4.9% for hamstring autografts [7]. In addition, a study by Kaeding et al. found a higher risk of ACL reconstruction failure among younger patients and those who underwent allograft procedures (versus autograft) [8]. Despite extensive study of graft failure, the mechanism of graft failure remains poorly understood. Traumatic loading, indolent infection, biological failure, and surgical error have all been suggested to play a role [8]. Specifically, biologic failure has been described as failure after ACL reconstruction not related to new trauma or surgical technical error and may in part be due to issues in graft vascularization, matrix remodeling, and/or cell repopulation [9,10,11,12]. However, biological failure remains an understudied and inadequately understood mechanism of ACL graft failure.
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