Journal of vascular surgery
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Case Reports
Primary aortoesophageal fistula from aortic aneurysm: successful surgical treatment by use of omental pedicle graft.
A 65-year-old woman sought treatment for sentinel upper gastrointestinal hemorrhage. Three years previously she had undergone graft replacement of her ascending aorta for aneurysm. In the interim she was followed for chronic dissection of her remaining aorta, and 6 months before this admission she had undergone graft replacement of a large abdominal aortic aneurysm. ⋯ Development of a primary aortoesophageal fistula caused by aneurysms of the aorta is a rare but lethal complication. We present a technique for treatment of primary aortoesophageal fistula using omentum and preservation of gastrointestinal continuity as a one-stage operation. It is possible in selected cases to manage the esophageal perforation with primary closure and omental coverage to achieve healing free of infection without temporary or permanent discontinuity of the gastrointestinal tract.
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Epidural spinal cord electrical stimulation has been suggested as an alternative treatment in patients with limb-threatening ischemia in whom vascular reconstructive surgery is not possible anymore. We studied the effects of epidural spinal cord electrical stimulation on microcirculatory blood flow in 20 patients with ischemic rest pain and ulcers. Angiography showed occluded crural arteries technically unsuitable for reconstructive surgery. ⋯ In 12 patients pain relief continued, and ischemic ulcers healed; capillary microscopy confirmed improved microcirculatory blood flow. Microcirculatory parameters were significantly higher in respondents than in nonrespondents (p less than 0.001). Life-table analysis revealed a cumulative foot salvage of 80% and 56% after 1 and 2 years, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)