Journal of vascular surgery
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Prolonged anastomotic and needle hole bleeding from synthetic vascular prostheses is a common surgical problem in heparinized patients and in the patient with a coagulopathy. The relative effectiveness of various hemostatic agents has not previously been determined by controlled comparisons. In this study 6 mm polytetrafluoroethylene (PTFE) vascular prostheses were used to perform carotid-carotid and femorofemoral bypasses in eight heparinized dogs. ⋯ Although application of isobutyl 2-cyanoacrylate resulted in the shortest MTH in each experimental group, the reported inflammatory response that it induces and its possible carcinogenicity limits its availability for clinical use. Application of fibrin adhesive prepared from single-donor hepatitis-screened plasma resulted in a significantly shorter MTH in each experimental group when compared with oxidized regenerated cellulose. We recommend clinical use of fibrin adhesive to control needle hole and anastomotic bleeding from PTFE vascular prostheses.
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Comparative Study
Optimal fluid management after aortic reconstruction: a prospective study of two crystalloid solutions.
To determine optimal fluid management after elective aortic surgery we compared postoperative administration of 5% dextrose Ringer's lactate solution (102 patients) with 5% dextrose half-normal saline solution (80 patients). For 72 hours after operation, intravenous fluids were titrated to maintain urine output between 50 and 100 ml/hr. The group receiving 5% dextrose Ringer's lactate required less intravenous volume per day (2005 +/- 138 ml [mean +/- standard error of the mean] vs. 2701 +/- 145 ml, p less than 0.05), gained less weight (0.8 +/- 0.2 kg vs. 3.2 +/- 0.2 kg, p less than 0.05), and sustained less hyponatremia (serum sodium reduction, 0.1 mEq/L vs. 4.5 mEq/L, p less than 0.05). ⋯ PaO2, 67 +/- 5 torr, p less than 0.05). Optimal fluid management was approached by the use of 5% dextrose Ringer's lactate solution postoperatively. The use of hypotonic saline solution after aortic surgery offered no advantage and predisposed the patient to volume overload.
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Recent reports in the literature have promulgated nonresective treatment of abdominal aortic aneurysm as a safer procedure than conventional aneurysmectomy with graft replacement in high-risk patients. This review of 106 high-risk patients who underwent conventional aneurysm repair between 1980 and 1985 was undertaken to compare the relative risks, perioperative morbidity, and operative mortality of these patients to that reported for patients treated by nonresective therapy. ⋯ The mortality rate for conventional aneurysm repair in high-risk patients was 5.7%, compared with a reported 7% mortality rate for nonresective therapy. In those patients with severe cardiac dysfunction, intraoperative pharmacologic manipulation and the selective use of intra-aortic balloon counterpulsation appeared helpful in achieving survival.(ABSTRACT TRUNCATED AT 250 WORDS)
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Coarctations of the abdominal aorta are often associated with renal artery stenosis resulting in hypertension, which is commonly the presenting symptom. Controversy exists concerning the origin of these lesions, but there is general agreement that surgical intervention is the treatment of choice. We report four patients with abdominal aortic coarctation and concomitant renal artery stenosis who required aortoaortic bypass and appropriate bypass to the renal vessels. We advise total correction in one stage and proximal renal artery bypass from native aorta or iliac artery when it is technically feasible.