Annals of vascular surgery
-
Comparative Study
Survival and quality of life after arterial revascularization or major amputation for critical leg ischemia in Guadeloupe.
Functional outcome and survival in 253 patients treated for critical leg ischemia (CLI) in Guadeloupe (French West Indies) were analyzed. Analysis included calculation of quality-of-life score (QLS) from telephone survey data, with a median follow-up time of 42 months (range 12-109). ⋯ Survival was comparable in the two groups. Inadequate medical follow-up that was either totally lacking or performed only in case of recurrent CLI as well as low rates of rehabilitation (50%) and prosthetic fitting (32%) in the amputation group highlight the existence of a double problem involving therapeutic compliance and vascular follow-up care/rehabilitation in Guadeloupe.
-
The purpose of this study was to determine the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) and to define risk factors allowing identification of high-risk patients for MRSA nasal carriage at admission to the vascular surgery unit. From March 23, 2004 to July 13, 2004, screening for nasal carriage of MRSA was conducted at admission to the vascular surgery unit and 1 week thereafter. To analyze risk factors for MRSA nasal carriage at admission to the vascular surgery unit, a case-control study was carried out in patients presenting colonization at the time of admission. ⋯ The prevalence of nasal carriage in vascular surgery was 4.2%. Nasal screening is highly cost-effective since 60% of MRSA carriers were undetected using diagnostic specimens alone. French recommendations issued for cardiac and orthopedic surgery by the consensus conference on preoperative management of infectious risk on March 5, 2004, should be extended to vascular surgery.
-
This report describes two cases involving small-caliber gunshot wounds to the chest with embolization of the bullet (.22 long rifle). In the first patient, hemodynamic status permitted additional imaging before surgery. Findings demonstrated embolization of the bullet into the right external carotid artery after penetration into the left ventricle. ⋯ Bullet embolization into the left hypogastric artery through an acquired aortopulmonary fistula suspected during thoracic exploration was diagnosed after the procedure. Postoperative recovery was uneventful in both cases. The bullet in the hypogastric artery was not extracted, with no complications being observed after a follow-up period of 3 years.
-
Aortoenteric fistula (AEF) is an infrequent but disastrous complication of open abdominal aortic repair. Left untreated, it has a 100% fatality rate. ⋯ At 1-year follow-up, the patient was doing well without any signs of recurrent fistula. Endovascular treatment of AEF provides another treatment option that may be particularly valuable in patients whose comorbidities would preclude open repair.
-
We report a case of combined colon cancer and Clostridium septicum aortitis involving the suprarenal abdominal aorta with rupture. An 82-year-old male presented with fever, abdominal pain, and back pain associated with constipation. ⋯ Only 20 other cases of C. septicum mycotic aneurysm, aortitis, or aortic dissection have been reported. Concomitant surgical treatment for Clostridium aortitis or mycotic abdominal aortic aneurysm and colon cancer can be accomplished successfully in selected cases when the diagnosis of both conditions is made preoperatively.