Annals of vascular surgery
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Case Reports
Surgical removal of a knotted and entrapped subclavian hemodialysis catheter guidewire.
Many mechanical complications associated with insertion, maintenance, and removal of the hemodialysis catheters have been reported in the literature. A 47-year-old man was consulted to our hospital because of an entrapped hemodialysis catheter guidewire. ⋯ He was discharged home on postoperative day 2 without any complication. Our suggestion is that any abnormal resistance should be immediately evaluated for the presence of any potential knots using the most appropriate imaging technique.
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Cardiovascular complications, such as death, myocardial infarction, or heart failure, are the leading causes of morbidity and mortality in adult patients undergoing major noncardiac surgery. ⋯ These data suggest a significant benefit of an intensive cardiac preoperative evaluation in reducing the incidence of perioperative and postoperative cardiac morbidity and mortality.
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We reviewed our experience to determine the effect of epidural versus intravenous analgesia on postoperative pulmonary function and pain control in patients with chronic obstructive pulmonary disease (COPD) undergoing open surgery for abdominal aortic aneurysm. ⋯ Epidural anesthesia and postoperative epidural analgesia improve the postoperative respiratory function, compared with general anesthesia and systemic analgesia, and reduce postoperative pain as well, in COPD patients undergoing elective infrarenal abdominal aortic aneurysm repair.
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Case Reports
Delayed axillary artery pseudoaneurysm as an isolated consequence to anterior dislocation of the shoulder.
Injury to the axillary artery after anterior shoulder dislocation is a very rare occurrence; although infrequently seen as an iatrogenic complication, very few cases have been reported. We describe a case of delayed axillary artery pseudoaneurysm, presenting as single complication after anterior shoulder dislocation reduction, which was successfully managed by surgical intervention-resection-anastomosis. Although uncommon, pseudoaneurysms should not be forgotten after trivial trauma. The early diagnosis of upper-limb pseudoaneurysms should prevent the risk of vascular and neurological compromises with potential serious long-term sequelae.
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Aortoenteric fistulas (AEFs) are a rare complication of infrarenal abdominal aortic aneurysm repair. They occur in <1% of aortic grafting procedures, result from graft defects, foreign bodies, and trauma, and are associated with a high mortality rate. We report a complex AEF associated with vertebral body osteomyelitis, likely secondary to tuberculous infection. ⋯ With fluoroscopic guidance, injection of contrast in the aortic sac drainage catheter demonstrated complex fistulous communications from the aortic sac to the overlying small intestine. After a course of drainage, antibiotic therapy, and parenteral nutrition, the patient underwent a transperitoneal repair of the AEF with duodeno-duodenectomy and wide debridement of the aortic sac and Dacron graft. Pathology revealed giant cell granulomas, highly suggestive of tuberculosis.