European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
-
Eur J Vasc Endovasc Surg · Jan 1997
Comparative StudyGeneral anaesthesia versus cervical block and perioperative complications in carotid artery surgery.
To compare the influence of anaesthetic technique on perioperative complications in patients undergoing carotid endarterectomy. ⋯ Cervical block anaesthesia yields better perioperative results than general anaesthesia probably because it allows more reliable cerebral monitoring, reducing or even eliminating perioperative strokes related to clamping ischaemia. It facilitates detection of the mechanism underlying intraoperative stroke allowing surgical techniques and intraoperative management to be modified accordingly. Cervical block anaesthesia significantly reduces the need for internal carotid artery shunting.
-
One hundred and fifty consecutive patients presenting with limb-threatening ischaemia were studied prospectively to determine treatment and rehabilitation costs in the first year. Limb salvage was attempted in 104 (69%) patients but failed in 13%. Mortality at 1 year was 27%. ⋯ The cost of revascularisation for acute ischaemia was comparatively low because these patients required minimal rehabilitation. The median cost of managing a patient following amputation was almost twice that of successful limb salvage justifying an aggressive revascularisation policy. However, justification of such a policy on economic grounds requires salvage failure episode to be minimised as they increase costs considerably.
-
Eur J Vasc Endovasc Surg · Aug 1996
Randomized Controlled Trial Comparative Study Clinical TrialRandomised controlled trial of percutaneous transluminal angioplasty for intermittent claudication.
To determine differences between PTA and conventional medical treatment in treadmill distance until onset of claudication, treadmill maximum walking distance, patient reported maximum walking distance, ankle brachial pressure index (ABPI), quality of life (Nottingham Health Profile, NHP) and Duplex measured extent of occlusive disease. ⋯ Only 10% of claudicants had discrete lesions suitable for PTA. Treatment of these patients with PTA produces a greater short-term improvement in walking and quality of life than medical treatment alone and is associated with less progression of disease.
-
Eur J Vasc Endovasc Surg · Aug 1996
Factors associated with early failure of arteriovenous fistulae for haemodialysis access.
The radiocephalic arteriovenous fistula remains the method of choice for haemodialysis access. In order to assess their suitability for fistula formation, the radial arteries and cephalic veins were examined preoperatively by ultrasound colour flow scanner in conjunction with a pulse-generated run-off system. Intraoperative blood flow was measured after construction of the fistulae. ⋯ The intraoperative fistula blood flow did not correlate with the outcome of the operation probably due to vessel spasm from manipulation. However, blood flow velocities measured non-invasively 1 day after the operation were significantly lower in fistulae that failed early compared with those that were adequate for haemodialysis. Most of the increase in fistula diameter and blood flow occur within the first 2 weeks of surgery.