Int Surg
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Postoperative iliac and popliteal arteriovenous fistulas are extremely rare. This article describes the percutaneous endovascular treatment of iatrogenically induced arteriovenous fistula in two patients with simultaneous use of intravascular ultrasound. In a 61-year-old woman, a fistula between popliteal artery and vein, inadvertently created during implantation of a prosthetic knee joint, was treated with a novel polytetrafluorethylene (PTFE) stent graft. ⋯ Congestive heart failure induced by the arteriovenous communication was reduced rapidly. Our results indicate that percutaneous treatment in conjunction with intravascular ultrasound is a useful therapeutic option for vascular lesions. It is less invasive than open vascular reconstruction and has a comparably high success rate.
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We studied patients who underwent a coronary artery bypass grafting (CABG) procedure with previous percutaneous transluminal coronary angioplasty (PTCA). Forty patients had undergone successful PTCA, and required subsequent CABG, between January 1993 and June 1996 (Group I). These patients were matched with 40 patients surgically revascularized without previous PTCA at the same term (Group II). ⋯ Survival rates for three years were 92.5% and 95% in Group I and in Group II, respectively. In conclusion, the method of initial revascularization procedure should be considered carefully, as markers of more severe disease may indicate primary CABG and avoidance of an initial PTCA. The initial PTCA may complicate the operation and may increase postoperative morbidity and mortality.
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In this experimental study, the effects of mannitol and hydroxyethyl starch solution (HES) on bacterial translocation were evaluated in a rat model of simple mechanical bowel obstruction. The mechanical bowel obstruction was created by ligation of the ileum 1 cm proximal to the ileocecal valve. Excluding the control group (n = 7), the rats were given 2 ml of mannitol or 2 ml of 6% hydroxyethyl starch solution intraperitoneally during the procedure. ⋯ The bacterial population/g tissue obtained from intraluminal bacterial cultures of the ileum was also depressed in hydroxyethyl starch solution group when compared to the control (P<0.03). As a result, we confirmed that hydroxyethyl starch solution, a plasma volume expander, depressed the bacterial translocation to the mesenteric lymph nodes and liver and also reduced intraluminal bacterial overgrowth in the simple mechanical bowel obstruction model of rats. We believe that hydroxyethyl starch solution may be an alternative therapeutic agent for the pre-operative fluid resuscitation in simple mechanical bowel obstruction.