European journal of vascular surgery
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Renal failure is an important cause of postoperative morbidity and mortality in infrarenal aortic reconstruction. Several mechanisms for this postoperative renal dysfunction have been suggested. However, biochemical testing of renal function is insensitive since it shows only gross renal changes. ⋯ Six months later GFR decreased, the mean decrease was 9 ml/min. (P = 0.007 Wilcoxon rank). Some of our patients showed an increased GFR, a phenomenon that was recognised recently. None of the factors studied, except division of the left renal vein, had any effect on the changes in the GFR in the immediate postoperative period or 6 months later.
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Randomized Controlled Trial Comparative Study Clinical Trial
Local versus general anaesthesia in carotid surgery. A prospective, randomised study.
A randomised, prospective study was performed to compare local (LA) and general anaesthesia (GA) in carotid surgery with special emphasis on complications and the need for intra-operative shunting. Fifty-six patients were randomised to LA and 55 to GA. Eight patients in the LA group required a GA for various reasons. ⋯ During surgery the highest recorded systolic pressure was significantly higher in the LA group (210 mmHg versus 173 mmHg, P less than 0.001). LA for carotid endarterectomy is comparable with general anaesthesia regarding peroperative complications but produces significantly higher blood pressures than general anaesthesia. On the other hand it allows the possibility of neurologic monitoring of the patient and leads to significantly less use of an intra-operative shunt.
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Case Reports
Phaeochromocytoma and abdominal aneurysm: confirmation of diagnosis after aortic surgery using mIBG imaging.
Four cases of dissecting thoracic aneurysm associated with phaeochromocytoma have been reported in the World literature, of which only one survived surgery. We report what we believe to be the first case of intra-adrenal phaeochromocytoma presenting as a leaking abdominal aneurysm; which is of further interest as post-reconstruction 131-I meta-Iodobenzylguanidine (mIBG) imaging confirmed the existence of the tumour, despite equivocal urinary metanephrines.
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Randomized Controlled Trial Clinical Trial
Epidural vs general anaesthesia and leg blood flow in patients with occlusive atherosclerotic disease.
Total leg blood flow (plethysmography), skin blood flow (laser-Doppler flowmetry), and haemodynamic stability (MAP, HR, RPP) were studied in vascular (ABI less than 1.0; n = 31) and in non-vascular (ABI greater than 1.0; n = 24) surgical patients during epidural or fentanyl-supplemented general anaesthesia. During epidural anaesthesia significant increases in total leg blood flow were observed in vascular (from 1.9 +/- 0.2 to about 3 ml/100 ml tissue/min) as well as in non-vascular (from 2.5 +/- 0.6 to about 7 ml/100 ml tissue/min) patients and leg blood flow remained high in the postanaesthetic period. During general anaesthesia total leg blood did not increase, either in vascular or in non-vascular patients, and in the postanaesthetic period blood flow values even lower than the initial ones were observed. ⋯ In vascular patients no critical redistribution of blood flow within the limb was observed irrespective of the type of anaesthesia. Good haemodynamic stability could only be maintained in the epidural group. It is concluded that epidural anaesthesia seems to offer considerable advantages over general anaesthesia for high-risk vascular patients during arterial reconstructions since better haemodynamic stability and higher leg blood flow can be achieved.