A randomized controlled trial comparing an intraoperative goal-directed strategy with routine clinical practice in patients undergoing peripheral arterial surgery.

Background And Objective: We hypothesized that, in vascular surgery patients, the application of a goal-directed strategy based on a pulse contour-derived cardiac index would be associated with a better haemodynamic status than the application of routine perioperative care and that the amount of fluid and/or inotropes required in such a goal-directed therapy depended on the general anaesthetic technique used.

Methods: Patients undergoing peripheral arterial bypass grafting were randomly assigned to three groups. In group 1, haemodynamic management was performed according to routine clinical practice.

The post-thrombotic syndrome - a condition to prevent.

The incidence of the post-thrombotic syndrome (PTS) is increasing along with the incidence of deep vein thrombosis (DVT). The overall frequency of PTS ranges from 20 percent to 50 percent of DVT patients; severe PTS, which includes leg ulcers, occurs in a quarter of cases. Because of its severity and chronicity, PTS is associated with great morbidity and cost.

Endovascular treatment of axillary artery dissection following anterior shoulder dislocation.

Injury to the axillary artery is a rare complication of anterior shoulder dislocation. Open surgical repair is technically demanding because of the anatomical position of the vessel and the propensity for concomitant injuries. Standard surgical exposure techniques involve extensive dissection, including a combination of supraclavicular or infraclavicular incision, median sternotomy, and thoracotomy causing significant morbidity and mortality rates.

[Spontaneous rupture of utero-ovarian vessels in postpartal period: a case report and review of the literature].

Spontaneous rupture of utero-ovarian veins occurring during pregnancy or the peripartal period is generally considered to be a medical curiosity (approximately 100 reported cases) rarely mentioned in obstetric textbooks. It is nevertheless a dramatic cause of maternal and /or fetal mortality. The available statistics are the following: 60% of the cases are directly related to labor and 50% occur in primiparas; when the rupture is associated with labor, mortality is 40%.

Use of cryopreserved arterial homografts for management of infected prosthetic grafts: a multicentric study.

The objective of this study was to evaluate the effectiveness of cryopreserved arterial homografts for management of prosthetic graft infection. Between October 1992 and July 1998, 90 patients (84 men) with a mean age of 64 years from six different hospitals were treated for prosthesis infection by in situ replacement using a cryopreserved arterial homograft (CAH). In 43 patients (47%), the primary procedure had been performed at a nonparticipating center.

[Rupture of an abdominal aortic aneurysm in a nonagenarian].

Rupture of an infrarenal aortic aneurysm occurring in a 94- year old man is reported. Eight months after surgery the patient is still alive. Indications of elective surgery for asymptomatic abdominal aneurysm in the elderly are discussed.

Vascular graft infection caused by Aspergillus species: case report and review of the literature.

We report an unusual case of vascular graft infection caused by Aspergillus fumigatus that began with a false aneurysm, major arterial emboli, and septic arthritis. Successful treatment included resection of the infected graft, restoration of circulation by extraanatomic bypass, and administration of amphotericin B and itraconazole, a new antifungal agent. Graft infection in the case reported herein most likely occurred during surgery and took place during an insidious outbreak of postoperative infection.

[Surgery of severe ischemias and infections of the foot in the diabetic. (Role of arterial revascularization)].

From overall data on 54 diabetic patients, who, over a period of 7 years, underwent operations to save their feet from ischaemia (whether linked or not to infection), the authors study 31 cases of revascularization through arterial bridging in the diabetic's lower limbs. The lesions were identified by doppler examination followed by arteriography. Various types of bridging were undertaken: 24 femoro-popliteal bridges, including 16 super-articular and 8 sub-articular ones; and 7 femoro-distal bridges on the leg artery trunks.

Effects of clonidine on anesthetic drug requirements and hemodynamic response during aortic surgery.

The authors studied in a double-blind placebo-controlled study the effects of oral preoperative administration of 5 micrograms/kg clonidine upon the alfentanil and droperidol requirements, hemodynamic lability, distribution of the values of heart rate and blood pressure, and plasma noradrenaline levels, in two groups of ten normotensive patients undergoing infrarenal aortic surgery. The amounts of alfentanil supplementing a standardized continuous infusion, injected to maintain hemodynamic stability, were statistically identical between the groups (P = 0.23).

[Transluminal percutaneous angioplasty by thermal lasers. 20 cases of peripheral artery occlusion].

The authors report their experience of laser thermal angioplasty in a series of 20 patients. An argon laser with a 1.5 or 2.

[Myocardial risk in patients undergoing carotid intervention. Medium-term follow-up].

We have evaluated the cardiac risk for 212 patients who underwent internal carotid surgery (245 operations). The mean age at the time of operation was of 63 +/- 8 years. A complete pre-operative cardiac assessment was performed splitting the patients in two groups: one considered as having a coronary heart disease (CHD) and the other as "healthy heart" (HH).

Infected false aneurysm following carotid endarterectomy with vein patch angioplasty.

The authors report a case of infected false aneurysm that developed after carotid endarterectomy with vein patch angioplasty. This complication is extremely rare and occurs most commonly when a Dacron patch graft has been employed. Various clinical presentations are described and the etiology of infection is discussed.

[Autologous venous graft disease. Incidence, physiopathologic aspects and therapeutic means of graft salvage].

From 1980 to 1985, 134 patients with severe ischemia of lower limbs benefited from surgical recovery by inversed autologous venous graft in subarticular femoropopliteal and distal femoral position. During the 5 year follow-up period, 14 grafts (9%) developed hemodynamic degradation requiring angiographic surveillance followed by surgical repair or percutaneous dilatation. A retrospective study of evolution of venous grafts implanted in the contralateral supra-articular femoropopliteal and femoro (ilio) femoral position demonstrated a lower incidence of hemodynamic degradation (5.

Vertebral arteriovenous fistula following central venous cannulation: a case report.

The authors report a case of vertebral arteriovenous fistula that has been disclosed three years after central venous cannulation (CVC). The real incidence of this complication is discussed and various clinical presentations are enumerated. From a review of the literature, some recommendations are made to prevent the diagnosis from being missed and chiefly to reduce the risk of arterial puncture that results in fistula formation.