Visceral patch rupture after repair of thoracoabdominal aortic aneurysm--a case report.

This is a unique case of a visceral patch rupture in a Marfan patient after a repair of a thoracoabdominal aneurysm. The patient presented with abdominal pain and in shock 6 years after repair. The retained aortic wall containing the origins of the celiac, mesenteric, and renal arteries was aneurysmal and had ruptured.

Distal venous arterialization for limb salvage--a case report.

The reperfusion of an ischemic limb in the absence of suitable target artery remains a formidable task. The authors report a case of an ischemic limb in patient whose distal arteries were identified intraoperatively as unsuitable for conventional revascularization. A distal arteriovenous fistula was created between the already arterialized in situ greater saphenous vein conduit and the inframalleolar superficial venous system of the foot.

A case of massive thymolipoma.

A massive anterior mediastinal tumor was discovered in a 9-year-old girl with long-standing symptoms of asthma. Preoperative computed tomography (CT) scan and magnetic resonance imaging (MRI) results suggested the presence of a thymolipoma, a rare benign tumor of the thymus. Few cases have been reported in the literature, although the histological and radiographic features have been well described.

Combined carotid endarterectomy and coronary artery bypass in a community hospital.

A study examining combined carotid endarterectomy and coronary artery bypass (CAB) outside the metropolitan or university hospital setting was performed. Over a 5-year period, 52 patients underwent carotid endarterectomy and CAB under a single anesthetic. Twenty-two patients (42%) had unstable angina and 23 (44%) had previous neurologic symptoms.

Management of suspected mycotic suprarenal aortic aneurysm.

Mycotic aortic aneurysm is an uncommonly encountered entity. The diagnosis and management are challenging problems. Involvement of the visceral aorta creates additional problems in management.

Bullet embolism.

Bullet embolism is a rare complication of vascular trauma. During the last ten years we have treated six patients with bullet embolism. Three patients had inferior vena caval injuries with embolizations of the bullets to the heart or pulmonary arteries.

Limb loss despite functioning distal bypass.

Five patients are reported who failed to heal ischemic foot wounds despite patient, functioning in situ saphenous vein grafts to infrapopliteal arteries. All were diabetic and two died before amputation could be performed. Contributing to this paradoxical failure of attempted limb salvage were: (a) extensive preexistent gangrene, (b) infection and failure of wound management, and (c) occlusive disease in runoff beds despite the distal site of anastomosis.

Routine revascularization with resection of infection femoral pseudoaneurysms from substance abuse.

Infected femoral artery pseudoaneurysms in narcotic addicts present challenging management options. Our policy of routine revascularization is based on the concern that a high rate of amputations must follow ligation and resection alone or with selective delayed revascularization. Fifteen of 16 patients with infected pseudoaneurysms of femoral arteries, treated with resection and bypass grafts, were observed from 1 to 44 months.

An unusual case of epiglottitis in a patient with asthma.

An unusual case of epiglottitis in a child with asthma is reported. This patient presented with impending respiratory failure and failed to respond to aggressive asthma therapy. Subsequent intubation revealed acute epiglottitis, and appropriate management was initiated.

Extended reconstruction rate for limb salvage with intraoperative prereconstruction angiography.

A prospective study was performed between May 1982 and March 1987 to assess the value of intraoperative prereconstruction angiography (IPA) in limb salvage. Eligibility was limited to patients with rest pain, ischemic ulcers, or gangrene limited to the toes: only candidates for infrapopliteal bypass were included. Seventy-eight such patients were examined with preoperative angiography.

Atraumatic control in calcified arteries.

We have attempted distal saphenous vein bypasses for limb salvage in increasingly difficult situations. Severe calcification in the recipient artery makes vascular control and anastomosis troublesome. An atraumatic method of intraluminal control, which has been of aid in this situation, is described.

Coexisting carotid stenosis in patients undergoing cardiac surgery: indications and guidelines for simultaneous operations.

The coexistence of critical carotid stenosis with coronary artery or valvular heart disease occurs in a small percentage of patients requiring open heart surgical procedures. Recognition of such combined lesions by noninvasive carotid testing identifies patients at risk for neurologic events. Our experience with 62 patients having combined simultaneous carotid and cardiac operations among 2,400 open heart surgery patients was compared with the results in 110 patients with only carotid endarterectomy operations.

Gallstone pancreatitis. Support for a flexible approach.

We reviewed records of 63 patients with diagnosed gallstone pancreatitis. Most of them (89%) responded to nonoperative treatment. Nearly one quarter of patients undergoing operation 2.