Improving survival and limb salvage in patients with aortic graft infection

Article Abstract:

Infection is a complication of abdominal aortic prosthetic grafting (insertion of a biocompatible graft to replace a blocked or damaged aorta, the major artery carrying blood from the heart) that has a poor prognosis. A review of medical records is reported from a series of patients examined over a 15-year period who developed infections after receiving such a graft. A total of 38 patients were studied. Perioperative mortality was defined as death within one month of surgery, or during initial hospitalization. Results showed that the average interval between graft insertion and the diagnosis of infection was six years, and ranged from two weeks to 18 years. Symptoms associated with the infection included fever, wound infection or draining, weight loss, and gastrointestinal bleeding. Although the perioperative mortality for the whole group was 26 percent and the overall five-year survival was 52 percent, results for the most recent seven-year period were better. These showed a perioperative mortality of 14 percent and a 14 percent death rate. Five-year survival for the 28 perioperative survivors was 77 percent. The overall amputation rate was 18 percent. Twenty-two percent of the infected patients who then underwent axillofemoral grafting (a graft that allows blood to flow between the axillary artery in the upper limb and the femoral artery in the lower limb) developed infections. Overall, mortality following aortic graft infections has decreased substantially in recent years. A sequential approach (two-stage operation) is recommended in cases where subsequent axillofemoral grafting is required. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Amputation, Arterial grafts

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Surgical treatment of distal ulnar artery aneurysm

Article Abstract:

Although approximately half of the patients who experience reduced blood flow (ischemia) to the hand and fingers are suffering from diseases affecting the whole body, such as autoimmune conditions (where the body's immune system attacks its own cells), many have obstructed arteries that can be surgically corrected. Such patients often have an occupation, such as carpentry, in which repetitive trauma occurs to the hypothenar area (the side of the hand near the little finger). In fact, the syndrome has been called the 'hypothenar hammer syndrome'. Six patients with an average age of 29, who developed finger ischemia as a result of arterial occlusion (blockage), are described. The patients reported cold, painful fingers on one hand, especially in the fingers closest to the little finger. Arteriography (X-rays of the arteries) in both arms was performed on the subjects for comparative purposes. Seven aneurysms (local dilatations of the arterial wall) in the ulnar artery (one of the main arteries carrying blood to the hand) were identified, which were corrected using venous grafts taken from the patients' own bodies. One patient had aneurysms on both sides. The symptoms of all patients improved, and no complications were noted. Ulnar artery aneurysm is uncommon, but most cases are caused by repeated trauma. These patients and their employers were made aware of the risks of using the hand as a hammer. Acute unilateral (on one side) ischemia in the hand of individuals with certain occupations, in the absence of autoimmune disease symptoms, indicates the possibility of ulnar artery aneurysm. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Diagnosis, Occupational diseases, Ischemia, Aneurysms, Aneurysm

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Sartorius myoplasty for deep groin wounds following vascular reconstruction

Article Abstract:

Infection of groin wounds after femoral artery surgery is potentially serious, especially if there is a prosthetic (artificial) graft in place. The groin area is particularly vulnerable to infection. It is most important that the wound be closed and the artery or graft covered as quickly as possible. Results are presented of the outcomes achieved for 11 patients with deep groin wound infections following vascular surgery. The average patient age was 62 years. Five patients were at risk for prosthetic graft failure, and two of these grafts were exposed. The patients were treated for their wound infections with sartorius muscle myoplasty, which is repair using the sartorius muscle, the large muscle that extends from the pelvis to the calf of the leg. A flap of muscle is used to close the wound. The average interval between the initial vascular procedure and myoplasty was four weeks. All 11 patients had removal of dead and infected soft tissue and closure of the wound using a modified technique of myoplasty of the sartorius muscle. Wound closure with complete primary healing was achieved in nine patients. Two patients had delayed wound healing. Follow-up (lasting an average of 20 months) revealed all vascular reconstructions to be patent (meaning the blood vessels were not blocked), and the legs remained improved. It is concluded that this modified technique of sartorius myoplasty is effective in hastening wound closure, reducing the hospital stay, and shortening convalescence for patients with deeply infected groin wounds following vascular surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Muscles, Blood vessels, Vascular grafts

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