Total excision and extra-anatomic bypass for aortic graft infection

Article Abstract:

Infection is a complication occurring in from 1 to 6 percent of patients who undergo placement of a vascular graft in the aorta (the main trunk of the arterial system). Although uncommon, this complication has a high mortality. Although early operations reported up to 75 percent mortality, in the past 20 years reports from large centers with extensive experience have reported a decrease to between 40 and 60 percent. A study was undertaken to determine if this decrease is representative of the experience at other, more diverse institutions and to identify factors influencing outcome. A review was undertaken of all graft infections treated at two vascular centers and in the private practice of three vascular surgeons. There were 32 patients with aortic graft infection; eight patients had fistula (abnormal opening) between the aorta and the intestinal tract. The average patient age was 66. The average interval between development of infection and graft placement was 34 months. At the time of initial surgery 75 percent of patients had exposure of the groin and 50 percent of patients had undergone previous vascular surgery. Treatment included partial removal of the aortic graft (12 patients) or total graft removal (20 patients). Six of these patients (four with partial and two with total graft removal) also underwent revascularization outside the normal anatomic position. Overall mortality was 25 percent, similar to other recently reported studies. Patients who underwent total excision with revascularization had the best results; 17 percent mortality and no reoperation or reinfection. These findings reveal that total excision and extra-anatomic bypass for aortic graft infection produces good results and can be successfully performed by most well-trained vascular surgeons. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Aorta, Vascular grafts

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Anatomic and functional abnormalities of the esophagus in infants surviving congenital diaphragmatic hernia

Article Abstract:

Today, increasing numbers of infants born with congenital diaphragmatic hernias (an abnormal protrusion of the stomach and sometimes the intestine up into the chest cavity) are surviving. This increased survival is due, in part, to the fact that more are being treated by means of extracorporeal membrane oxygenation (ECMO), in which the venous blood is diverted outside the body to a heart-lung machine to oxygenate the blood. Now that these babies are surviving, new abnormalities are being seen in association with congenital diaphragmatic hernia. Of 30 infants born with congenital diaphragmatic hernia and respiratory distress within four hours of birth, 22 survived; 15 had been treated with ECMO and 7 had not. There were 21 patients shown to have a mediastinal mass (mass in the chest between the lungs) on chest X-ray; further studies revealed that 20 of these infants had dilated ectatic (stretched) esophagus. Seventeen of these infants survived for further follow-up. A prenatal diagnosis of polyhydramnios (excess amount of amniotic fluid) was associated with dilated ectatic esophagus in 13 of 16 patients with prenatal history available. All study patients had symptoms of gastroesophageal reflux (backflow of the stomach contents into the esophagus) but were successfully treated without surgery. Follow-up (averaging 32 months) showed that these patients had slower weight gain than other children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Birth defects, Esophagus, Diaphragm, Diaphragmatic hernia

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An anatomic and functional classification for the diagnosis and treatment of inguinal hernia

Article Abstract:

This paper provided a simple classification scheme for recording and communicating the anatomic and functional differences in common hernia of the groin (inguinal hernia) cases. The author presented the scheme as a valuable method for providing the surgeon with a follow-up method for each case and with a means of correlating this experience with a better documentation of the type of hernia under treatment. The author concludes that the classification of inguinal hernias is intended to provide surgeons with a better method of evaluating their own methods, and with a means of more clearly communicating results to others.

Diagnosis, Hernia, Hernia repair, Inguinal hernia, Groin

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