Abstract:
:Patients with ischemic ulceration of the foot and no continuous tibial or inframalleolar vessels acceptable for bypass are often treated with primary amputation. We have performed autogenous vein bypass to isolated tibial artery segments (ITAS) in nine patients with ischemic foot ulcers and no other outflow options. We reviewed the clinical and hemodynamic results of these bypasses to assess the efficacy of this approach. Hemodynamic comparisons of these ITAS bypasses were made to a concurrent series of 26 bypasses to intact tibial arteries and 24 inframalleolar artery bypasses assessed during routine follow-up. Eight of the bypasses originated from the above-knee popliteal artery and one from the profunda femoris artery. Recipient vessels were the anterior tibial (seven), peroneal (one), and posterior tibial (one) arteries. Although mean ankle brachial indices (ABI) increased significantly from 0.26 +/- 0.06 preoperatively to 0.75 +/- 0.04 postoperatively (p = 0.0015), ITAS bypass patients had lower mean postoperative ABIs than patients with bypasses to intact tibial (ABI = 0.98 +/- 0.03, p = 0.0001) or pedal arteries (ABI = 1.02 +/- 0.04, p = 0.0005). Similarly, duplex scan-derived peak systolic flow velocities of the ITAS bypasses (mean: 52.9 +/- 5.8 cm/sec) were lower than those of intact tibial artery bypasses (mean: 80.1 +/- 6.1 cm/sec, p = 0.02) but did not differ from those of pedal bypasses (mean: 59.5 +/- 3.5 cm/sec, p = 0.34). No ITAS bypass grafts have failed during a mean follow-up of 12.3 +/- 2.7 months. Although wound healing was prolonged (mean: 3.1 +/- 0.6 months), the wounds of eight of nine patients eventually healed, with three patients requiring minor amputations (one digital amputation and two transmetatarsal amputations). Although the hemodynamic results of ITAS bypass are inferior to those of more conventional bypasses, the early patency rates and successful healing of ischemic wounds confirm that it is a valid alternative in the threatened limb with no other outflow options.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Belkin M,Welch HJ,Mackey WC,O'Donnell TF Jrdoi
10.1016/s0002-9610(05)81088-8subject
Has Abstractpub_date
1992-09-01 00:00:00pages
281-4; discussion 284-5issue
3eissn
0002-9610issn
1879-1883pii
S0002-9610(05)81088-8journal_volume
164pub_type
杂志文章abstract:BACKGROUND:Laparoscopic adrenalectomy is now the standard for pheochromocytoma. We report two decades of institutional experience with pheochromocytoma adrenalectomy. METHODS:A retrospective review was undertaken of pheochromocytoma adrenalectomy patients between 1997 and 2017. Clinical variables and postoperative com...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2019.03.016
更新日期:2019-05-01 00:00:00
abstract::We evaluated the hormonal and metabolic responses of denervated pancreas allografts in nine volunteers 3 to 12 months after the transplant (initial) and again 1 year later (follow-up). Eight of the patients received simultaneous pancreas-kidney transplants. The glucose clamp technique was used to create a square wave ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80398-8
更新日期:1993-01-01 00:00:00
abstract::The relationship between platelet count and aggregability was serially evaluated after splenectomy in patients with normosplenism and hypersplenism, and the results were compared with those found in patients undergoing only upper abdominal surgery. The preoperative count and aggregability of platelets were significant...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(78)90242-8
更新日期:1978-08-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to identify patients with rib injuries who were at risk for solid organ injury. METHODS:A retrospective chart review was performed of all blunt trauma patients with rib fractures during the period from July 2007 to July 2012. Data were analyzed for association of rib fractures ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2016.08.002
更新日期:2017-04-01 00:00:00
abstract::Following its introduction in 1993, the LAP-BAND (INAMED Health, Santa Barbara, CA) has been used extensively across the world for the treatment of obesity, and data on safety and effectiveness are now available. This review draws on the literature and our own clinical patient base to provide an overview of the early ...
journal_title:American journal of surgery
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更新日期:2002-12-01 00:00:00
abstract:BACKGROUND:There is little evidence supporting or refuting clamping trials, a period of clamping thoracostomy tubes prior to removal. We sought to evaluate whether clamping trials reduce the need for subsequent pleural drainage procedures. METHODS:We conducted a retrospective cohort study of trauma patients who underw...
journal_title:American journal of surgery
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更新日期:2020-08-01 00:00:00
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journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(91)91103-p
更新日期:1991-04-01 00:00:00
abstract::This study has summarized our results with popliteal-tibial in situ saphenous vein bypass in 26 patients, 25 of whom were diabetic, over a 2 year period. Both above- and below-knee popliteal inflow sites were used for bypass of limb-threatening ischemia. Distal calf or pedal outflow sites were required in all but two ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(87)90191-7
更新日期:1987-08-01 00:00:00
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journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/S0002-9610(96)00130-4
更新日期:1996-08-01 00:00:00
abstract:BACKGROUND:Endovascular treatment of abdominal aortic aneurysms is a rapidly evolving technique that has gained broad acceptance in the treatment of patients with abdominal aortic aneurysms. METHODS:A review of the English literature was done to determine the short- and long-term outcomes of endovascular repair of abd...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
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更新日期:2005-02-01 00:00:00
abstract::A combination of heparin and dihydroergotamine mesylate (Heparin-Dihydergot) has been shown to be more effective than either of these drugs alone in preventing postoperative venous thromboembolism. The possible mechanism for the synergistic effect of heparin and dihydroergotamine was assessed. Phlebograms obtained aft...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:
更新日期:1985-10-08 00:00:00
abstract::Colonic and rectal anastomotic strictures occur with an incidence ranging from 3% to 30%. Several factors, such as defunctionalization, anastomotic leak, ischemia, radiation, and neoplasms, have been implicated in their pathogenesis. Management of large bowel strictures is generally based on their cause, location, and...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.02.030
更新日期:2008-04-01 00:00:00
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journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(00)00246-4
更新日期:2000-02-01 00:00:00
abstract::Nine cases of microemboli of arterial origin to the upper extremity are reported. The source of emboli in five of these cases was in the subclavian artery compressed by osseous anomalies in the thoracic outlet. Three aneurysms, one in a subclavian vein graft and two traumatic false aneurysms in the hand, were also not...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(77)90296-3
更新日期:1977-07-01 00:00:00
abstract:BACKGROUND:Little is known about postgastrectomy syndrome and quality of life (QOL after laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG). The aim of this study was to assess postgastrectomy syndrome and QOL after LAPPG as compared with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2016.09.041
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:The relationship between preoperative stenosis and the effect of carotid endarterectomy (CEA) upon internal carotid blood flow (ICF) is not well understood. With the intention of better characterizing this, we compared intraoperative measurements of internal carotid blood with the maximum single diameter ste...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(94)80051-0
更新日期:1994-08-01 00:00:00
abstract::Feeding gastrostomy can be troublesome, inconvenient and painful to the patient, especially if the catheter is redundant, thereby causing deformity of the opening ad leakage of gastric juice and food around the tube. A skin level permanent feeding gastrostomy was fashioned in four patients with neurologic disease. The...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(81)90205-1
更新日期:1981-03-01 00:00:00
abstract:BACKGROUND:Human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV) infections are transmitted by blood exposure. Surgeons have been concerned about the risks of blood exposure in the operating room as a potential source of occupational infections from these viruses. The actual risk and frequency of...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/j.amjsurg.2005.05.021
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:The effect of the number of lymph nodes harvested on the long-term survival of gastric cancer according to Tumor, Node, and Metastasis (TNM) stage and tumor location remains unclear. METHODS:Patients who underwent gastrectomy for gastric cancer (1998 to 2009) were evaluated retrospectively (1,637 patients)....
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2015.01.029
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Research has shown that pulsed electromagnetic fields (EMFs) promote wound healing in experimental colonic anastomosis; however, the effects of static EMFs in this setting have not been investigated to date. METHODS:Fifty male Wistar rats were used. Ten served as controls for mechanical strength testing, an...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2006.01.024
更新日期:2006-07-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:The clinical pulmonary infection score (CPIS) and bronchoalveolar lavage (BAL) are 2 tools that have been validated to diagnose pneumonia in critically ill patients. However, the role of the CPIS in diagnosing trauma-associated pneumonia (TAP) remains in question. METHODS:This prospective observational stud...
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更新日期:2011-07-01 00:00:00
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journal_title:American journal of surgery
pub_type: 杂志文章
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更新日期:2013-12-01 00:00:00
abstract::Breast symptoms of pain, tenderness, and engorgement correlate with objective findings of nodularity on physical examination. Like all other factors for breast disease, they are not a single determinant of diagnosis, as shown by the 3 X 3 contingency table, but they are a useful addition to our understanding. From the...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(85)90135-7
更新日期:1985-08-01 00:00:00
abstract:BACKGROUND:We examined and compared APP versus surgical resident perceptions of the role of APPs in surgical subspecialty teams. METHODS:Residents/first year surgical critical care fellows and inpatient service-specific APPs responded to a survey that examined perceptions about the APP-resident/fellow relationship. St...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.10.014
更新日期:2019-06-01 00:00:00
abstract:BACKGROUND:Bile duct calculi (BDC) can be cleared or treated with modern endoscopic techniques in most patients. However, large stones, bile duct strictures, or unusual anatomy may make endoscopic clearance difficult. The purpose of the present study was to determine the efficacy of extracorporeal shock-wave lithotrips...
journal_title:American journal of surgery
pub_type: 杂志文章
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更新日期:1998-01-01 00:00:00
abstract:BACKGROUND:This study explores assistance-seeking and reporting behaviors in surgical residents faced with stressful circumstances. METHODS:Three surgical societies distributed a multiple choice, free-text response survey to residents. RESULTS:One hundred sixty-four residents (39% male) responded; 58% of women (43% m...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2015.05.011
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:The aim of this study was to determine whether differing neoadjuvant chemotherapy (NAC) regimens for HER2 positive breast cancer (HER2+ BC) are associated with differing surgical complications. Our goal was to evaluate postoperative complications in HER2+ BC patients receiving NAC with Herceptin (trastuzumab...
journal_title:American journal of surgery
pub_type: 杂志文章
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更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Residents are more likely to learn from educational experiences when properly prepared from the start of instruction and expectations are clear and consistent. The purpose of this study was to examine what first year residents need to know and be able to perform before starting their rotation in the intensiv...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(96)00029-3
更新日期:1996-06-01 00:00:00
abstract:BACKGROUND:The aim of the current study was to identify predictors of pathologic complete response (pCR) following neoadjuvant therapy. METHODS:From 2000 to 2007, 518 breast cancer patients received neoadjuvant therapy. Data were compared using chi(2) and Fisher's exact tests and multivariate analysis of variance, as ...
journal_title:American journal of surgery
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doi:10.1016/j.amjsurg.2009.06.004
更新日期:2009-10-01 00:00:00