Abstract:
OBJECTIVE:To reevaluate the benefits of a Gritti-Stokes amputation (GSA), as an alternative to the traditional above-knee amputation (AKA), in patients who are nonambulatory or not a candidate for a below-knee amputation (BKA). TECHNIQUE:A fish-mouth incision is fashioned below the tibial tuberosity into the popliteal crease, resulting in an anterior soft tissue flap and smaller posterior soft tissue flap. Thus the incision line will be on the posterior thigh, instead of the end of the stump. The patellar tendon is detached from the anterior tibial tuberosity, then the dissection is carried proximally behind the patellar tendon and the adjoining tendons of the vastus medialis and vastus lateralis, until the patella can be flipped over to expose the posterior patellar surface and joint capsule. The patellar's posterior surface is shaved down flat to medulla bone, with an electric small-toothed bone saw and large bur. The femur is then cleared circumferentially at its base. The foot is then placed at 90°, creating a 45-degree angle between the femur and the tibia, and the femur is then transected with a Gigli saw near the base or just above the base, depending on the size of the patellar surface area. This creates a 45-degree angle to the femur posteriorly, which allows the shaved patella to be secured to the end of the femur, with less chance of shifting. The fascia is then circumferentially closed around the patella and femur. Then, the remnant patellar tendon is sutured to the tendons of the posterior compartment. The dermis and skin are then closed in the standard tension-free manner using 2-0 interrupted vicryl sutures, followed by interrupted 2-0 nylon vertical mattress sutures. The dressing consisted of a single layer of ADAPTIC Non-Adhering Dressing to allow drainage, gauze fluffs, 6-inch kerlix, and finally a 6-inch ACE wrap was applied. The dressings are left intact for 2-3 days and then replaced daily thereafter. METHODS:A retrospective chart review was performed to identify patients who had undergone a GSA from January 2016 to September 2017 by a single surgeon. Estimated blood loss (EBL), operative time, and perioperative and postoperative complications were assessed. RESULTS:A total of 16 GSAs were performed on 15 patients by a single surgeon between January 7, 2016 and September 19, 2017. In our series, intraoperative outcomes were notable for an average EBL of 114 mL, lower than the traditional AKA (average EBL: 300-500 mL) with comparable operative times as short as 90 min (skin incision to dressing). No transfusions were required in the GSA group (postop days: 1-4) compared with traditional AKA group which required an average of 2.1 units. Postoperative outcomes showed low complication rates. Postoperative complications were limited to 2 cases of a stump infection, which were treated with local wound care and subsequently healed completely. One patient died from septic shock secondary to pneumonia unrelated to the GSA surgery. CONCLUSIONS:A reevaluation of the GSA in the nonambulatory patient population is warranted in the United States as an alternative to the traditional AKA whenever possible. Our experience with a small series of GSA's has yielded promising advantages including potential for decreased blood loss and fewer complications in the postoperative period when compared with the standard AKA. Retained muscle attachments facilitate increased limb function and allow use of slide joint prosthetics, which are gaining popularity for ambulatory patients. The thickened skin and subcutaneous tissues overlying the patella, and the posterior incision have the potential benefit of protection against trauma and osteomyelitis seen with traditional AKA, in which case the open ended medullary bone is deep to the incision. We believe that for these same reasons the GSA should be considered in the nonambulatory patient as well.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Theriot J,Bhattarai P,Finlay DJdoi
10.1016/j.avsg.2019.03.006subject
Has Abstractpub_date
2019-10-01 00:00:00pages
468-473eissn
0890-5096issn
1615-5947pii
S0890-5096(19)30360-7journal_volume
60pub_type
杂志文章abstract:BACKGROUND:This study was performed to summarize our experience in treating acute superior mesenteric artery embolism (SMAE) by percutaneous mechanical thrombectomy (PMT). METHODS:The clinical data of five patients with acute SMAE treated by PMT in our center from October 2015 to May 2018 were retrospectively analyzed...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.08.096
更新日期:2020-02-01 00:00:00
abstract::This report describes the surgical management of 24 patients with concurrent abdominal aortic aneurysm (AAA) and urinary tract neoplasm. The patient population consisted of 22 men and two women whose average age was 65.5 years. AAA sizes ranged from 3.1 to 9.0 cm (mean 5.2 cm) in diameter. Urinary tract neoplasms incl...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02143854
更新日期:1995-09-01 00:00:00
abstract::The case being presented is a 35-year-old female with a 3-year history of progressive dyspnea and right-sided heart failure following spine surgery. Physical examination identified a continuous bruit in the lower abdomen radiating to her back which prompted further evaluation. Echocardiography showed normal left ventr...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.06.033
更新日期:2017-11-01 00:00:00
abstract::We describe a technical modification of the "Preclose" technique that changes the cross-pattern sutures created with the Prostar XL as in a previously described variation using the Proglide device for longitudinal interrupted sutures. This technique was used in 19 femoral arteries, with satisfactory hemostasis achieve...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2009.05.002
更新日期:2009-09-01 00:00:00
abstract::Primary popliteal venous aneurysm is a rare condition. To date, approximately 150 cases have been reported. In the present article, we report a 59-year-old man who presented with a swelling of the left popliteal fossa. Duplex ultrasound scan revealed a saccular aneurysm of the popliteal vein, with a diameter of 2.5 × ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2011.11.027
更新日期:2012-07-01 00:00:00
abstract:BACKGROUND:We tested whether shock wave (SW) offers additional benefits in improving left ventricular (LV) function after acute myocardial infarction (AMI) in rabbits receiving SW-treated autologous bone marrow-derived mononuclear cells (BMDMNCs) transplantation. METHODS AND RESULTS:Saline (750 microL; group 2), BMDMN...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.03.027
更新日期:2010-08-01 00:00:00
abstract::We illustrate the safety and feasibility of the application of fenestrated stent-grafts for the preservation of spinal artery flow during endovascular repair of thoracoabdominal aortic aneurysms (TAAA) in 2 patients deemed high-risk for spinal cord ischemia (SCI). In one case, an unstented fenestration was used in a 7...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2020.08.005
更新日期:2021-01-01 00:00:00
abstract::Despite major advances in pharmacologic and endovascular therapies, acute limb ischemia (ALI) continues to result in significant morbidity and mortality. The incidence of ALI may be as high as 13-17 cases per 100,000 people per year, with mortality rates approaching 18% in some series. This review will address the con...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2011.05.017
更新日期:2012-01-01 00:00:00
abstract::We report the use of manufacturer-customized fenestrated iliac stent grafts to treat common iliac artery aneurysms (CIAAs) in patients with challenging iliac anatomy, unsuitable for iliac branched devices (IBDs). A 71-year-old woman presented with bilateral CIAAs measuring 44 mm and 29 mm and a perivisceral abdominal ...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2019.02.044
更新日期:2019-10-01 00:00:00
abstract::The aim of this study was to evaluate the 30-day outcome of carotid endarterectomy in patients with contralateral carotid artery occlusion and compare it to that in patients with patent contralateral carotid artery. We compared 2,959 carotid endarterectomies performed in patients with patent contralateral internal car...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2006.06.003
更新日期:2007-01-01 00:00:00
abstract::Internal jugular vein (IJV) thrombosis is a rare vascular event. The most common causes of internal jugular vein thrombosis are prolonged central venous catheterization, infection, malignancy and ovarian hyperstimulation syndrome. We have presented here a case of an 82-year-old male with chronic kidney disease who pre...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2019.08.074
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Given the various types of anesthesia used for endovascular abdominal aortic aneurysm repair (EVAR), we sought to determine the effect of anesthesia type in the outcomes of elective EVAR in a large multiinstitutional healthcare maintenance organization. METHODS:A retrospective chart review was conducted on ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.04.031
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Lymphatic interventions have recently been increasingly used for treating lymphatic leak of the abdomen and pelvis. This retrospective case study series and systematic review evaluated the efficacy and safety of lymphatic interventions for the treatment of postoperative lymphatic leak of the abdomen and pelv...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.04.063
更新日期:2020-10-01 00:00:00
abstract::A patient presenting with urinary retention was found to have progressive spinal cord ischemia subsequent to an end-to-side aortobifemoral bypass for atherosclerotic disease. This serves as a vivid reminder of the possibility of this complication even in ischemic disease and that urinary retention may be the initial s...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1007/BF02000153
更新日期:1993-11-01 00:00:00
abstract::The aim of this study was to present a case of iatrogenic thromboembolectomy-related tibialis anterior false aneurysm (FA) treated with endovascular FA exclusion and anterior leg compartment (ALC) operative decompression and to assess the current management options in posttraumatic leg vessel FAs. A 68-year-old man ha...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2012.09.013
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:To assess the peripheral blood flow of patients with peripheral arterial disease (PAD) by indocyanine green (ICG) arteriography (ICGA) with intraarterial injection of ICG and evaluate the efficacy of the ICGA tests. METHODS:This study was undertaken from a retrospective review of patients with PAD who under...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2013.12.036
更新日期:2014-07-01 00:00:00
abstract::Between 1985 and 1988 45 patients with descending thoracic or thoracoabdominal aortic aneurysms underwent selective arteriography of the intercostal and lumbar arteries to delineate preoperatively the artery of Adamkiewicz and the thoracic radicular artery. Identification of these vessels failed in five patients (11%)...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)62382-0
更新日期:1989-01-01 00:00:00
abstract:BACKGROUND:This study aimed to determine the body mass index (BMI) at which duplex ultrasonography does not accurately detect deep vein thrombosis. METHODS:This is a retrospective review of all patients who underwent lower extremity venous duplex examination at a single institution, tertiary vascular laboratory from J...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.03.038
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:Endovascular therapy (EVT) is being adopted by many surgeons as a suitable first choice in the treatment of most femoropopliteal disease when clinically indicated. However, there are multiple factors affecting the outcome of EVT including the anatomy of lesions and distal runoff status. The evidence of runof...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.11.024
更新日期:2020-12-24 00:00:00
abstract:BACKGROUND:Controversy remains over how to best manage chronic total occlusions of the aortoiliac (AI) system. Uncovered stents are the traditional choice but offer less durability in theory with the risk of stent ingrowth. External iliac artery (EIA) occlusions are challenging due to access difficulty. METHODS:We per...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2018.06.002
更新日期:2018-11-01 00:00:00
abstract::A 66-year-old man with multiple comorbidities presented with a juxtarenal perianastomotic aortic aneurysm 10 years after open abdominal aortic aneurysm repair. The aneurysmal disease also involved both iliac bifurcations, the right internal iliac artery, the left common femoral artery (CFA) up to its bifurcation, and ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.12.044
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Recurrent symptoms of thoracic outlet syndrome (TOS) after first rib resection have varying etiologies. Regrowth of a first rib is a rare event. Recurrent symptoms in the presence of a regrown rib strongly suggest a causal relationship. We report our experience with recurrent symptoms of TOS and regrown firs...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.01.004
更新日期:2014-05-01 00:00:00
abstract::The purpose of this study is to describe the advantages and value of an endovascular suite in the operating room from a vascular surgeon's perspective. All endovascular procedures were performed in a specially equipped operating room by vascular surgeons using digital fluoroscopic imaging equipment. Between January 1,...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900157
更新日期:1998-05-01 00:00:00
abstract:BACKGROUND:Angiography remains the gold standard imaging modality before infrainguinal bypass. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have emerged as noninvasive alternatives for preoperative imaging. We sought to examine contemporary trends in the utilization of CTA and MRA as i...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.avsg.2015.03.039
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:A number of surgical strategies and graft enhancements have been trialled to improve the performance of prosthetic grafts. Neointimal hyperplasia may, in part, be a normal cellular response to an abnormal (turbulent) flow environment. This first-in-many study assesses the safety and medium-term patency perfo...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.avsg.2012.02.001
更新日期:2012-11-01 00:00:00
abstract::We encountered two cases of spontaneous rupture of a saphenous vein bypass graft for lower-leg peripheral arterial disease possibly associated with collagen disease. Rupture occurred 5 and 14 days postoperatively. Neither case had any signs of infection, graft degeneration, or evident injury, but both were associated ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2012.02.026
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:We investigated the outcome of vein stenting placement for chronic proximal venous outflow obstruction (PVOO) in a predominantly Asian-American cohort to improve patient selection, enhance technical approach, and better define quality measurements of this emerging vascular intervention. METHODS:A total of 4...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.01.018
更新日期:2020-07-01 00:00:00
abstract::Severe hyperhidrosis is a disabling disorder whose management is controversial. Medical treatment consists of topical aluminum chloride, oral anticholinergics, ionotophoresis, and botulinum toxin A (Botox) injections. Despite the minimally invasive nature of thoracoscopic sympathectomy, there is a common perception th...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2008.04.014
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Because of improved medical therapy in contemporary practice, some have advocated that, most if not, all patients with asymptomatic carotid disease should be managed medically without intervention. Disease progression in this patient population is not well established, and data describing risk factors for di...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.02.007
更新日期:2015-01-01 00:00:00
abstract::This study is based on a unique registry of 632 patients who underwent great saphenous vein (GSV) stripping and liberal use of subfascial endoscopic perforator vein surgery (SEPS) for minimal to severe lower limb venous insufficiency. Clinical examinations and color-coded duplex scanning were performed on a randomly s...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-003-0032-z
更新日期:2003-09-01 00:00:00