Abstract：
BACKGROUND:The purpose of this study was to review the results of lower extremity revascularization in patients with end-stage renal disease and to determine in these patients the functional benefit and cost of an aggressive approach to limb preservation. METHODS:During a 5-year period at our institution, 33 bypass operations were performed on 31 limbs of 23 dialysis-dependent patients. Indications for revascularization were limited (18) or extensive (12) tissue loss or ischemia without tissue loss (3). Procedures included aortobifemoral bypass (1), femoropopliteal bypass (10), and femorotibial/pedal bypass (22). A digital or transmetatarsal amputation was performed in 57% of limbs. RESULTS:The 30-day primary patency was 100%. Cumulative primary and secondary patency rates at 2 years were 65% and 79%, respectively. Limb salvage was 67% and 59% at 1 and 2 years, respectively. Patient survival was poor (47% at 2 years). Peritoneal dialysis was predictive of poor survival (P <.001). Four of 5 patients on peritoneal dialysis died within 3 months of intervention. Extensive tissue loss was predictive of a diminished rate of limb salvage (P =.027). Only 39% of limbs with extensive tissue loss were salvaged at 1 year compared with 78% and 100% of limbs with limited and no tissue loss, respectively. The average hospital cost was $44,308 per year of limb salvage. CONCLUSIONS:Although revascularization of ischemic limbs in dialysis patients can be achieved with an excellent initial graft patency and reasonable limb salvage, patient survival is poor and costs are high. A selective approach to revascularization in these complicated patients may be indicated. For patients treated with peritoneal dialysis and for those with extensive tissue loss, primary amputation may be the preferred approach.
journal_name
Surgeryjournal_title
Surgeryauthors
Korn P,Hoenig SJ,Skillman JJ,Kent KCdoi
10.1067/msy.2000.108049subject
Has Abstractpub_date
2000-09-01 00:00:00pages
472-9issue
3eissn
0039-6060issn
1532-7361pii
S0039-6060(00)91072-9journal_volume
128pub_type
杂志文章相关文献
SURGERY文献大全abstract：:From 1975 to 1980, 79 major limb amputations were performed from a group of 552 lower extremity vascular reconstructions with glutaraldehyde-stabilized umbilical vein grafts. All amputations were performed in instances in which limb salvage had been the indication for the attempted bypass (n = 520)--an incidence of 15...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1982-01-01 00:00:00
abstract：:The acute and chronic changes produced in canine femoral arteries by ischemia and by perfusion with D10W were examined by light and by scanning electron microscopy. Mild changes of injury characterized by medial and adventitial inflammation and an increase in intimal lining cells occur following 30 minutes of perfusio...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1977-05-01 00:00:00
abstract：BACKGROUND:An understanding of the regeneration power and operative risk of steatotic livers after hepatectomy is still unclear. We evaluated the volume regeneration and outcome of steatotic livers after donor hepatectomy. METHODS:Fifty-four, consecutive living liver donors from September 2002 to December 2003 were ev...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2005.09.007
更新日期：2006-04-01 00:00:00
abstract：:Peripheral parenteral nutrition avoids the use of central lines and is a useful means of nutritional support for selected patients. Amino acids alone have been used for peripheral parenteral nutrition and have been shown to give near nitrogen equilibrium. The addition of small amounts of dextrose to amino acids furthe...
journal_title：Surgery
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：1982-10-01 00:00:00
abstract：:Pathological fibrinolysis due to pseudoaneurysms was observed in a patient 4 years after aortobifemoral bypass graft. The patient presented with a pulsatile abdominal mass and ischemic changes in the legs. Excessive bleeding from venipuncture sites prompted coagulation screening, which disclosed rapid clot lysis, fibr...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1980-02-01 00:00:00
abstract：BACKGROUND:Ruptured abdominal aortic aneurysm is one of the most difficult clinical problems in surgical practice, with extraordinarily high morbidity and mortality. During the past 23 years, the literature has become replete with reports regarding ruptured endovascular aneurysm repair. METHODS:A variety of study desi...
journal_title：Surgery
pub_type： 杂志文章,评审
doi：10.1016/j.surg.2017.08.008
更新日期：2017-12-01 00:00:00
abstract：BACKGROUND:Endoscopic endocrine neck surgery requires insufflation with carbon dioxide (CO(2)) at 10 to 15 mm Hg, which may decrease the cerebral venous return and increase intracranial pressure. This study evaluated the effect of CO(2) neck insufflation on intracranial pressure (ICP) and hemodynamic parameters. METHO...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1067/msy.2000.110238
更新日期：2000-12-01 00:00:00
abstract：:The esophageal mucosa is exposed to damaging agents both by ingestion and reflux. Using our in vivo rabbit model of esophagitis, we have observed that acute luminal exposure (within 1 to 5 minutes) to potentially harmful agents, such as acid, bile, or ethanol, induces a rapid increase in mucosal blood flow; whereas pr...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1991-08-01 00:00:00
abstract：BACKGROUND:The influence of diabetic therapies on myocardial substrate selection during cardiac surgery is unknown but may be important to ensure optimal surgical outcomes. We hypothesized that metformin and insulin alter myocardial substrate selection during cardiac surgery and may affect reperfusion cardiac function....
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2017.10.020
更新日期：2018-02-01 00:00:00
abstract：BACKGROUND:Depression has been associated with delayed presentation, inadequate treatment, and poor survival in patients with cancer. METHODS:Using Surveillance, Epidemiology and End Results and Medicare linked data (1992-2005), we identified patients with pancreatic adenocarcinoma (N = 23,745). International classifi...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2012.06.010
更新日期：2012-09-01 00:00:00
abstract：BACKGROUND:Groin hernia repair occasionally leads to severe chronic pain associated with entrapped or damaged nerves. Conservative treatment is often unsuccessful. Selective neurectomy may be effective, but long-term results are scarce. The authors assessed the long-term efficacy of surgical neurectomy for chronic, pos...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2009.08.008
更新日期：2010-02-01 00:00:00
abstract：:We will describe the development of new resectional techniques with the use of the ultrasonic scalpel in 33 patients with liver disease. Our experience is presented in the performance of anatomic and nonanatomic liver resections by use of this device. Its saline-cooled tip vibrated at ultrasonic frequencies and select...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1984-02-01 00:00:00
abstract：BACKGROUND:The hypermetabolic response to severe burn is characterized by muscle protein catabolism. Current opinion states that the hypermetabolic state resolves soon after complete wound closure. Clinically, we have witnessed that burned children appear to be hypermetabolic and catabolic long after full healing of th...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1067/msy.2000.108059
更新日期：2000-08-01 00:00:00
abstract：BACKGROUND:Vocal cord paralysis is associated with extrathyroidal invasive malignancy. This study was performed to analyze the presentation of patients with invasive thyroid malignancy and to determine the preoperative symptomatic and radiographic correlates of vocal cord paralysis. METHODS:In a group of 365 consecuti...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2005.08.009
更新日期：2006-03-01 00:00:00
abstract：BACKGROUND:Although preoperative administration of high-dose glucocorticoid may lead to improved recovery after operative procedures, this regimen has not been examined in patients undergoing abdominal wall reconstruction for repair of large ventral hernias. The aim of the current trial was to examine the effects of pr...
journal_title：Surgery
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.surg.2019.12.007
更新日期：2020-04-01 00:00:00
abstract：BACKGROUND:Few studies discuss causes and outcomes of peritonitis in low-income settings. This study describes epidemiology of patients with peritonitis at a Rwandan referral hospital. Identification of risk factors associated with mortality and unplanned reoperation could improve management of peritonitis. METHODS:Da...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2016.08.036
更新日期：2016-12-01 00:00:00
abstract：:A patient's condition was initially diagnosed as constrictive pericarditis, but an echocardiogram revealed the presence of an intracardiac tumor. The tumor was a slow-growing leiomyosarcoma that originated in the left internal iliac vein, extended into the inferior vena cava, and reached the right ventricle. This tumo...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1981-05-01 00:00:00
abstract：:Previously, we documented that nonlethal doses of endotoxin cause the translocation (escape) of bacteria from the gut to systemic organs. The purpose of this study was to determine which portion(s) of the endotoxin molecule induces bacterial translocation and to examine the role of xanthine oxidase activity in the pat...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1989-08-01 00:00:00
abstract：:Studies on animals implicating reflux of bile salts in formation of "stress ulcer" often are suspect because of the inordinately high intragastric concentrations of bile salts used to induce experimental acute gastric mucosal damage. We studied reflux of bile salt in 11 patients after operation. Nine refluxed bile sal...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1976-07-01 00:00:00
abstract：BACKGROUND:Our purpose was to determine whether the combination of total liver vascular inflow occlusion (Pringle maneuver) and rapid hepatic transection with a clamp-crush technique results in significant reduction of blood loss and transfusion requirements during major hepatic resections. METHODS:A series of 49 adul...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1999-02-01 00:00:00
abstract：BACKGROUND:Thoracopancreatic fistula is a rare clinical entity but a serious complication of inflammatory pancreatic diseases, caused by a disruption of the pancreatic ductal system. Its diagnosis is frequently misleading, however, and thus is often delayed. METHODS:Seven patients with thoracopancreatic fistula who pr...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2006.02.020
更新日期：2006-11-01 00:00:00
abstract：INTRODUCTION:Tertiary hyperparathyroidism (3HPTH) patients who undergo parathyroidectomy (PTX) are often managed with calcium lowering medications such as cinacalcet (Sensipar) before surgery. Here, we assess how cinacalcet treatment influences intraoperative parathyroid hormone (IOPTH) kinetics and surgical findings i...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2014.08.003
更新日期：2014-12-01 00:00:00
abstract：BACKGROUND:Bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT) has good postoperative and excellent cosmetic outcomes. To assess the surgical completeness of BABA RoT, it was compared to open thyroidectomy (OT) after propensity score matching of the cohorts. METHODS:Between 2008 and 2010, 760 patients ...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2011.09.015
更新日期：2011-12-01 00:00:00
abstract：BACKGROUND:Although pentoxifylline has been shown to improve tissue oxygenation and restore hepatocellular function after hemorrhagic shock, its effect on hepatic ischemia and reperfusion injury has not been fully clarified. The purpose of this study was to determine whether pentoxifylline exerted beneficial effects on...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/s0039-6060(97)90106-9
更新日期：1997-05-01 00:00:00
abstract：BACKGROUND:From a post hoc analysis a hypothesis was generated that women deposit more collagen in a surrogate test wound than men. The purpose of this study has been to verify this hypothesis prospectively in a controlled study. METHODS:Post hoc analyses were done on 37 volunteers (study A). The prospective trial inc...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1067/msy.2002.119986
更新日期：2002-03-01 00:00:00
abstract：:In this study we evaluated the relative effects of ischemia with and without antibiotic bowel preparation on colonic wound healing. Thirty-two Sprague-Dawley rats (185 to 300 gm) were divided into five study groups: Groups I and II (n = 14) had no colonic ischemia, half receiving antibiotic bowel preparation before co...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1985-04-01 00:00:00
abstract：:We identified 106 patients who had undergone complete resection of isolated colorectal hepatic metastases. Nine of these patients subsequently underwent repeat liver resections for isolated hepatic recurrences. The median follow-up for these patients was 21 months. One postoperative death was related to the second hep...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1990-01-01 00:00:00
abstract：:Nine patients (median age, 81 years) with primary hyperparathyroidism were treated with intravenous infusions of disodium pamidronate (APD), which is a bisphosphonate drug. Six patients had severe hypercalcemia (serum calcium concentration, greater than 3 mmol/L) persisting after rehydration with saline and treatment ...
journal_title：Surgery
pub_type： 杂志文章
doi：
更新日期：1991-09-01 00:00:00
abstract：BACKGROUND:The Michigan Surgical Home and Optimization Program is a structured, home-based, preoperative training program targeting physical, nutritional, and psychological guidance. The purpose of this study was to determine if participation in this program was associated with reduced hospital duration of stay and hea...
journal_title：Surgery
pub_type： 杂志文章
doi：10.1016/j.surg.2016.12.021
更新日期：2017-06-01 00:00:00
abstract：BACKGROUND:Case-control studies have reported an inverse relationship between appendectomy and the risk of ulcerative colitis, but the association has not been confirmed in prospective studies. METHODS:Using national hospital discharge registry data in Denmark, the authors followed up 154,434 patients who underwent ap...
journal_title：Surgery
pub_type： 杂志文章,meta分析
doi：10.1067/msy.2001.115362
更新日期：2001-07-01 00:00:00
