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Richard P. Cambria – One of the best experts on this subject based on the ideXlab platform.
postoperative renal dysfunction independently predicts late mortality in patients undergoing Aortic ReconstructionJournal of Vascular Surgery, 2013Co-Authors: Virendra I Patel, Robert T Lancaster, Emel Ergul, Mark F Conrad, Daniel J Bertges, Marc L Schermerhorn, Phillip Goodney, Richard P. CambriaAbstract:
Objective Preoperative chronic kidney disease (CKD) has been shown to predict postoperative renal complications and mortality after open Aortic surgery; the impact of postoperative renal complications less severe than permanent dialysis are unknown. We evaluated the impact of postoperative renal dysfunction severity on survival using a regional quality improvement registry. Methods Patients undergoing intact open Aortic Reconstruction in the Vascular Study Group of New England registry (2003-2012) were stratified by severity of postoperative renal complications; none, creatinine increase of greater than 0.5 mg/dL (incCr), or any hemodialysis (HD). Predictors of renal dysfunction and impact of renal complications on survival were analyzed using multivariable methods. Results We included 2695 patients, of which 65% (n = 1733) underwent open abdominal Aortic aneurysm repair, and 35% (n = 962) open aortoiliac Reconstruction. At baseline, 15% of patients had preoperative moderate CKD and 1.2% had severe CKD. Postoperative renal complications of incCr occurred in 8.5% of patients, and 1.5% required HD. Multivariable cumlogit regression identified severe baseline CKD (odds ratio [OR], 15; 95% confidence interval [CI], 6.4-34; P P P P P P P = .01), baseline chronic obstructive pulmonary disease (OR, 1.6; 95% CI, 1.2-2.2; P P = .009), and HD (OR, 4.8; 95% CI, 1.8-12.7); P = .009) independently increased 30-day mortality. Risk-adjusted multivariable Cox regression showed that incCr (hazard ratio, 1.8; 95% CI, 1.3-2.6; P P P Conclusions Increasing severity of postoperative renal dysfunction independently predicts increased risk of late mortality after open Aortic surgery. Perioperative measures to decrease renal complications may potentially prolong the survival of patients after open Aortic surgery.
Transperitoneal versus retroperitoneal approach for Aortic Reconstruction: A randomized prospective studyJournal of Vascular Surgery, 1990Co-Authors: Richard P. Cambria, David C. Brewster, William M. Abbott, Marion Freehan, Joseph Megerman, Glenn M. Lamuraglia, Roger S. Wilson, Donna J. Wilson, Richard Teplick, J.kenneth DavisonAbstract:
A prospective, randomized study was conducted to compare the retroperitoneal versus transperitoneal approach for elective Aortic Reconstruction. One hundred thirteen patients (transperitoneal = 59, retroperitoneal = 54) were randomized between March 1987 and October 1988. In addition, to assess the changing course of patients undergoing Aortic Reconstruction similar data were gathered retrospectively on a group of 56 patients undergoing Aortic Reconstruction by the same surgeons performed via a transperitoneal approach in 1984 to 1985. Randomized patients were identical in age, male to female ratio, smoking history, incidence and severity of cardiopulmonary disease, indication for operation, and use of epidural anesthetics. Details of operation including operative and Aortic cross-clamp times, crystalloid and transfusion requirements, degree of hypothermia on arrival at the intensive care unit, and perioperative fluid and blood requirements did not differ significantly for patients undergoing transperitoneal versus retroperitoneal Reconstruction. Respiratory morbidity, as assessed by percent of patients requiring postoperative ventilation, deterioration in pulmonary function tests, and the incidence of respiratory complications, was identical in randomized patients. Other aspects of postoperative recovery including recovery of gastrointestinal function, the requirement for narcotics, metabolic parameters of operative stress, the incidence of major and minor complications, and the duration of hospital stay were similar for randomized patients undergoing transperitoneal and retroperitoneal Reconstruction. When compared to retrospectively reviewed patients having Aortic Reconstruction, randomized patients undergoing transperitoneal and retroperitoneal operations had highly significant (p less than 0.001) reductions in postoperative ventilation, transfusion requirements, and length of hospital stay. Such trends were all independent of transperitoneal versus retroperitoneal approach.(ABSTRACT TRUNCATED AT 250 WORDS)
F U Weiguo – One of the best experts on this subject based on the ideXlab platform.
femorofemoral cardiopulmonary bypass in descending thoracic Aortic ReconstructionChinese Journal of Thoracic and Cardiovaescular Surgery, 2002Co-Authors: F U WeiguoAbstract:
Objective: To study the role of femorofemoral cardiopulmonary bypass in descending thoracic Aortic Reconstruction. Methods: Twelve patients underwent descending thoracic Aortic Reconstruction under femorofemoral cardiopulmonary bypass between December, 1999 and June, 2001. Fifteen cases of descending thoracic Aortic Reconstruction between June, 1994 and August, 1999 were selected as non-bypass group. Comparison was made in the two groups in terms of paraplegia, visceral ischemia, blood transfusion and coagulopathy. Results: Femorofemoral cardiopulmonary bypass minimized the likelihood of paraplegia when Aortic cross-clamping time exceeded 60 minutes (P0.05). Abnormal hepatic function occurred less in the bypass group than in the non-bypass group (P0.05), but no statistical difference was found in abnormal renal function between the two groups (P0.05). There was significantly less blood transfusion in the bypass group (P0.01), and more coagulopathies in the non-bypass group (P0.05). Conclusions: Femorofemoral cardiopulmonary bypass, an easy and safe approach, has significant advantages over simple Aortic cross-clamping, in preventing paraplegia and visceral ischemia and reducing blood transfusion and coagulopathy, in descending thoracic Aortic Reconstruction.
Calvin B. Ernst – One of the best experts on this subject based on the ideXlab platform.
Supraceliac Aortic cross-clamping: Determinants of outcome in elective abdominal Aortic ReconstructionJournal of Vascular Surgery, 1993Co-Authors: Timothy J. Nypaver, Alexander D. Shepard, Daniel J. Reddy, Joseph P. Elliott, Calvin B. ErnstAbstract:
Abstract Purpose: A 7-year experience in which 43 patients underwent supraceliac Aortic cross-clamping (SC-AXC) during elective abdominal Aortic Reconstruction was reviewed. Methods: Operation was performed for abdominal Aortic aneurysm (AAA) in 29 (68%) patients, aortoiliac occlusive disease in seven (16%), proximal anastomotic AAA in three (7%), “shaggy” aorta syndrome in three (7%), and in situ grafting of a previously ligated aorta in one (2%) patient. The indications for supraceliac control included pararenal AAA origin (25), pararenal Aortic atherosclerosis (18), inflammatory AAA (2), and a short infrarenal Aortic stump (1). Vital organ ischemic complications (VOICs) were defined as any major ischemic complication involving the liver, kidneys, bowel, or spinal cord. Results: The incidence of VOICs was significantly increased when concomitant renal or visceral revascularization (CRVR) was required ( p = 0.002) and correlated with an increasing SC-AXC time ( p = 0.015). In patients undergoing CRVR ( n = 16) the perioperative mortality rate was 25%; VOICs developed in six patients and included renal failure (3), mesenteric/colonic ischemia (3), hepatic ischemia with coagulopathy (2), and spinal cord ischemia (1). In contrast, in those not requiring CRVR ( n = 27), SC-AXC was well tolerated. There were no VOICs and no deaths; morbidity rate was 33%. Conclusions: The incidence of VOICs associated with the use of SC-AXC is primarily related to the level of preoperative renal or mesenteric insufficiency, the severity of pararenal Aortic atherosclerosis, the extent of the operative procedure, and the duration of proximal Aortic cross-clamping. In complex abdominal Aortic Reconstruction in which infrarenal Aortic control is either not possible or deemed hazardous, SC-AXC is a safe and valuable technique for achieving proximal control. (J VASC SURG 1993;17:868-76.)
Retroperitoneal Aortic Reconstruction: Indications and PitfallsModern Vascular Surgery, 1992Co-Authors: David F.j. Tollefson, Calvin B. ErnstAbstract:
The first reported use of the retroperitoneal approach for abdominal vessel Reconstruction was ligation of an external iliac artery aneurysm by Sir Astley Cooper in 1808.1 The first successful repair of an abdominal Aortic aneurysm was performed via the retroperitoneal approach and was reported by Dubost in 1951.2 Since then, numerous authors have reported on the advantages of the retroperitoneal approach.3,4,5 However, retroperitoneal Aortic Reconstruction still remains a novel and little used approach by most surgeons.
Colon Ischemia Following Aortic ReconstructionAnnals of Vascular Surgery, 1991Co-Authors: David F.j. Tollefson, Calvin B. ErnstAbstract:
Ischemic colitis following Aortic Reconstruction, although uncommon, has potentially devastating consequences. While clinically apparent after only about 2% of Aortic Reconstructions, subclinical episodes undoubtedly occur much more frequently. The mortality associated with transmural colonic infarction can exceed 50%. Colon ischemia is usually due to a watershed phenomenon, wherein the collateral blood flow to the sigmoid colon from the superior mesenteric artery (SMA) or hypogastric arteries (HGA) is inadequate after inferior mesenteric artery (IMA) occlusion occurring incident to Aortic Reconstruction. This collateral blood flow is through either the meandering mesenteric artery (for SMA to IMA flow) or the marginal artery of Drummond. Certain criteria are useful in predicting individuals at risk for postoperative colon ischemia. Early postoperative diagnosis is crucial to minimize morbidity and mortality associated with ischemic colitis. While diarrhea, fever, severe postoperative abdominal pain, or signs of sepsis and peritonitis all suggest colonic ischemia, flexible sigmoidoscopy is essential to establish the diagnosis and can be performed at the bedside. Nonoperative management, including broad spectrum antibiotics and careful attention to fluid and electrolyte administration, is the preferred treatment for mild cases of colon ischemia involving only the mucosa. However, at the first signs of advanced ischemia, whether noted endoscopically or clinically, resection of all necrotic bowel with