Edward T. O'Hara

Is axillo-bilateral femoral graft an effective substitute for aortic-bilateral iliac/femoral graft?: an analysis of ten years experience.

During the past ten years, 88 aorto-bilateral iliac/femoral grafts and 56 axillo-bilateral femoral grafts were electively performed for occlusive disease of the abdominal aorta or iliac vessels. The results of this retrospective study indicate that the axillo-bilateral femoral graft, although performed in an older population and more frequently for limb salvage, has a lower operative mortality than does conventional aortic bypass surgery with similar patency (76%) and survival (67%) at five years. However, axillo femoral grafting requires more frequent remedial surgery to obtain long term patency.

Staged infrainguinal reascularization: Initial prosthetic above-knee bypass followed by a distal vein bypass for recurrent ischemia

Abstract Optimal infrainguinal revascularization should provide limb salvage for the longest duration of time. It is not known whether limb salvage is longer with an initial below-knee popliteal or tibial in situ saphenous vein graft or with staged bypasses; that is, an initial above-knee popliteal prosthetic bypass if feasible, followed by a more distal vein graft should the above-knee prosthetic graft fail. A retrospective review of 197 lower extremity vascular reconstructions performed since 1976 utilizing polytetrafluoroethylene (PTFE), umbilical vein, or in situ saphenous vein was completed. The data were analyzed for differences in limb salvage and prevention of limb threatening ischemia among three subgroups: above-knee prosthetic bypass, below-knee or tibial in situ saphenous vein bypass, and staged reconstructions (above-knee prosthetic bypass with subsequent in situ bypass). The groups were similar with respect to severity of limb threatening ischemia as indicated by mean preoperative ankle-brachial indices. Cumulative secondary limb salvage at 36 months was 73 percent for prosthetic grafts in the above-knee position, 78 percent for in situ saphenous vein grafts in the below-knee or tibial position, and 87 percent for staged reconstruction with an initial prosthetic graft to the above-knee position followed by a distal in situ vein bypass when the prosthetic graft fails.

Portal hypertension changes following selective splenorenal shunt surgery. Evaluation by percutaneous transhepatic portal catheterization, venography, and cinefluorography.

Considerable diagnostic data can be gathered by selectively catheterizing the portal vein and the major tributaries of the splanchnic venous system to evaluate pressure and blood flow. Combined with cinefluorography, this is a superior method for demonstrating the anatomy and hemodynamics of portal hypertension as well as the effects of splenorenal shunt surgery. Thirty-one attempts with a 19 gauge trocar in 17 patients resulted in 28 successful portal entries and 24 successful selective catheterizations. Portal vein pressure, flow, and diameter were less after shunting.

Surgical significance of the Ehlers-Danlos syndrome

Abstract Bleeding from major arteries is the most formidable complication encountered in Ehlers-Danlos syndrome and results from fragility of the vessels as well as the lack of tamponade by the adjacent connective tissue structures. A case is presented to illustrate this, and the literature is reviewed to show that hemorrhage might result from surgery or from trauma which sometimes is very trivial. Young men seem to be predominantly affected. Other complications include wound dehiscence and perforation of the bowel. It is important that those afflicted be aware of the dangers of trauma and that their physicians be aware of their unusual tissues.

Pseudocyst of the pancreas complicating distal splenorenal shunt. A report of three cases with successful percutaneous drainage.

Three cases of pseudocysts of the pancreas complicating the operative procedure of distal splenorenal shunt are reported. In all of these patients, gross changes in the pancreas, consistent with chronic pancreatitis were found. Attention is called to the possibility of this complication occurring in association with this particular operation, specifically, when it is carried out in patients who may prove to have a considerable degree of pancreatic and retroperitoneal fibrosis secondary to alcoholic pancreatitis. All three pseudocysts were satisfactorily managed by percutaneous drainage under ultrasonic control, which provided a very satisfactory alternative to surgical decompression.

Bleeding esophageal varices: treatment with vasopressin, transhepatic embolization and selective splenorenal shunting.

The fate of 359 consecutive alcoholic cirrhotic male patients with bleeding esophageal varices was determined through chart review and personal interview. Three historical periods (1966-70; 1971-75; 1976-80) were defined based on availability of different therapeutic modalities. Management of acutely bleeding varices by conservative, nonsurgical means, including embolization, was preferable to emergency surgery when considering 30-day mortality rates. Percutaneous transhepatic embolization of esophagogastric varices significantly improved the rate of control of hemorrhage and 30-day survival over previously employed nonsurgical methods. The combination of nonsurgical management of acute variceal hemorrhage followed by selective distal splenorenal shunting resulted in maximum salvage of the alcoholic cirrhotic patient.