The collateral circulation of ischemic limbs can be augmented and regulated by a connection to an extracorporeal centrifugal pump, with isolation from the systemic circulation provided by balloons and with an access system providing repeatable pump connections. Major amputation may be avoided in selected cases.
In this series "anaortic" OPCAB surgery significantly decreases the risk of neurological complications compared to both ONCAB and OPCAB with aortic manipulation. If possible, we advocate avoiding aortic manipulation in OPCAB surgery.
SummaryWe describe a case of pulmonary air embolism that occurred during laparoscopic cholecystectomy using the neodymium:yttriumaluminium-garnet laser.
Blood flow through collaterals can be very significantly augmented by connection to an extracorporeal pump with isolation from the systemic circulation. The pancycle hyperperfusion can be safely repeated by implantation of an arterial access device. In the longer term, there is evidence of collateral development. When amputation is the only alternative, hypertensive extracorporeal limb perfusion should be considered.
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