Arterial Spasm Complicating Distal Vascular Bypass Procedures

Samson, Russell H.; Gupta, Sushil K.; Scher, Larry A.; Veith, Frank J.

doi:10.1001/archsurg.1982.01380310079020

Cited by 9 publications

(1 citation statement)

References 7 publications

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“…In injury of all three crural arteries, at least two should be reconstructed, with priority given to vessels of larger diameter25,33. Successful recognition and treatment of arterial spasm following trauma and after reconstruction substantially improves the early graft patency rate34, 35. Indications for venous reconstruction after crural vascular injuries are contr~versial~~,~'.…”

Section: Discussionmentioning

confidence: 99%

War injuries of the crural arteries

Radonić

Barić

Petricević

et al. 1995

Journal of British Surgery

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Twenty-eight patients with military crural vascular injuries are presented. In the group undergoing immediate repair (21 patients), the time interval between trauma and surgery was 20 min to 30 h (mean 8 h 30 min). In those receiving delayed repair (seven patients), the interval between trauma and surgery was 3-47 (mean 14) days. Hyperbaric oxygenation therapy was used in conjunction with surgery and antibiotic therapy in 13 of the 28 patients. Explosive injuries were found in 14 patients and high-velocity missile injuries in nine; associated fractures were present in 20. Twenty of the 28 patients with crural vascular injuries had combined arterial and venous injuries, while eight had isolated arterial injuries. Twenty-five patients with distal ischaemia required arterial repair; five late amputations resulted. Military crural vascular injuries should be treated with soft tissue debridement, removal of foreign material, and microvascular arterial and concomitant vein reconstruction. This should be followed by external skeletal stabilization for bony and/or soft tissue instability, with fasciotomy for any associated compartment syndrome. The wound should be left open, with delayed closure or split skin grafting. It was felt that hyperbaric oxygen therapy reduced the amputation rate following combat-related crural vessel injuries.

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Section: Discussionmentioning

confidence: 99%

War injuries of the crural arteries

Radonić

Barić

Petricević

et al. 1995

Journal of British Surgery

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Devastating distal arterial trauma and continuous intraarterial infusion of tolazoline

Peck¹,

Fitzgibbons²,

Gaspar

1983

The American Journal of Surgery

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Low-dose thrombolytic therapy for infrainguinal graft occlusions: An idea whose time has passed?

Perler

White

Ernst

et al. 1985

Journal of Vascular Surgery

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Despite the growing enthusiasm for low-dose intra-arterial thrombolytic therapy, the efficacy and risks in specific clinical situations have not been defined. During the past 13 months, 10 infrainguinal bypass graft occlusions occurred in nine patients 2 to 48 months postoperatively and were treated with local infusions of either streptokinase or urokinase. The grafts treated included two saphenous vein femoropopliteal grafts, two expanded polytetrafluoroethylene (PTFE) femoropopliteal grafts, four saphenous vein femoroanterior tibial grafts, one saphenous vein-PTFE composite femoro-anterior tibial graft, and one saphenous vein-PTFE composite femoroperoneal graft. The graft occlusions occurred 2 to 14 days prior to initiation of treatment. The infusion failed to restore flow completely in seven grafts; and of the three successes, two patients required surgical treatment of complications. All successful recanalizations occurred within 48 hours of the initiation ofthrombolytic therapy. Of the seven failures, two patients had viable limbs and were discharged, whereas two required amputation (one above and one below knee). Three patients underwent surgical thrombectomy and revisions that were successfifl in two and resulted in a below-knee amputation in the other. Despite all precautions, complications occurred in five patients. Low-dose intra-arterial thrombolytic therapy is a poorly efficacious, risky method of infrainguinal graft occlusion management. (J VASC SURG 1985; 2:799-805.) The infrainguinal bypass graft is now widely accepted as an effective and durable method of revascularization of the ischemic lower extremity secondary to femoropopliteal occlusive disease. Nevertheless, progressive graft failure occurs over time? -6 "~vaft thrombosis in the immediate postoperative period invariably results from technical or judgmental error on the surgeon's part. There is little disagreement that prompt reoperation is indicated in this ,situation and will usually save the bypass graft. 7 When graft occlusion occurs later, weeks, months, or years after implantation, the causes may be more complex, treatment more difficult, and the results not always satisfactory. 4 Late thrombectomy of an autologous saphenous vein graft is particularly difficult From the Departments of Surgery (Drs. Perler, Ernst, and Williams) and Radiology, (Dr. White), The Johns Hopkins Medical Institutions.

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Arterial Spasm Complicating Distal Vascular Bypass Procedures

Cited by 9 publications

References 7 publications

War injuries of the crural arteries

War injuries of the crural arteries

Devastating distal arterial trauma and continuous intraarterial infusion of tolazoline

Low-dose thrombolytic therapy for infrainguinal graft occlusions: An idea whose time has passed?

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