Coronary artery bypass re-operations: basic principles [Koroner bypass reoperasynolari: temel prensipler.]

PubMed ID: 12122970Mortality and major complications during primary coronary artery bypass operation has decreased substantially during the past 20 years. However, patients undergoing reoperative myocardial revascularization still face markedly elevated perioperative mortality and morbidity. On the other hand, the incidence of reoperative coronary bypass surgery continues to increase. Aggressive perioperative care and optimal myocardial protection is mandatory in these patients. In this article we reviewed the patient profiles, indications for operation, operative techniques and their impact on the surgical results for patients undergoing reoperative coronary artery bypass surgery

Bilateral Spontaneous and Isolated Dissection of the External Iliac Arteries: Report of A Case

Spontaneous dissection of the external iliac artery without involvement of the aorta is extremely rare, especially, if bilateral. We report a case of a 41 year-old man complaining of sudden onset left lower limb and groin pain. Digital subtraction angiography showed dissection of both external iliac arteries. Patient was initially managed with medical treatment consisting of heparin and ß blocker. One week later his symptoms worsened. Endovascular treatment was not deemed appropriate since the dissection involved long segments of both arteries. The patient underwent aortobifemoral bypass by using a Dacron Y graft and remained free of symptoms with good distal pulses 2 months after surgery. To the best of our knowledge, this is the second reported case of bilateral and spontaneous external iliac artery dissection. © 2005 Elsevier Ltd. All rights reserved

Right intra-atrial catheter placement for hemodialysis in patients with multiple venous failure

PubMed ID: 22280164The purpose of this study is to evaluate the efficacy and safety of direct right atrial catheter insertion for hemodialysis in patients with multiple venous access failure. We retrospectively evaluated the charts of 27 patients with multiple venous access failure who had intra-atrial dialysis catheter placement between October 2005 and October 2010 in our clinic. Permanent right atrial dialysis catheters were placed through a right anterior mini-thoracotomy under intratracheal general anesthesia in all patients. Demographics of the cases, the patency rates of hemodialysis via atrial catheterization, existence of any catheter thrombosis, and catheter-related infections were documented and used in statistical analysis. Seventeen women (63%) and 10 men (37%) with the mean age of 59.0±7.1 years (47-71) were enrolled in this study. Chronic renal failure was diagnosed for the mean of 78.9±24.3 months (33-130). Five patients (18.5%) died. Ventricular fibrillation and myocardial infarction were the causes of death in the early postoperative period in two patients. Two of the remaining three patients died because of cerebrovascular events, and one patient died because of an unknown cause. Ten patients (37%) had been using anticoagulate agents (warfarin) because of concomitant disorders such as deep vein thrombosis, operated valve disease, and arrhythmias. Catheter thrombosis and malfunction was determined in three cases (11.1%). Intra-atrial hemodialysis catheterization is a safe and effective life-saving measure for the patients with multiple venous failure and without any possibility of peritoneal dialysis or renal transplantation. © 2012 The Authors. Hemodialysis International © 2012 International Society for Hemodialysis

Perigraft to right atrial shunt by using autologous pericardium for control of bleeding in acute type A dissections

WOS: 000178452500024PubMed ID: 12400747Background. We report our experience with creating a perigraft to right atrial fistula by using autologous pericardium to control the inaccessible bleeding after aortic root repair in patients with acute type A aortic dissection. Methods. Between 1994 and 2001, perigraft to right atrial fistula was used in 7 of 109 patients (mean age; 55 years) who underwent emergency operation for acute type A dissections. A chamber around the aortic graft was created by suturing a patch of pericardium to the right ventricular wall inferiorly, to the pulmonary artery medially, to the Teflon felt at the distal aortic anastomosis or innominate vein superiorly, and to the superior vena cava and right atrium laterally. A large stab wound was created on the medial aspect of the right atrium. The perigraft space was then closed expeditiously. Results. None of these patients required reexploration for bleeding and they were discharged from the hospital without complications. The average blood and fresh frozen plasma requirement was 3.4 +/- 0.9 and 2.7 +/- 0.7, respectively. All underwent echocardiographic examination before discharge and no perigraft to right atrial shunt was detected. Conclusions. If intractable bleeding is encountered after the administration of protamine and thrombotic agents and a discrete bleeding site can not be found, then a perigraft to right atrial fistula using autologous pericardium can be created as a last resort. It provides primary and definite sternal closure and avoids the detrimental effects of a second pump run and continued bleeding

Acute intraoperative arterial elongation: an experimental study

WOS: 000169992900008PubMed ID: 11461102Objectives: small arterial defects resulting from either trauma or resection of an aneurysm often present difficult problems to the vascular surgeon. Design: to demonstrate that certain arterial gaps as a result of traumatic injury or aneurysm resection could be closed with acute intraoperative arterial elongation. Materials: fifteen mongrel dogs underwent acute intraoperative arterial elongation of the right superficial femoral artery, with the left side used for a control vessel. Methods: arterial defects created surgically (median 50 (range 25 to 60 mm) mm). Appropriate length of artery was then undermined. A Foley catheter was placed proximally and distally directly beneath this undermined portion of vessel. The vessel is lengthened following 3 expansion/relaxation cycle of Foley catheter. Arterial gaps were closed by end to end anastomosis. Arterial pressure study was performed in all vessels. Results: acutely, arterial pressure differences proximal and distal to the anastomosis were seen only when arterial gaps were exceeded 55 mm. There was no occlusion either acutely or after 4 weeks follow-up period. Light microscopic examination of arterial specimens revealed partial disruption of internal elastic lamina. At the end of the follow-up period, formation of neointima with regeneration of the internal elastic lamina was demonstrated. Scanning electron microscopy revealed minimal endothelial denudation. Conclusions: we believe that, acute intraoperative elongation can be used as an alternative technique to vein grafting for the repair of small traumatic arterial defects in selected cases