Faculty Bibliography

To define the group of patients at high risk for myocardial infarction (MI) and death associated with abdominal aortic aneurysm repair, resting gated blood pool studies were obtained on 50 such aneurysm patients preoperatively. The results indicated that three groups could be distinguished among these patients by cardiac ejection fraction. Group I (n = 25) had preoperative ejection fractions ranging from 56% to 85%. None of the patients in group I suffered an acute perioperative MI. Group II (n = 20) comprised patients with ejection fractions ranging from 36% to 55%. There was a 20% incidence of MI in group II but no cardiac deaths. Group III included five patients with ejection fractions ranging from 27% to 35%. There was an 80% incidence of perioperative MI in these patients, with one cardiac death and one cardiac arrest. All perioperative MIs occurred within the first 48 hours after surgery. In addition there was a 50% incidence of perioperative MI among all those patients who were 80 years of age or older. These results indicate guidelines for the management of patients undergoing abdominal aortic aneurysm repair based on their preoperative ejection fraction. The data further suggest that the noninvasive gated blood pool method of determining ejection fraction may serve a more broadly useful function in helping to determine which of those patients about to undergo major surgical procedures are at high risk for perioperative MI

Aortocaval fistulization is usually manifested by signs of rupture of an aneurysm or of the large fistula. Absence of symptoms is unusual with this rare complication. Two cases of asymptomatic aortocaval fistula are presented. An awareness of this possibility should facilitate management when unexpected venous bleeding is encountered

The early complications of carotid endarterectomy are attributed to clamping ischemia, intraoperative embolization, and thrombosis of the newly endarterectomized carotid artery. An unusual mechanism is due to intracranial hemorrhage. The differential diagnosis can usually be established by a combination of oculoplethysmography, CT scanning of the brain, exploration of thrombosed carotid arteries, and repeat angiographic studies. Other complications, including acute myocardial infarction, wound hemorrhage, and infection, are discussed

In patients with common carotid artery (CCA) occlusion, successful vascular reconstruction can be performed if there is a patent internal or external carotid distal to the occlusion. Preoperative selection of suitable candidates is often difficult because of the inability to visualize patent distal vessels with conventional angiography. In reviewing 24 patients operated upon for CCA occlusion since 1962, the distal internal or external carotid arteries were visualized in only four (17%) of the preoperative angiograms. When these 24 patients were explored, the internal carotid was found to be patent in 11 (46%) patients and the external patent in 15 (62%) cases. Of the 15 patients reconstructed, thromboendarterectomy was performed in six and saphenous vein bypass in nine. In the remaining nine patients, exploration revealed both the internal and external carotids to be thrombosed and unsuitable for CCA reconstruction. Recently we have used rapid sequential computerized tomography (RSCT) scanning to aid in the evaluation of the nonvisualized internal carotid artery (ICA). In two patients with CCA occlusion, RSCT correctly diagnosed patency of the ICA although it appeared to be occluded on angiography. Preliminary data suggest that RSCT will permit accurate preoperative selection of those CCA occlusion patients who are suitable surgical candidates and eliminate the need for surgical exploration

High-resolution real-time ultrasonography was performed in 11 patients with clinically suspected deep venous thrombosis (DVT) of the lower extremity. Contrast venography was performed in all patients within 24 hours of sonographic examination. The common femoral vein at the groin and the popliteal vein in the popliteal fossa were evaluated for presence or absence of intraluminal soft-tissue mass (thrombi), compressibility of the veins, and response to performance of the Valsalva maneuver. Of the 11 patients, six were shown to have DVT by contrast venography. In all six cases there was complete agreement between sonography and contrast venography as to the presence or absence of thrombi in the common femoral vein or the popliteal vein