The blood pressure in the ankle and great toe was measured with cuff and strain-gauge technique in 39 patients after insertion of aorto-femoral bifurcation graft. In 40 limbs with patent superficial femoral artery (complete reconstruction) the distal blood pressure remained unchanged from the tenth postoperative day to follow-up after 12 to 26 months. In 30 limbs with occluded superficial femoral artery (partial reconstruction) the ankle/arm pressure index rose from 0.54 to 0.61 between the tenth day and late follow-up. The blood pressure in the great toe had increased by 8 mmHg on the tenth postoperative day and by additionally 17 mmHg during the next 12 to 26 months. The delayed pressure rise after partial arterial reconstruction presumably reflected development of collateral vessels from the deep femoral artery system. The clinical significance of the findings is discussed.
To find out if the number of lower limb amputations for peripheral occlusive arterial disease increased during the period of increased vascular surgical activity 1977-1990.Retrospective review of a database covering all admissions to Danish hospitals.All patients admitted to Danish hospitals with peripheral occlusive disease during the period 1977-1990.Numbers, and age and sex specific incidence rates for admission, arterial reconstruction and amputation.The number of admissions during which arterial reconstruction for OAD was done increased from 963 in 1977 to 2311 in 1990 (p < 0.001). The number of admissions during which a diagnosis of OAD was made and an amputation done increased from 1290 in 1977 to a maximum of 1609 in 1983 (p < 0.001). The number remained nearly constant in the mid-1980s but decreased during last part of the period to 1181 in 1990 (p < 0.001).The reduction in the number of amputations may indicate that vascular surgery even on a national scale is effective in preventing amputations for OAD.
The object of this study was to investigate whether the history, general clinical examination, chest radiography, ECG, and preoperative exercise haemodynamics afforded a basis for pointing out individuals who were likely to develop postoperative cardiac complications. Particular emphasis was placed on whether haemodynamic testing yielded a major contribution to predicting such complications. 48 patients carried out preoperative exercise tests. The hemodynamic parameters were obtained by using a Swan-Ganz pulmonary artery thermodilution catheter. The clinical examinations, laboratory findings, and haemodynamic parameters were assessed by comparing the results with the outcome of the postoperative course. In assessing the results, the same diagnostic accuracy was found for the history (0.56-0.65), laboratory findings (0.50-0.65), and hemodynamic parameters (0.44-0.71). By combining the various parameters, however, it was possible to achieve a very high sensitivity (0.86) as regards the prediction of postoperative cardiac complications, but this was at the cost of many false positives and consequently a low accuracy (0.46). We conclude that haemodynamic exercise testing is not better than conventional means of prediction individual patient's postoperative cardiac complications.
Orthostatic changes in first-toe systolic blood pressure, measured with cuff and strain-gauge technique, were compared with changes expected according to hydrostatic calculations. Twenty-five limbs with occlusive arterial disease were studied. When the first toe was lowered 40 cm below the heart, the toe blood pressure--corrected for changes in systemic blood pressure--rose on median 3.9 (-8.7 to 11.4) mmHg more than expected. The difference was statistically significant. Elevation of the first toe 40 cm above the heart did not lead to significant deviation from the expected blood pressure. Twelve normal limbs showed no significant deviations in blood pressure during the orthostatic changes. It is proposed that the additional increase in the indirectly measured systolic pressure also represents an additional increase in the mean arterial blood pressure. The mechanism of this additional increase seems to be reflex vasoconstriction in the distal tissues, reducing the pressure gradient across the proximal collateral vessels. The additional increment may contribute to the abnormalities of local blood flow regulation observed in ischaemic limbs.
This paper contains certain proposals for future graft studies. Graft failure should be defined as any occlusion of the graft. Time should be measured from the end of operation to the first occlusion of the graft. The results should be analysed by the Kaplan-Meier estimator, and patency rates should be compared by the log-rank test or Gehan's test. It is stressed that scientifically valid data can only be obtained in prospective, randomized trials.
Information was retrieved from the national patient register (Landspatientregisteret), that contains information on all admissions to Danish hospitals 1977-1993. The number of admissions during which a diagnosis of occlusive arterial disease (OAD) of the lower extremities was made and an amputation performed increased from 1290 in 1977 to a maximum of 1609 in 1983 (p < 0.001). From 1987 on the number decreased almost 30% to 1111 in 1993 (p < 0.001). During the period the number of admissions during which arterial reconstruction for OAD were performed increased steadily from 963 in 1977 to 2637 in 1993 (p < 0.001). The result may indicate that vascular surgery is effective on a national scale in preventing amputations for OAD.
To study the incidence of various hospital manifestations of abdominal aortic aneurysms.Retrospective review of a database covering all admissions to Danish hospitals.All patients admitted to Danish hospitals during the period 1977 to 1990.Number, and age and sex specific incidence rates of hospital admission for, operation for, or death from abdominal aortic aneurysm.The number of admissions during which an abdominal aortic aneurysm was diagnosed increased fourfold from 362 in 1977 to 1317 in 1990, and the number of admissions, during which an abdominal aortic aneurysm was operated on, increased by a factor of nearly five from 66 to 307. A quarter of the operations were done for ruptured aneurysm. The number of deaths in hospital increased from 119 in 1978 to about 200 towards the end of the period, but during the last three years it decreased from 236 to 177.Although the study records abdominal aortic aneurysm in hospital only, the data may indicate that the incidence is increasing. The reduction in mortality towards the end of the period may indicate that vascular surgery even on a national scale is effective in reducing mortality from aortic aneurysm.
A new case of appendico-vesical fistula is submitted. After a brief review of the literature, it is concluded that these fistulas usually manifest themselves clinically in recurrent urinary infections without gastro-intestinal symptoms. The best aids in the difficult diagnosis are cystography and cystoscopy. Treatment is by appendectomy and excision of the fistular opening.
Blood flow measurements using either a strain gauge plethysmograph or the Dohn air-filled plethysmograph were compared by means of successive measurements in the calf in six normal subjects (12 extremities) and in five patients with arterial insufficiency (nine extremities). Flows were recorded during rest as well as after 5 minutes of ischemia. The strain-gauge plethysmograph tended to give lower values than the Dohn plethysmograph, although at higher flow rates the results were identical. It is concluded that, for most purposes, the Dohn plethysmograph can be replaced by the strain gauge plethysmograph, which is considerably simpler to use.
