H 1466 When Can the Patient be Given Dialysis

For all problems with dialysis accesses an important issue is the patient's need for dialysis. Inserting a temporary catheter in the neck or groin should be weighed against the possibility of a successful operation. A basic rule is that a revised dialysis access should be allowed at least a couple of days to heal after the procedure to avoid bleeding complications. Dialysis requires heparinization, which in combination with uremic patients' tendency for coagulopathy increases the risk for...

Aortic Graft Infection

The first investigation done to reveal signs of aortic graft infection is CT. The question to be answered is whether there is fluid or gas around the graft and inside the aneurysm sac. The normal postoperative course is that fluid and gas should be absorbed within 3-6 weeks. Accordingly, gas bubbles around the graft after 20 days postopera-tively suggest that infection is a possible diagnosis. Unfortunately, it is not always easy to differentiate from intestinal gas. Magnetic resonance imaging...

H 1371 Thrombophlebitis

Thrombophlebitis, thrombosis of a superficial vein with secondary inflammation insurrounding tissue, is a very common condition. The exact explanation for its occurrence is unknown, but coagulation disturbances or local inflammation probably contribute. Because varicose veins are prone to be damaged by minor trauma and also often have a low blood flow, they are at risk for thrombophlebitis. Patients with malignancy have an increased risk for this condition and if there are no apparent causes -...

Note

In the classic case of a ruptured AAA, no diagnostic tools except the physical examination are needed. Table 7.2. Clinical findings and management of ruptured aortic aneurysms (AAA abdominal aortic aneurysm, OR operating room, CTcomputed tomography) Table 7.2. Clinical findings and management of ruptured aortic aneurysms (AAA abdominal aortic aneurysm, OR operating room, CTcomputed tomography) (lack of mass may be due to obesity or low blood pressure) If history of AAA or signs peritonitis,...

H 154 Control of Bleeding and Clamping

Catheter Clamp Injury

In all vascular procedures, including vascular trauma, proximal and distal control is mandatory before attempting repair or doing an arteriotomy. It is desirable to have a completely empty vascular segment in order to perform a vascular operation without unnecessary technical difficulties. To Fig. 15.2. Different methods for controlling bleeding are demonstrated. From left to right doubly applied vessel-loop, bulldog (small metallic vascular clamp), balloon catheter, loop of ligature, vascular...

Acute Upper Extremity Ischemia

4.2 Background and Pathogenesis ____41 4.3 Clinical Presentation 41 4.4 Diagnostics 42 4.5 Management and Treatment 42 4.5.1 Management Before Treatment 42 4.5.2 Operation 42 4.5.2.1 Embolectomy 42 4.5.2.2 Endovascular Treatment 43 4.5.3 Management After Treatment 43 4.6 Results and Outcome 43 Further Reading 44 History and physical examination are sufficient for the diagnosis. Few patients need angiography. Embolectomy should be performed in most patients. It is important to search for the...

H 94 Diagnostics

Recommendations for management of suspected vascular injuries in the leg have evolved from mandatory exploration of all suspected injuries (a common practice during past wars), to routine angiography for most patients, to a more selective approach today. Regarding exploration and subsequent angiography, it was found that negative explorations and arteriograms were obtained in over 80 of the patients. The associated risk for complications and morbidity after these invasive procedures is the...

H 57 Iatrogenic Vascular Injuries in the Abdomen

It is not uncommon that vessels are injured during abdominal surgery for malignancy or other procedures. Some procedures are particularly prone to cause injury to abdominal vessels. A discussion on some of these follows below. The principles of repair are essentially the same as for traumatic injury caused by accidents or violence. Trocars used for laparoscopic access frequently cause injury to major blood vessels in the abdomen. When the aorta or vena cava is injured, outcome may even be...

Abdominal Vascular Injuries

5.2.2 Magnitude of the Problem 46 5.2.3 Etiology and Pathophysiology 46 5.2.3.1 Penetrating Injury 46 5.2.3.2 Blunt Injury 46 5.2.3.4 Associated Injuries 47 5.3 Clinical Presentation 47 5.3.1 Medical History 47 5.3.2 Clinical Signs and Symptoms 48 5.4 Diagnostics 48 5.5 Management and Treatment 50 5.5.1 Management Before Treatment 50 5.5.1.1 Treatment and Management 5.5.1.2 Unstable Patients 50 5.5.1.3 Stable Patients 51 5.5.1.4 Laparotomy or Not 51 5.5.1.5 Renal Artery Injuries 51 5.5.2...

Info

Aortoiliac Crossover

One alternative way to treat a ruptured AAA with endovascular technique. A unilateral aortoiliac endovascular graft decompresses the aortic aneurysm. A coil in the right internal iliac artery and an occluder in the left common iliac artery eliminate pressure caused by backflow, the latter deployed to allow retrograde flow to the internal iliac artery from the groin. A femo-rofemoral bypass restores perfusion of the left leg The problems related to endovascular repair include the...

Vascular Injuries in the

3.2.2 Etiology and Pathophysiology S2 3.3 Clinical Presentation SS 3.3.1 Medical History SS 3.3.2 Clinical Signs and Symptoms SS 3.4 Diagnostics SS 3.5 Management and Treatment S4 3.5.1 Management Before Treatment S4 and Unstable Patients S4 3.5.1.2 Less Severe Injuries S4 3.5.1.3 Amputation SS 3.5.2 Operation S6 3.5.2.1 Preoperative Preparation S6 3.5.2.2 Proximal Control S6 3.5.2.3 Exploration and Repair S6 3.5.2.4 Finishing the Operation SS 3.5.2.5 Endovascular Treatment S9 3.5.3 Management...

H 1435 Steal and Arterial Insufficiency

Steal implies that the blood flow in the graft or fistula is so large that it reduces perfusion to the tissue distal to the fistula. All AV fistulas and grafts cause some degree of steal (Fig. 14.2), but rarely to an extent that symptoms of arterial insufficiency in the hand develop. The frequency of symptomatic arterial insufficiency due to steal is 1-2 for AV fistulas and 5-6 for AV grafts constructed on the forearm. For accesses in the upper arm the frequency is even higher. Patients with...

12522 Physical Examination

In addition to a general physical examination, including graft function, the operation wound is examined with special emphasis on infection signs and secretions Fig. 12.2 . Also, the areas around the scars need to be investigated for fistulas, pulsating masses, and tender swellings. If an infected Fig. 12.2. Clinical signs of graft infection following infrainguinal bypass surgery Fig. 12.2. Clinical signs of graft infection following infrainguinal bypass surgery surgical wound is open due to...

Outlet Area

Retro Pectoralis Minor Space

TS TS 2.2.1 Magnitude of the Problem T6 2.2.2 Etiology and Pathophysiology T6 2.2.2.1 Penetrating Trauma T6 2.2.2.2 Blunt Trauma T6 2.3 Clinical Presentation T7 2.3.1 Medical History T7 2.3.2 Clinical Signs T7 2.3.2.1 Physical Examination TB 2.4 Diagnostics TB 2.5 Management and Treatment T9 2.5.1 Management Before Treatment T9 2.5.1.1 Management in the Emergency 2.5.1.2 Patients in Extreme Shock 2G 2.5.1.3 Unstable Patients 22 2.5.1.4 Control of Bleeding 22 2.5.1.5 Stable Patients 23 2.5.1.6...