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Arterial repair in the treatment of aneurysms and arteriovenous fistulae
SELECTED
Freeman, Fistulae.
N. :
Arterial Ann.
Repair
in
124:888
(Nov.),
Surg.
the
ABSTRACTS
Treatment
553
of
Aneurysms
and
.4rteriovenous
1946.
The incidence of gangrene due to acute ischemia following operations on aneurysms and arteriovenous tistulas is rare. Not a single instance occurred in 100 patients operated upon at the DeWitt General Hospital. There was but one case in the entire series of patients in the three \*ascular Centers of the U. S. Army. This splendid record is probably due both to the policy of waiting a sufficient length of time for the development of collatera! circulation and to the perfection of surgical technique designed to spare the important collaterals. In addition, prophylactic sympathectomy may have helped in practically abolishing gangrene after operations on arterial lesions. Although there is sufficient circulation to care for the metabolic needs of the tissues at rest, interruption of the major artery to a limb may lead to persistent symptoms of impaired circulation such as intermittent claudication. .-\rterial repair was attempted in the treatment of twentythree aneurysms and arteriovenour fi+tulae. Success was demomtrable either by arteriograph? or by the presence of normal peripheral arterial pulsations in eighteen of these attempts. In 0°C case, recurrence of an arterial aneurysm was subsequently reported by the patient. In a second patient, recurrence of an arteriovenous fistula followed transvenous suture and subsequent excision of the lesion was necessary. Thrombosis at the suture line occurred in three of the twentythree patients but the collateral circulation proved sufficient to prevent gangrene. Repair of the defect in the wall of the vein was performed on 18 patients After the recover! of 12 of these patients, phlebography demonstrated the patency of the vein in six patients, but in six others postoperative studies showed the vein to he occluded. No instance of thrombophlebitis or pulmonary embolism was encountered. Transverse suture of the defect in the arteria! wall after excision of the damaged portion has been found more satisfactory than longitudina! suture, end-to-end anastomosls, or transvenous repair. Oscillometry has demonstrated marked improvement in the circulation in patients after repair of arterial lesions. The functional capacity, especially as shown by freedom from intermittent claudication, is increased in patients when the continuity of the major artery to the estrcmity is preserved. NAIDE. Winton,
S. Patients.
S.,
and
Wallace,
Psychosom.
L.:
Med.
8:332
.4n
Electrocardiographic
(Sept.-Oct.),
Study
of
Psychoneurotic
1946.
The authors analyzed the electrocardiographic records of seventy-six psychotic and neurotic patients, shown by physical examination and functional inquiry to be free of organic heart disease, in order to determine whether certain combinations of electrocardiographic changes could be found which formed any definite pattern characteristic of this type of patient. Twelve per cent of these patients showed right ventricular hypertrophy; as seen by tall P waves, right axis deviation and RS-T segment depression in the limb leads. Deep S waves as an isolated abnormality occurred almost as frequently as in routine electrocardiograms of normal young individuals. Flat or inverted T waves in Leads I and II occurred about fifteen times as frequently in psychoneurotic patients as in a large group of young healthy aviators. RS-T depressions of at least 0.5 mm. in Leads I and II were about six times as frequent as in normal individuals. It was concluded that there is no combination of abnormalities which fits a distinct electroRELLET. cardiographic pattern characteristic of this group of patients. Wolf,
G. With
A., and Wolff, Cardiovascular
H.
Studies G.: Disorders.
on
the
Psychosom.
Nature
Med.
of
Certain
8:293
Symptoms
(Sept.-Oct.),
Associated
1946.
These authors focused their study upon the reactions of a small group of individuals to a variety of life situations, with special reference to the effect of these situations upon cardiovascular and respiratory functions. Emphasis was placed upon the reactions to persistent low-grade stresses and strains which are a part of everyday living rather than upon the well-known responses
Freeman, Fistulae.
N. :
Arterial Ann.
Repair
in
124:888
(Nov.),
Surg.
the
ABSTRACTS
Treatment
553
of
Aneurysms
and
.4rteriovenous
1946.
The incidence of gangrene due to acute ischemia following operations on aneurysms and arteriovenous tistulas is rare. Not a single instance occurred in 100 patients operated upon at the DeWitt General Hospital. There was but one case in the entire series of patients in the three \*ascular Centers of the U. S. Army. This splendid record is probably due both to the policy of waiting a sufficient length of time for the development of collatera! circulation and to the perfection of surgical technique designed to spare the important collaterals. In addition, prophylactic sympathectomy may have helped in practically abolishing gangrene after operations on arterial lesions. Although there is sufficient circulation to care for the metabolic needs of the tissues at rest, interruption of the major artery to a limb may lead to persistent symptoms of impaired circulation such as intermittent claudication. .-\rterial repair was attempted in the treatment of twentythree aneurysms and arteriovenour fi+tulae. Success was demomtrable either by arteriograph? or by the presence of normal peripheral arterial pulsations in eighteen of these attempts. In 0°C case, recurrence of an arterial aneurysm was subsequently reported by the patient. In a second patient, recurrence of an arteriovenous fistula followed transvenous suture and subsequent excision of the lesion was necessary. Thrombosis at the suture line occurred in three of the twentythree patients but the collateral circulation proved sufficient to prevent gangrene. Repair of the defect in the wall of the vein was performed on 18 patients After the recover! of 12 of these patients, phlebography demonstrated the patency of the vein in six patients, but in six others postoperative studies showed the vein to he occluded. No instance of thrombophlebitis or pulmonary embolism was encountered. Transverse suture of the defect in the arteria! wall after excision of the damaged portion has been found more satisfactory than longitudina! suture, end-to-end anastomosls, or transvenous repair. Oscillometry has demonstrated marked improvement in the circulation in patients after repair of arterial lesions. The functional capacity, especially as shown by freedom from intermittent claudication, is increased in patients when the continuity of the major artery to the estrcmity is preserved. NAIDE. Winton,
S. Patients.
S.,
and
Wallace,
Psychosom.
L.:
Med.
8:332
.4n
Electrocardiographic
(Sept.-Oct.),
Study
of
Psychoneurotic
1946.
The authors analyzed the electrocardiographic records of seventy-six psychotic and neurotic patients, shown by physical examination and functional inquiry to be free of organic heart disease, in order to determine whether certain combinations of electrocardiographic changes could be found which formed any definite pattern characteristic of this type of patient. Twelve per cent of these patients showed right ventricular hypertrophy; as seen by tall P waves, right axis deviation and RS-T segment depression in the limb leads. Deep S waves as an isolated abnormality occurred almost as frequently as in routine electrocardiograms of normal young individuals. Flat or inverted T waves in Leads I and II occurred about fifteen times as frequently in psychoneurotic patients as in a large group of young healthy aviators. RS-T depressions of at least 0.5 mm. in Leads I and II were about six times as frequent as in normal individuals. It was concluded that there is no combination of abnormalities which fits a distinct electroRELLET. cardiographic pattern characteristic of this group of patients. Wolf,
G. With
A., and Wolff, Cardiovascular
H.
Studies G.: Disorders.
on
the
Psychosom.
Nature
Med.
of
Certain
8:293
Symptoms
(Sept.-Oct.),
Associated
1946.
These authors focused their study upon the reactions of a small group of individuals to a variety of life situations, with special reference to the effect of these situations upon cardiovascular and respiratory functions. Emphasis was placed upon the reactions to persistent low-grade stresses and strains which are a part of everyday living rather than upon the well-known responses