Question 5

Which of the following are acceptable corrective options for limb-threatening steal following proximal access construction Fig. 39.1. a The operation before the creation of the corrective procedure. b The corrective procedure with ligation of the artery just distal to the AV graft take-off and the venous bypass from a point proximal to the inflow to a point just distal to ligation (DRIL procedure). A, brachial artery AV, axillary vein BV, basilic vein G, arteriovenous PTFE graft VG, vein graft....

Neurogenic Thoracic Outlet Syndrome

A 30-year-old woman presented with complaints of pain in her neck, right shoulder, right trapezius, right anterior chest wall, right arm, elbow, and forearm occipital headaches every other day numbness and tingling in all fingers of the right hand, worse in the fourth and fifth fingers aggravation of her symptoms when elevating her arms, especially to comb or blow dry her hair or drive a car weakness of her right hand and dropping coffee cups and coldness and color changes in her right hand....

References

Summary of the 10th International Congress of Lymphology Working Group Discussions and Recommendations. Lymphology 1985 18 175-80. 2. Kissin MW, Querci della Rovere G, Easton D, Westbury G. Risk of lymphoedema following the treatment of breast cancer. Br J Surg 1986 73 580-4. 3. Brorson H. Liposuction in arm lymphedema treatment. Scand J Surg 2003 92 287-95. 4. Kuhnke E. Die Volumenbestimmung entrundeter Extremit ten aus Umfangsmessungen. Lymphologie 1978 2...

Commentary

The first order of business is to determine whether the individual has a reversible condition such as obstructive uropathy, drug-induced acute tubular necrosis, or another nephrotoxic condition. Commencement of hemoaccess would be unnecessary at this time since the individual has minimal symptoms however, the degree of renal insufficiency is sufficient to predict that it will likely be required within several months to a year. Since some access procedures require several months before they are...

Qustion

There is no clear indication to offer any treatment. B. Offer injection sclerotherapy. C. Offer below-knee compression stockings. The patient was advised that the disease progression is very slow. However, the varicosities are likely to deteriorate with age and therefore it is likely that some active measures would need to be taken. Patient compliance and some change in lifestyle, along with conservative measures such as compression stockings, seem to provide symptomatic relief in the...

Chronic Critical Limb Ischemia

An 85-year-old male with a history of diabetes, hypertension, hypercholesterolemia, coronary artery bypass, and active tobacco use presented with a gangrenous right first toe. The patient stated that he had no history of trauma to the area, and complained of rest pain in the foot. The patient had been in otherwise good health since his coronary artery bypass 12 years ago. On physical examination, the patient was in no physical distress. The patient had a well-healed median sternotomy scar....

Erectile Dysfunction due to Aortic Disease

A 60-year-old married man presented with sudden onset of erectile failure about 1 month previously. This occurred in the absence of critical life changes, psychological stress, or known intercurrent illness. Initially, the patient was seen by a general practitioner and treated with sildenafil in incremental doses up to 150 mg. This had only a minor effect ejaculation was maintained but erections remained insufficient for penetration. Risk factors consisted of mild hypertension controlled by an...

A Management of Upper Extremity Lymphoedema with Microsurgical Lymphovenous Anastomosis

Corradino Campisi and Francesco Boccardo A 59-year-old woman presented with an 8-year history of oedema of the left arm. Initially, the oedema appeared in the upper arm. The patient was treated with combined decongestive physiotherapy (manual and mechanical lymphatic drainage), bandaging and exercises three to four times over a 12-month period. Despite these measures, the oedema extended as far as the forearm and hand (Fig. 47a.1), and she had several episodes of erysipeloid lymphangitis. In...

Aortofemoral Graft Infection

A 66-year-old man, an ex-smoker with hypertension and hypercholesterolemia, had undergone a Dacron bifurcated aortic graft and bilateral ureteric stents for an inflammatory aortic aneurysm with ureteric obstruction at another hospital 4 years previously. The left limb of the graft had been anastomosed to the common femoral artery and the right limb to the common iliac bifurcation. Postoperatively he had suffered a mild groin wound infection, which had healed with antibiotics. At follow-up he...