Fistula Banding - Success-promoting Approach in Peripheral Steal Syndrome

AIM: Evaluation of the diagnostic and therapeutic management of peripheral steal syndrome after placement of an autologous arteriovenous (av-) fistula and presentation of treatment results after its surgical correction. METHODS: During a time period from 1994 to 1999, 1 253 av-fistulas for hemodialysis were placed in our surgical department. Twenty-one patients (1.68 %) underwent service operations because of considerable lower perfusion of the hand. In 14 patients the av-fistula was ligated, whereas in 7 patients, a polytetrafluorethylene (PTFE) sleeve was implanted at the venous site for fistula "banding" to diminish blood flow. In addition to the clinical finding, pre-, intra- and postoperative blood flow rates were determined using Duplex ultrasonography. RESULTS: In patients showing flow rates of < 250 ml (carefully disclosed empiric value) ligation was chosen, whereas in cases with distinctly increased flow rates, banding of the arterialized vein was performed (authors' individually selected borderline flow). The extension of the banding was specified according to the intraoperatively determined flow rates. Recurrent steal syndrome was not observed over the entire postoperative observation period of 1-3 years. CONCLUSION: Arterial steal syndrome is a rare complication after placement of an av-fistula. In the majority of cases, surgical therapy is necessary. Pre- and intraoperative analysis of flow rates using Duplex ultrasonography may help to select the appropriate surgical approach and may, thus, determine the success rate of service operation.     

A Novel Approach to the Treatment of Distal Malperfusion Secondary to Ascending Aortic Dissection

Abstract Acute Type A dissection is a surgical emergency. The presence of visceral and extremity malperfusion syndromes increases perioperative mortality twofold. On occasion, significant malperfusion may best be addressed in a staged fashion with preliminary attention to specific vascular beds with delayed repair of the dissection itself. We present a subacute Type A dissection associated with malperfusion of multiple vascular beds (mesenteric, renal, and iliofemoral) managed with a complication‐specific approach utilizing endovascular thoracoabdominal aortic repair prior to ascending repair. (J Card Surg 2010;25:220‐222)     

Treatment of Steal Syndrome Complicating a Proximal Arteriovenous Bridge Graft Fistula by Simple Distal Artery Ligation without Revascularization Using Intraoperative Pressure Measurements

This case report describes the treatment of a patient with a steal syndrome complicating a brachioaxillary prosthetic bridge graft AV fistula by simple ligation of the brachial artery beyond the fistula. Intraoperative pressure measurements showed concomitant distal revascularization to be unnecessary.     

Biliopancreatic Diversion as a Novel Approach to the HAIR-AN Syndrome

Background. The HAIR-AN syndrome is a rare multisystem disorder in women, that consists of hyperandrogenism (HA), insulin resistance (IR) and acanthosis nigricans (AN). The IR is likely due to a primary defect of the insulin receptor. Methods: We report the case of a 42-year-old Caucasian woman with HAIR-AN syndrome, impaired glucose tolerance (IGT), mild hyperlipemia, and hypertension, who underwent biliopancreatic diversion (BPD). Results: Within 24 months follow-up after BPD, impaired glucose tolerance, mild hyperlipemia, and hypertension completely reversed. Although insulin sensitivity, estimated by the euglycemic hyperinsulinemic clamp, did not improve, signs and symptoms of hyperandrogenism and acanthosis nigricans resolved fully. Conclusion: In HAIR-AN syndrome, malabsorptive bariatric surgery is effective in improving hyperandrogenism and acanthosis nigricans, with noteworthy esthetic consequences. BPD was followed by disappearance of co-morbidities of the syndrome, such as IGT, hypertension and hyperlipemia.     

Preoperative Assessment of the Efficacy of Distal Radial Artery Ligation in Treatment of Steal Syndrome Complicating Access for Hemodialysis

Hand ischemic steal syndrome due to a forearm arteriovenous fistula is a rare occurrence. We report here a case in which we applied a new diagnostic method to assess the efficacy of distal radial ligation to treat this syndrome. A favorable comparison of distal radial artery pressure measurements before and after temporary occlusion of the artery with a balloon catheter indicated that perfusion of the hand would be dramatically improved after surgical artery ligation.     

Revision of Failed Gastric Bypass to Distal Roux-en-Y Gastric Bypass: A Review of 65 Cases

Background: No bariatric operation has been documented to effect adequate weight loss in all patients. Patients with inadequate weight loss or significant weight regain with an anatomically intact short-limb gastric bypass, of which the Fobi pouch operation (FPO) for obesity is a modification, are usually revised to a distal Roux-en-Y gastric bypass (DRYGBP) to enhance weight loss. Method: A retrospective review of the charts of all patients who had a revision to a DRYGBP at our Center during an 8-year period was carried out and the findings analyzed. Results: 65 patients who had the FPO had a revision to the DRYGBP.Most were super obese patients who, even though they had lost significant weight, were still morbidly obese. Some were patients who had not lost adequate weight or <40% excess weight, and a small number were patients who requested more weight loss even though they had a BMI of < 35. 15 patients developed protein malnutrition requiring supplemental feeding. 6 required rerevision to short-limb gastric bypass. Conclusion: Revision of short-limb gastric bypass to DRYGBP usually enhances weight loss but at a cost of an increased incidence of protein malnutrition.     

经肱三头肌两侧入路双钢板内固定治疗肱骨远端粉碎性骨折

作者自2001年3月～2003年9月采用经肱三头肌两侧入路配合使用双钢板内固定治疗肱骨远端粉碎性骨折28例,取得了良好的效果. 1 病例资料 1.1 一般资料 本组28例,男25例,女3例,平均年龄31(20～60)岁.术前X线检查:肱骨髁间粉碎性骨折5例,髁上粉碎性骨折23例.按AO分型:A2 2例,A3 3例,C1 12例,C2 2例,C3 9例.伴桡神经挫伤2例,尺神经挫伤11例.     

Distal Pancreatectomy and Splenectomy: A Robotic or LESS Approach

Introduction:The role and application of robotic surgery are debated, particularly given the expansion of laparoscopy, especially laparoendoscopic single-site (LESS) surgery. This cohort study was undertaken to delineate differences in outcomes between LESS and robotic distal pancreatectomy and splenectomy.Methods:With Institutional Review Board approval, patients undergoing LESS or robotic distal pancreatectomy and splenectomy from September 1, 2012, through December 31, 2014, were prospectively observed, and data were collected. The results are expressed as the median, with the mean ± SD.Results:Thirty-four patients underwent a minimally invasive distal pancreatectomy and splenectomy: 18 with robotic and 16 with LESS surgery. The patients were similar in sex, age, and body mass index. Conversions to open surgery and estimated blood loss were similar. There were two intraoperative complications in the group that underwent the robotic approach. Time spent in the operating room was significantly longer with the robot (297 vs 254 minutes, P = .03), although operative duration (i.e., incision to closure) was not longer (225 vs 190 minutes; P = .15). Of the operations studied, 79% were undertaken for neoplastic processes. Tumor size was 3.5 cm for both approaches; R0 resections were achieved in all patients. Length of stay was similar in the two study groups (5 vs 4 days). There was one 30-day readmission after robotic surgery.Conclusions:Patient outcomes are similar with LESS or robotic distal pancreatectomy and splenectomy. Robotic operations require more time in the operating room. Both are safe and efficacious minimally invasive operations that follow similar oncologic principles for similar tumors, and both should be in the surgeon''s armamentarium for distal pancreatectomy and splenectomy.