Search

A retrospective case-control study was carried out to assess the importance of lymphatic fistulas that develop after vascular reconstruction and to determine the risk factors associated with them. The authors compared 35 patients who had lymphatic fistula after vascular reconstruction with 70 control patients, taken from the same database. They found a significant difference between the two groups only in age and indication for surgery: lymphatic fistulas were more likely to develop in older patients and in patients who underwent aortobifemoral bypass for limb salvage rather than for claudication (p less than 0.05).

Between 1970 and 1985, 172 consecutive patients (146 men, 26 women) underwent repair of ruptured abdominal aortic aneurysms. The mean age was 69.8 years. The overall death rate was 49.4%. The most significant predictors of death were an intraoperative urine output under 100 ml, systolic blood pressure less than 90 mm Hg on admission or in the operating room, cardiac arrest and a history of collapse. Discriminant analysis correctly classified 90% of the survivors and 84% of the nonsurvivors. Aneurysm size was documented in 133 cases; the average diameter was 8.78 cm, and 13 (10%) of the aneurysms were smaller than 6.0 cm. A correct diagnosis was made preoperatively in 46% of these 13 cases compared with 77% overall (p less than 0.05), and the time from arrival to transfer to the operating room was 6.71 versus 2.37 hours (p less than 0.05). The death rate for patients who had the small aneurysms was 77% versus 45% for those with larger aneurysms (p less than 0.06). This study confirms the continuing poor results after repair of ruptured abdominal aortic aneurysms. A subset of patients having small aneurysms (less than 6.0 cm) require an aggressive approach to diagnosis and treatment.

Marlex and Gore-tex, two prosthetic materials used to close abdominal wounds, were compared with respect to strength and adhesion formation. A 2.5 X 3.5-cm full-thickness area of abdominal wall was excised in 32 CD rats. The defect was repaired using identically sized patches of Marlex or 1-mm Gore-tex, determined by alternate assignment, and sutured with continuous 4-0 Gore-tex. Adhesion formation was graded at necropsy and recorded photographically in each animal. The mean adhesion index (none = 0, maximal = 4) was 1.37 +/- 0.12 and 2.62 +/- 0.12 (mean +/- SEM) for Gore-tex and Marlex groups respectively (p less than 0.005, unpaired t-test). A template was used to fashion 2-cm coronal strips of abdominal wall for tensile-strength testing. The relative strengths were 2.67 +/- 0.14 and 3.02 +/- 0.16 kg/cm (mean +/- SEM) for the Gore-tex and Marlex groups respectively (NS). Histologically, there were more epithelioid giant cells and less collagen formation in the Gore-tex group. Abdominal wall reconstruction with Gore-tex resulted in wound strength equal to that of Marlex and fewer adhesions. Gore-tex is preferred when prosthetic material and viscera are in close proximity.