Stump pressure measurement as a predictor of limb salvage in infected femoral artery pseudoaneurysms in recreational drug abusers

Background: Cross-clamp ischemia during carotid endarterectomy (CEA) can cause perioperative stroke. Selectively shunting patients based on intraoperative monitoring modalities that assess risk for ischemia can reduce the occurrence of immediate stroke. An experience with combined cerebral oximetry and stump pressure measurement to direct selective shunting is presented here. Methods: Study comparing intraoperative monitoring data, the decision to shunt, and presence of immediate post-operative deficits. Patients were shunted if either cerebral oxygen saturation dropped by more than 10% by cerebral oximetry, or stump pressure during cross-clamping was less than 40 mmHg. Cross-clamp ischemia was determined by the presence of ipsilateral neurological deficit upon awakening. Results: 245 patients were included in this study. 22% were shunted. Patients who were not shunted were significantly more likely to have collateral blood flow detected on angiography. Immediate post-operative stroke was not encountered in any of the patients included in the study. One patient who met shunting criteria but was excluded since he could not have a shunt inserted due to difficult anatomy did suffer stroke. Conclusions: With the dual-monitoring criteria presented here, 22% of patients were shunted. With the exception of one patient who could not have a shunt placed, no immediate post-operative stroke was encountered.

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Direct approaches to the distal portions of the deep femoral artery for limb salvage bypasses

Journal of Vascular Surgery ◽

10.1067/mva.1988.avs0080576 ◽

1988 ◽

Vol 8 (5) ◽

pp. 576-581 ◽

Cited By ~ 6

Author(s):

Anselmo A. Nunez ◽

Frank J. Veith ◽

Paul Collier ◽

Enrico Ascer ◽

Sheila White Flores ◽

...

Keyword(s):

Limb Salvage ◽

Femoral Artery ◽

Deep Femoral Artery

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Femoral Artery to Prosthetic Graft Anastomotic Dehiscence Owing to Infection: Successful Treatment with Arterial Reconstruction and Limb Salvage

Vascular ◽

10.1258/rsmvasc.13.6.355 ◽

2005 ◽

Vol 13 (6) ◽

pp. 355-357 ◽

Cited By ~ 1

Author(s):

Kenneth A. Goldstein ◽

Frank J. Veith ◽

Takao Ohki ◽

Nicholas J. Gargiulo ◽

Evan C. Lipsitz

Keyword(s):

Limb Salvage ◽

Femoral Artery ◽

Artery Bypass ◽

Balloon Catheter ◽

Anastomotic Dehiscence ◽

Prosthetic Graft ◽

Anterior Tibial Artery ◽

Skeletal Traction ◽

Os Calcis ◽

Anterior Tibial

A 66-year-old man had foot gangrene and a fixed contracture of the knee following two failed femoropopliteal bypasses, one with vein and one with polytetrafluoroethylene (PTFE). An external iliac to anterior tibial artery bypass and skeletal traction via the os calcis resulted in limb salvage and successful normal ambulation. After 3 months, he ruptured the infected femoral anastomosis of the failed PTFE femoropopliteal bypass with external bleeding. The use of arteriography and a balloon catheter to obtain proximal control allowed arterial repair, removal of the graft, and preservation of flow within a patent common and deep femoral artery. This flow preservation maintained the viability and function of the limb when the anterior tibial bypass closed 4 years later, and the limb continues to be fully functional 3 years later. Aggressive secondary attempts at limb salvage are worthwhile even in unfavorable circumstances.

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