Document Detail

Cardiac mortality and morbidity after vascular surgery.
MedLine Citation:
PMID:  3955471     Owner:  NLM     Status:  MEDLINE    
To determine the clinical, hemodynamic and pathological features that contribute to major cardiac complications after vascular surgery, six patients with early postoperative cardiogenic shock (group 1) were analysed retrospectively and compared to nine patients without complications (group 2) who were carefully analysed prospectively. Four group 1 patients had elective repair of an abdominal aortic aneurysm, one had repair of a false iliac artery aneurysm and one had a femoropopliteal graft inserted. Four group 2 patients had elective repair of an abdominal aortic aneurysm and five had aortobifemoral reconstruction. The Goldman multifactorial index was similar in both groups and indicated an expected death rate of 2% and a morbidity rate of 5%. In group 1, the earliest sign of cardiovascular compromise was an elevated pulmonary wedge pressure during operation. Postoperatively, electrocardiographic evidence of myocardial ischemia was present in all six patients and preceded cardiogenic shock. Autopsy of the four patients who died demonstrated triple-vessel disease in all but recent occlusion in only one patient. There was evidence of extensive subendocardial infarction in all four. Angiography of the two survivors in group 1 also demonstrated triple-vessel disease. The authors conclude that by using ordinary clinical methods it is difficult to identify patients likely to have major complications postoperatively. Elevated pulmonary wedge pressures or electrocardiographic evidence of myocardial ischemia may be early warning signs of impending cardiac catastrophe and should be treated aggressively. The underlying pathophysiology appears to be perioperative stress in a setting of severe triple-vessel coronary artery disease.
J E Calvin; T M Kieser; V M Walley; N V McPhail; G G Barber; T K Scobie
Publication Detail:
Type:  Case Reports; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Canadian journal of surgery. Journal canadien de chirurgie     Volume:  29     ISSN:  0008-428X     ISO Abbreviation:  Can J Surg     Publication Date:  1986 Mar 
Date Detail:
Created Date:  1986-05-13     Completed Date:  1986-05-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372715     Medline TA:  Can J Surg     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  93-7     Citation Subset:  IM    
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MeSH Terms
Aortic Aneurysm / surgery
Arteriosclerosis / mortality*
Coronary Disease / mortality*,  physiopathology
Iliac Artery / surgery
Middle Aged
Postoperative Complications*
Prospective Studies
Pulmonary Edema / etiology
Pulmonary Wedge Pressure
Shock, Cardiogenic / etiology*
Vascular Surgical Procedures / adverse effects*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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