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M9490645.TXT
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1994-09-24
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Document 0645
DOCN M9490645
TI Vascular prostheses.
DT 9411
AU Manfredi RA; Allison EJ Jr; Department of Emergency Medicine, East
Carolina University,; Greenville, North Carolina.
SO Emerg Med Clin North Am. 1994 Aug;12(3):657-77. Unique Identifier :
AIDSLINE MED/94341227
AB The quest for an ideal vascular graft began in the early 1950s and
continues at a steady pace. The perfect graft has yet to be designed. As
a result, patients with vascular prostheses may suffer complications
that range from minor to catastrophic. The emergency physician may be
faced with the initial presentation of patients with these vascular
graft complications. If he or she is not familiar with these
possibilities, then the resulting morbidity and mortality could be
devastating. Probably the most unnerving complication involving the
failure of vascular prostheses is that of the aortoenteric fistula.
Instantaneous decisions and interventions must be made when a patient
presents in this state of pre-exsanguination. Massive GI bleeding is at
one end of the spectrum with other less-severe GI complications
involving aortoenteric erosions and small bowel obstructions due to
graft migration at the other end of the spectrum. Infection of a
vascular prosthesis is a complication much feared by vascular surgeons.
A spectrum of presentation also exists here whereby a patient may
present with an obvious draining wound or with subtle complaints of
fever, weakness, and a minimally elevated white blood cell count. The
function of the emergency physician is critical here but only if he or
she is able to suggest the possibility of graft infection to the
admitting physician. Fortunately, thrombosis of a vascular graft is an
infrequent complication that may occur at any time postoperatively,
although the frequency decreases with time. There are many different
causes of graft occlusion of which the emergency physician should be
aware. If the cause of the thrombosis is known, then the secondary
vascular reconstruction can be optimized. The dialysis population has
grown rapidly over the past two decades and as a result so have
complications of renal dialysis grafts. Because the dialysis population
now includes large numbers of older subjects as well as those with
systemic diseases such as diabetes and HIV, recognition and prompt
aggressive management of clinical complications is of paramount
importance.
DE Adult Aged Blood Vessel Prosthesis/*ADVERSE EFFECTS Case Report
Child Emergencies Female Gastrointestinal Diseases/ETIOLOGY Human
Male Prosthesis-Related Infections/ETIOLOGY Thrombosis/ETIOLOGY
JOURNAL ARTICLE REVIEW REVIEW OF REPORTED CASES
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).