[HSF] Any One Had This Complication?

[Michael Firstenberg]

Several comments....

Hal - tough case/problem.... I am still amazed at what you and your system
can get done in a day.  I would be lucky to get one of those cases done in a
day, let alone both.  While I clearly am not as fast as you - between room
turn-over, anesthesia pre-op delay, waiting for this-that-the other.  What
time do you usually finish?

Is there any role for possible emergent Ax-Fem is this case?

Ed/others - should we be getting LIMA angios in everyone who has had complex
aortic reconstructions?  I try to get them pre-op if there is anything
weird, but I can see the logic in any disaster AAA.

-michael


On 4/27/08, Edward Bender <ebender001 at charter.net> wrote:
>
> I haven't had that complication, but I think I have avoided it in the
> past.
> A few years back I did a CABG on a man in his 60's who had severe
> aorto-iliac occlusive disease.  The cardiologists in my institution have a
> habit of shooting the LIMA in patients referred for CABG (billable?).  The
> patient had a massively huge LIMA.  I have seen a few patients in whom
> lower
> extremity blood flow (and probably colon blood flow) was dependent on
> collaterals from the IMA's to the inferior epigastrics.  I therefore did
> not
> use a LIMA in that patient.
>
> Ed Bender, MD
>
>
> On 4/27/08 7:49 AM, "Hgrmd at aol.com" <Hgrmd at aol.com> wrote:
>
> > Dear Members,
> >   Last Friday was a tough day at the office.  First I did a  mitral,
> > tricuspid, Cox-maze, CABG x1 on a 72 yo lady.  I then did an AVR,  MVR
> > (heavily
> > calcified posterior annulus), tricuspid, CABG x 4, Cox-maze on a 78  yo
> man.
> > His
> > past history was notable for the fact that he had an  aorto-enteric
> fistula
> > (previous AAA repair) requiring excision of the graft and  a right
> > axillary-bifemoral bypass.  Intraop, I noticed that the LIMA
> had  unusually
> > brisk flow.
> > About 4 hours postop, he had a bright red  stool.  NG aspirate
> nonbloody.  By
> > yesterday afternoon, he had begun  to develop abdominal tenderness.  He
> had a
> > lap
> > in the early evening.   There was a dead colon requiring resection.  The
> small
> > bowel reportedly  looked ischemic, but viable.  He's much better this
> > morning, though he's  now developed ATN.  His heart is working
> great.  It'll
> > be a
> > struggle,  but I'm cautiously optimistic he'll make it.  Anybody seen
> this
> > scenario?
> >
> > Hal
> >
> >
> >
> > **************Need a new ride? Check out the largest site for U.S. used
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> > listings at AOL Autos.
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