[HSF] Any One Had This Complication?

[Edward Bender]

I wouldn't bother with LIMA angio in patients who have had complex aortic
reconstruction, but I would in patients who need complex aortic
reconstruction.

Ed Bender, MD


On 4/27/08 9:56 AM, "Michael Firstenberg" <msfirst at gmail.com> wrote:

> 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
>>> 
>>> 
>>> 
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