[HSF] Any One Had This Complication?

[MDavalle at aol.com]

Several years ago I  had the most unfortunate complication of  paraplegia 
following use of a very large LIMA in a patient with extensive  aortoiliac 
disease. Patient had bilateral subclavian stenosis as well and mostly  unusable 
varicose veins. Woke up with paraplegia and MRI showed cord infarct.  Only a few 
cases reported in literature at that time. Since then I have  avoided  very 
large LIMA in similar patients. Pre op angio of LIMA may be  of interest but not 
sure what to look for in order to determine which patients  are at risk of 
distal ischemia(cord,gut,extremities)..
 
 
 
In a message dated 4/27/2008 7:55:11 A.M. Central Daylight Time,  
Hgrmd at aol.com writes:

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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**************Need a new ride? Check out the largest site for U.S. used car 
listings at AOL Autos.      
(http://autos.aol.com/used?NCID=aolcmp00300000002851)