Vascular surgery and the Internet: a poor source of patient-oriented information.
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OBJECTIVE: Increasing numbers of patients use the Internet to obtain medical information. The Internet is easily accessible, but available information is under no guidelines or regulations. We sought to evaluate the type, quality, and focus of vascular disease information presented on the Internet and the role in patient education with simple search techniques. METHODS: The arbitrarily chosen search phrases "abdominal aortic aneurysm (AAA)," "carotid surgery (CEA)," "claudication surgery," and "leg gangrene surgery" were entered into five common Internet search engines. No attempt was made to refine searches. As indicated by the search engines, the 50 most commonly encountered web sites for both AAA and CEA were reviewed. The first 25 claudication sites and the first 25 gangrene sites were combined for a total of 50 leg ischemia (LIS) sites. An information score (IS) was developed as a weighted score ranging from 0 (poor) to 100 (outstanding) and was designed to assess how well the web page educated the patient about the disease, the treatment options, and the medical and surgical complications. Each vascular surgery web site was classified according to the author, the referenced information source, and the therapeutic recommendations. This was followed by an evaluation of each web site with the IS independently scored by two observers. RESULTS: Of the 150 web sites, 146 were accessible. Ninety-six sites (65.8%) had no useful patient-oriented information (IS < 10). The mean IS and the ranges were: AAA, 14.9 (0 to 72.0); CEA, 17.5 (0 to 77.0); and LIS, 12.2 (0 to 44.5; P =.9). The mean IS of the 59 sites with scores of more than 10 were: AAA, 39.8 (n = 17); CEA, 44.8 (n = 19); and LIS, 24.8 (n = 23; P <.01, as compared with LIS scores). Differences in IS between observers were not significant (P =.9). Misleading or unconventional care recommendations were recognized in one AAA site (1 of 47, 2.1%), two CEA sites (2 of 49, 4.1%), and 13 LIS sites (13 of 50, 26.0%). The Joint Vascular Societies web page was identified only as a tertiary link. CONCLUSION: Patient-oriented vascular surgery information, for common vascular diseases, is difficult to find on the Internet. The overall quality is poor, and information is difficult to obtain in part because of the large number of irrelevant sites. Of the sites that were relevant to patient education (33%), one third presented information that was classified by the authors as misleading or unconventional. This was most apparent in the leg ischemia sites. The Internet is a poor overall source of patient-oriented vascular surgery information and education. Focused and refined searches and improvements in search engines and educational web sites may yield improved information. Public and medical community awareness needs to be improved regarding the severe limitations of the Internet as an information resource. (+info)
In situ replacement of infected aortic grafts with rifampicin-bonded prostheses: the Leicester experience (1992 to 1998)
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PURPOSE: Prosthetic graft infection after aortic aneurysm surgery is a life-threatening complication. Treatment options include total graft excision and extra-anatomic bypass grafting or in situ replacement of the graft. The latter option is gaining increasing popularity, but the long-term outcome remains uncertain, particularly in light of the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA). We performed a prospective nonrandomized study to assess the outcome after graft excision and in situ replacement with a rifampicin-bonded prosthesis for the treatment of major aortic graft infection. METHODS: In a 6-year period from January 1992 to December 1997, 11 patients (eight men, three women) with major aortic graft infection underwent total graft excision and in situ replacement with a rifampicin-bonded prosthesis. The median age of the patients was 66 years (range, 49 to 78 years). Four patients had a hemorrhage from an aortoenteric fistula, three had a retroperitoneal abscess, two had graft occlusion, one had a perigraft collection shown by means of computed tomography, and one had a ruptured suprarenal false aneurysm. Organisms were cultured from 10 patients. RESULTS: MRSA was isolated in two patients, both of whom had originally undergone repair of a ruptured abdominal aortic aneurysm. Two patients died (18.2%) within 30 days, and three patients (27.6%) had nonfatal complications (peritoneal candidiasis, transient renal impairment, and profound anorexia). Two patients died late in the follow-up period. Seven patients remain alive and clinically free of infection. CONCLUSION: The long-term results after total graft excision and in situ replacement with a rifampicin-bonded prosthesis appear to be favorable. However, MRSA aortic graft infection appears to be associated with a poor prognosis. (+info)
Cryptococcal aortitis presenting as a ruptured mycotic abdominal aortic aneurysm.
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Mycotic processes occasionally complicate atherosclerotic aortic disease and usually require aggressive surgical therapy to control sepsis and prevent arterial rupture. Rarely, fungal organisms are responsible for primary infection of the abdominal aorta. We report the first case of Cryptococcal aortitis presenting as a ruptured abdominal aortic aneurysm. The surgical, pathologic, and microbiologic aspects of fungal aortitis are discussed. (+info)
A CD18 monoclonal antibody reduces multiple organ injury in a model of ruptured abdominal aortic aneurysm.
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The role of CD18 antibody (anti-CD18) in remote and local injury in a model of ruptured abdominal aortic aneurysm repair was investigated. Rats were divided into sham, shock, clamp, and shock + clamp groups. Shock + clamp animals received anti-CD18 or a control monoclonal antibody. One hour of hemorrhagic shock was followed by 45 min of supramesenteric aortic clamping. Intestinal and pulmonary permeability to (125)I-labeled albumin was determined. Myeloperoxidase (MPO) activity, F(2)-isoprostane levels, and transaminases were also measured. Only shock + clamp resulted in statistically significant increases in pulmonary and intestinal permeability, which were associated with significant increases in MPO activity and F(2)-isoprostane levels. Treatment with anti-CD18 significantly decreased intestinal and pulmonary permeability in shock + clamp animals. These reductions were associated with significantly reduced intestinal and hepatic MPO activity and pulmonary F(2)-isoprostane levels and reduced alanine and aspartate aminotransferase levels; however, anti-CD18 had no effect on intestinal or hepatic F(2)-isoprostane levels or on pulmonary MPO activity. These results suggest CD18-dependent and -independent mechanisms of local and remote organ injury in this model of ruptured abdominal aortic aneurysm. (+info)
Morphology of ruptured abdominal aortic aneurysms.
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OBJECTIVES: it has been suspected that the position at which aneurysm rupture occurs would affect outcome. The aim of this prospective study was to relate the morphology of the ruptured abdominal aortic aneurysm (RAAA) to the clinical characteristics and outcome of the patient. DESIGN, PATIENTS AND METHODS: over a five-year period 46 patients with RAAAs (11 identified at operation and 35 at post-mortem (PM)) were examined to identify the number and site of aneurysm rupture, the characteristics of the aneurysm (site, shape, length, diameter and associated iliac aneurysm) and the presence and site of retroperitoneal or intraperitoneal haematoma. The patients were also assessed for a range of associated medical conditions. Univariate analysis was used to identify variables predicting the site of aneurysm rupture and survival following rupture. RESULTS: most aneurysm ruptures (73%) occurred in the middle third where the aneurysm diameter was greatest. Relatively few ruptures (13%) were in the left posterior quadrant of the aneurysm. A history of chronic lung disease (p =0.04) significantly predicted the quadrant of aneurysm rupture, while a history of carcinoma (p =0.02) predicted the level of rupture. Nine of the 46 (20%) patients survived. Survival was predicted by the transverse site of rupture (p =0.0004) and the absence of ischaemic heart disease (p =0.02). CONCLUSION: these data suggest that the site of aneurysm rupture, which may be in part predicted by the clinical characteristics of the patient, influences outcome. (+info)
Deletion polymorphism in the gene for angiotensin-converting enzyme is not a risk factor predisposing to abdominal aortic aneurysm.
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OBJECTIVE: to establish whether deletion of the angiotensin-converting enzyme (ACE) gene is a risk factor predisposing to abdominal aortic aneurysm (AAA) or not. METHODS: the study included 125 patients with AAA and 153 controls randomly selected from 328 individuals. The control subjects were confirmed not to have an AAA, but matched with the AAA group for age, sex, hypertension, diabetes mellitus, and hyperlipidaemia. The presence of ACE polymorphism was detected by a polymerase chain reaction using DNA extracted from blood. RESULTS: the distribution of ACE genotypes and allele frequencies in the control and AAA groups was not significantly different. CONCLUSION: the deletion polymorphism in the ACE gene is not a risk factor for AAA. (+info)
Two cases of aorto-gastrointestinal fistula.
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We report two cases of aorto-gastrointestinal fistula. Case 1, a 60-year-old man, suffered from repeat hematemesis. He was preoperatively diagnosed as aortoesophageal fistula with thoracic aortic aneurysm and was successfully treated by graft replacement of the aneurysm. Case 2, a 73-year-old man, presented with massive gastrointestinal bleeding, yet repeat endoscopical examination did not reveal the origin of the bleeding. He died of catastrophic hematochezia. The pathological findings at autopsy revealed an aortoduodenal fistula. These two cases suggested the importance to consider an aorto-gastrointestinal fistula in the differential diagnosis of patients presenting gastrointestinal hemorrhage. (+info)
The influence of screening on the incidence of ruptured abdominal aortic aneurysms.
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PURPOSE: The purpose of this study was to estimate the influence of a screening program on the incidence and mortality of ruptured abdominal aortic aneurysms (RAAAs). METHODS: The effects of screening on the incidence and death rate of RAAAs were investigated with a stepped wedge study design. RAAAs that occurred in the Huntingdon district were traced with an examination of all hospital records and community postmortem records. RESULTS: During the 5-year period from 1991 to 1996, 78 RAAAs occurred in the Huntingdon district: 62 in men and 16 in women. Eleven of the 62 men with RAAAs had been invited for screening. The incidence of RAAA in the invited group was 3.7 per 10,000 person-years (py; 95% confidence interval [CI], 1.5 - 7.3). In the noninvited group, the incidence was 7.3 per 10,000 py (95% CI, 5.3. - 9.2), a rate ratio of 0.51 (95% CI, 0.26 - 0.97). The mortality of rAAAs in the invited group was 3.0 per 10, 000 py (95% CI, 1.4 - 5.4) as compared with 5.4 per 10,000 py in the noninvited group (95% CI, 3.9 - 7.3), resulting in a rate ratio of 0. 55 (95% CI, 0.26 - 1.15). CONCLUSION: Screening for asymptomatic AAAs can reduce the incidence rate of RAAAs by 49% (95% CI, 3% - 74%). (+info)