Surgical Specialist

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Northeast Philadelphia Vascular Surgery
2137 Welsh Rd
Ste 1C
Philadelphia, PA 19115
215-969-3944
Locations and availability (6)

Education ?

Medical School
Madras Medical College
Foreign school

Awards & Distinctions ?

Awards  
AM Board of Surgery
Associations
American College of Surgeons
Member

Affiliations ?

Dr. Mohan is affiliated with 10 hospitals.

Hospital Affilations

Score

Rankings

  • Nazareth Hospital
    2601 Holme Ave, Philadelphia, PA 19152
    • Currently 3 of 4 crosses
    Top 50%
  • Mercy Fitzgerald Hospital
    1400 Lansdowne Ave, Darby, PA 19023
    • Currently 2 of 4 crosses
  • Frankford Hospital
    4900 Frankford Ave, Philadelphia, PA 19124
    • Currently 2 of 4 crosses
  • Mercy Suburban Hospital
    2701 Dekalb Pike, Norristown, PA 19401
    • Currently 2 of 4 crosses
  • Aria Health Bucks County Campus
  • Aria Health Torresdale Campus
  • Aria Health Frankford Campus
  • Frankford Hospital - Torresdale Campus
    4900 Frankford Ave, Philadelphia, PA 19124
  • Frankford Hospital - Bucks County Campus
    380 Oxford Valley Rd, Langhorne, PA 19047
  • Aria Health
  • Publications & Research

    Dr. Mohan has contributed to 15 publications.
    Title Open Repair and Endovascular Covered Stent Placement in the Management of Bilateral Axillary Artery Aneurysms.
    Date February 2011
    Journal Vascular and Endovascular Surgery
    Excerpt

    A 72-year-old male with chronic obstructive pulmonary disease and hyperlipidemia presented with acute right upper limb ischemia. Arterial occlusion was found to be secondary to a thrombosed axillary artery aneurysm. An open repair was performed with a polytetrafluoroethylene (PTFE) graft. On further workup, the patient was found to have an asymptomatic axillary artery aneurysm on the left-hand side. Endovascular repair with a covered stent was chosen to treat this aneurysm.

    Title Endovascular Repair of Carotid Artery Pseudoaneurysm After Carotid Endarterectomy with Self-expanding Covered Stents-a Long-term Follow-up.
    Date January 2011
    Journal Annals of Vascular Surgery
    Excerpt

    A 66-year-old Caucasian man with type 2 diabetes mellitus, peptic ulcer disease, peripheral vascular disease, and a 70% symptomatic carotid stenosis underwent a successful carotid endarterectomy with intraoperative shunting and Dacron patch closure in October 2000. Three months later, he developed a pseudoaneurysm at the site of the surgical repair. This was successfully treated with endovascular covered stents and has continued to remain patent at 9-year follow-up. Carotid artery pseudoaneurysms are secondary to trauma, infection, or previous surgery. Open surgical repair has been the treatment of choice for these pseudoaneurysms. However, open repairs are difficult and carry a high morbidity. Thus, endovascular therapy is a valid treatment for carotid artery pseudoaneurysm. Reviewing the published data, this is the first case report with successful endovascular covered stent placement for a carotid pseudoaneurysm with 9-year follow-up.

    Title A Comparative Evaluation of Femorofemoral Crossover Bypass and Iliofemoral Bypass for Unilateral Iliac Artery Occlusive Disease.
    Date April 1998
    Journal Angiology
    Excerpt

    The purpose of this study was to compare the results of extra-anatomic femorofemoral crossover bypass grafting to the anatomic iliofemoral bypass grafting procedure in the treatment of patients with unilateral iliac artery occlusive disease with respect to patency and limb salvage. The records of all patients with unilateral iliac artery disease who underwent revascularization between January 1988 and December 1995 at the University of Iowa Hospitals and Clinics (UIHC) were retrospectively reviewed; 108 patients were identified and divided into two groups. Group I (n=68; male/female=44/24) was composed of all patients who underwent a femorofemoral crossover extra-anatomic bypass. All patients who underwent an iliofemoral anatomic bypass constituted group II (n=40; male/female=24/16). The mean age for group I was 60 years (range 28-87) and for group II, 54 years (range 14-86). The medical risk factors between both groups were comparable. Except for the higher incidence of gangrene in group II the indications for surgery were comparable between both groups. A polytetrafluoroethylene graft was used in 88% of group I patients and in 90% of group II patients (NS). In the remaining patients, an autogenous vein conduit was used. Two patients from group I (2.9%) died in the perioperative period (NS). Graft patency was assessed by clinical evaluation, Doppler-derived ankle/brachial indices, and color duplex imaging. The cumulative primary and secondary patency rates, limb salvage, and patient survival were calculated by use of life table analysis (SE<0.1). The need for simultaneous outflow and inflow procedures at the time of surgery was comparable between both groups. The proportion of patients who underwent further revascularization during follow-up was also comparable. The 5-year primary and secondary graft patency rates were 81.7% and 90.3%, in group I and 61.3% and 80.5% in group II. Although the difference between both groups was not significant there was a tendency toward higher rates with femorofemoral bypass. The 5-year survival rates of 80.3% for group I and 73.3% for group II were comparable. These data suggest that there is no significant difference in the long-term results between the femorofemoral crossover bypass grafts and iliofemoral grafts. Both procedures result in acceptable patency and limb salvage rates. The femorofemoral bypass is, however, more attractive, for it can be performed under local anesthesia if needed and does not involve the creation of the retroperitoneal incision necessary with the iliofemoral bypass.

    Title Internal Iliac Revascularization During Aortic Aneurysm Replacement: a Review and Description of a Useful Technique.
    Date November 1997
    Journal The American Surgeon
    Excerpt

    The coexistence of infrarenal aortic aneurysm and internal iliac artery aneurysm may represent a management problem with regard to preservation of the pelvic blood supply. In this article, we review the methods available for maintaining the pelvic blood flow and describe a useful technique that we have successfully utilized in seven patients to preserve the hypogastric artery blood flow.

    Title Rabbit Rectus Femoris Muscle for Ischemia-reperfusion Studies: an Improved Model.
    Date January 1997
    Journal The Journal of Surgical Research
    Excerpt

    The rabbit rectus femoris muscle was evaluated as a potential model for skeletal muscle reperfusion injury studies. Six white New Zealand rabbits were used. On one randomly selected hind limb, ischemia was induced by direct clamping of the rectus femoris muscle's vascular pedicle. On the other side, blood flow was interrupted by clamping the femoral artery above and below the origin of the vascular pedicle that supplies the rectus femoris muscle. The duration of normothermic ischemia was 4 hr and was followed by 24 hr of normothermic reperfusion. The interruption and restoration of blood flow was monitored using a laser flow meter. The rectus femoris muscles were weighed on a suspension spring balance prior to ischemia and at the end of reperfusion to estimate edema. The extent of muscle necrosis was determined using planimetry following staining with nitroblue tetrazolium. The muscle necrosis obtained by direct clamping of the vascular pedicle (66.9 +/- 14.3%) was significantly greater than that obtained by indirect clamping (18.6 +/- 11.4%) (P < 0.03 by t test). Unlike the indirect clamping technique, direct clamping achieved a good magnitude of muscle necrosis, thus allowing that specific model to be used in skeletal muscle reperfusion injury studies. The muscle weight gain observed in the direct clamping muscle group was 19.8 +/- 9.0% and was significantly greater than that observed in the opposite group being 6.3 +/- 6.5% (P < 0.05 by t test). The rabbit rectus femoris muscle is a suitable model for evaluating skeletal muscle reperfusion injury provided that direct clamping of the vascular pedicle is utilized.

    Title Revascularization of the Ischemic Diabetic Foot Using Popliteal Artery Inflow.
    Date November 1996
    Journal International Angiology : a Journal of the International Union of Angiology
    Excerpt

    Between March 1988 and June 1994, 35 popliteal to distal artery vein bypasses were done in 32 diabetic patients. There were 16 males and 16 females with an average age of 60 years. Eighteen patients (56%) had insulin dependent diabetes mellitus. Medical risk factors included coronary artery disease (CAD) in 15 (47%), hypertension in 15 (47%), chronic renal failure (CRF) in 9 (28%), and cigarette smoking in 10 (31%). Indications for revascularization were: non-healing ulcerations in 18 (51%), gangrene in 15 (43%), and rest pain in 2 (6%). The distal anastomosis was to the posterior tibial artery in 9, anterior tibial artery in 8, dorsalis pedis artery in 10 and peroneal artery in 8 cases. All the bypasses were done with autogenous saphenous veins (in-situ 11, reversed 17, and free non-reversed 7). The limbs were graded into three groups based on the preoperative angiographic evaluation of their pedal arch: patent arch (Grade "0"), partial occlusion of the arch (grade "1.5") and little or no arch visualized (Grade "3"). Eight limbs had Grade "0", 16 had Grade "1.5" and 11 had Grade "3" pedal circulation. Bypass follow up was done by clinical exam and color duplex surveillance (CDS) for a mean duration of 24 months. CDS identified 4 failing bypasses which were surgically revised and have subsequently remained patent. There were 3 bypass occlusions which resulted in a major amputation in 2 patients. Three additional major amputations were performed for persisting infection despite a patent bypass. By life table analysis the cumulative primary & secondary patency and limb salvage rates for this group of diabetic patients were 75% at 2 years, 89% at 3 years and 82% at 3 years respectively (S.E. < 10%). The 3 bypass occlusions, which occurred at 1 week, 5 weeks, and 20 months, were in patients with both CRF and Grade "3" foot circulation (significantly different outcome compared to the rest of the group, by chi 2 test, p < 0.05). Good results can be achieved in the majority of diabetic patients undergoing short popliteal-distal bypasses. However, the combination of chronic renal failure and very limited foot circulation (Grade "3") has a significant adverse outcome.

    Title Effects of the Lazaroid U74389g (21 Aminosteroid) on Skeletal Muscle Reperfusion Injury in Rabbits.
    Date October 1996
    Journal International Angiology : a Journal of the International Union of Angiology
    Excerpt

    The purpose of this experiment was to evaluate the effects of the aminosteroid U74389G on skeletal muscle reperfusion injury in rabbits. In 24 white New Zealand rabbits (weighing 7.0-8.0 lb), the rectus femoris muscle on both sides was completely isolated on a single vascular pedicle (artery and vein) and a major accessory vein. All muscles were weighed using a suspension spring balance and then underwent 4 hours of normothermic ischemia followed by 24 hours of reperfusion. Muscle ischemia was induced by the application of atraumatic vascular clamps to the vascular pedicles. Complete muscle ischemia and reperfusion were documented by a laser flow meter. The animals were divided into three groups; Group I (n = 8) served as control, Group II (n = 8) received an i.v. bolus of U74389G (1.5 mg/kg) five minutes prior to ischemia, Group III (n = 8) was given the same dose of lazaroid five minutes prior to reperfusion. Muscle biopsies were obtained before ischemia and after reperfusion for quantification of myeloperoxidase (MPO) activity. At the completion of reperfusion, the muscles were excised, weighed and cut into slices along the longitudinal axis and then incubated for 30 minutes in 0.05% nitroblue tetrazolium. Areas of necrosis were determined by computerized planimetry. The following results indicate that reperfusion muscle necrosis in rabbits is significantly decreased by the administration of the lazaroid U74389G. Leukocyte sequestration was not affected by the lazaroid administration. These beneficial effects were observed whether the lazaroid was administered prior to ischemia or prior to reperfusion and were independent of leukocyte sequestration.

    Title Selection of Patients for Cardiac Evaluation Before Peripheral Vascular Operations.
    Date August 1996
    Journal Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
    Excerpt

    PURPOSE: This study evaluated the value of preoperative cardiac screening with dipyridamole thallium scintigraphy and radionuclide ventriculography in vascular surgery patients. METHODS: From July 1, 1989, to Dec. 31, 1991, we routinely (irrespective of the patient's cardiac history or symptomatology) performed dipyridamole thallium scintigraphy (DTS) and radionuclide ventriculography (RVG) in 394 patients being considered for an elective vascular operation. Patients with reversible defects on DTS underwent coronary arteriography. RESULTS: DTS results were normal in 146 patients (37%), showed a fixed defect in 75 (19%), and showed a reversible defect in 173 (44%). Patients with and without a history of angina or myocardial infarction had identical rates of reversible defects. Normal left ventricular function (> 50%) was noted in 76% of the patients; 17% had moderate dysfunction (35% to 50%) and 7% had a low ejection fraction (< 35%). The finding of severe coronary artery disease led to cardiac revascularization in 17 patients who had no prior history of cardiac disease and in 13 patients with a history of angina or myocardial infarction. Two deaths and nine major complications were associated with coronary arteriography and cardiac revascularization. Vascular procedures (144 aortic, 53 carotid, 146 infrainguinal) were ultimately performed in 343 patients, with a mortality rate of 1.7% (3.5% aortic, 0% carotid, and 0.7% infrainguinal bypass). The nonfatal perioperative myocardial infarction rate was 2.0%. We monitored all 394 patients for cardiovascular events, with a mean follow-up of 40 months. Patients who underwent cardiac revascularization had a 4-year survival rate of 75%, which was similar to those with a normal DTS. Late cardiac events were significantly more frequent in patients who had either a reversible DTS or RVG < 35%. CONCLUSIONS: Routine cardiac screening of vascular surgery patients had similar impact on patients irrespective of their prior history or current symptoms suggesting coronary artery disease. Routine screening did not result in substantial benefit. Screening studies such as DTS or RVG may be most useful as part of an overall risk versus benefit assessment in patients without active symptoms of coronary artery disease who have less compelling indications for vascular intervention (claudication, moderate-sized aortic aneurysms, or asymptomatic carotid disease).

    Title The Aortic Polytetrafluoroethylene Graft: Further Experience.
    Date June 1996
    Journal European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
    Excerpt

    OBJECTIVES: We analysed our results with the use of aortic polytetrafluoroethylene PTFE grafts over the last 7.5 years. A historical comparison was also made between the results with non-stretch PTFE (NS-PTFE) (1987-91) and stretch PTFE (S-PTFE) grafts (1991-94). MATERIALS: 244 infrarenal aortic replacements or bypasses with PTFE grafts were performed at the University of Iowa Hospitals and Clinics from January 1987 to June 1994. Infrarenal aortic replacement was indicated for aortic aneurysmal disease in 192 patients (elective 151, symptomatic 20, ruptured 21) and bypass for aorto-iliac occlusive disease in 52 patients (disabling claudication 28, limb salvage 24). Patients ranged in age from 37 to 93 years (mean 68 years). There were 161 males and 83 females. Medical risk factors included hypertension (55%), coronary artery disease (31%), COPD (23%), diabetes mellitus (12%) chronic renal failure (9%), and smoking (61%). Aortic replacement or bypass was done with a NS-PTFE graft in 108 patients (44%) and a S-PTFE graft in 136 patients (56%). Postoperative ultrasound (US) scans and/or CT-studies were available in 40 patients with NS-PTFE and 26 patients with S-PTFE grafts. MAIN RESULTS: The 30 day operative mortality was: elective AAA patients (1.3%), symptomatic AAA patients (10%), ruptured AAA patients (48%), limb salvage patients (4.1%) and disabling claudication patients (0%). Graft related complications included five graft limb thromboses (4 NS-PTFE, 1 S-PTFE). Two thromboses occurred perioperatively and the three others at 24, 28 and 30 months postoperatively. Two other graft related complications included a mixed pseudomonas and streptococcus groin infection with a culture negative perigraft fluid collection occurring 3 weeks following surgery (NS-PTFE), and distal aortic anastomotic suture line bleed on the first postoperative day following replacement of a ruptured AAA with a S-PTFE graft. Based on US and/or CT imaging studies, the mean internal diameters of the bodies of 40 NS-PTFE and 26 S-PTFE grafts were 11% and 10% greater than the manufacturer's specified sizes at a mean follow-up duration of 36 and 10 months respectively. CONCLUSIONS: These data reveal that a PTFE graft performs satisfactorily in the aortic position with minimal adverse clinical sequence over a 7.5 year period. Continued long term follow up data will determine the ultimate suitability of aortic PTFE grafts.

    Title Lazaroid U74389g Attenuates Skeletal Muscle Reperfusion Injury in a Canine Model.
    Date November 1995
    Journal Transplantation Proceedings
    Title A Comparative Evaluation of Externally Supported Polytetrafluoroethylene Axillobifemoral and Axillounifemoral Bypass Grafts.
    Date June 1995
    Journal Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
    Excerpt

    PURPOSE: We analyzed a current 78-month experience with externally supported (ringed) polytetrafluoroethylene (PTFE) axillobifemoral (AxBF) and axillounifemoral (AxUF) bypass grafts to address the controversy about whether the addition of a femorofemoral limb to an axillofemoral bypass graft improves the patency results. METHODS: Between January 1988 and June 1994, 36 AxBF and 22 AxUF externally supported PTFE ringed bypass grafts were performed at our institution. The age of the patients in the AxBF group was 67 +/- 11 years and 69 +/- 11 years in the AxUF group. The male/female ratio was 22:13 (AxBF) and 8:9 (AxUF). In 71% of cases (29/36 AxBF, 12/22 AxUF), the operations were performed for aortoiliac atherosclerotic occlusive disease in patients with significant medical risk factors or a "hostile" abdomen. The remaining 29% were patients requiring revascularization during treatment of an infected aortic graft. Bypass patency was assessed in the follow-up period by clinical evaluation, color-flow duplex imaging, or segmental limb pressure measurements. RESULTS: There was no significant difference in the 30-day operative mortality rate for all AxBF bypasses (11%) and all AxUF bypasses (6%) (p = 0.89 by chi-squared testing). The primary and secondary patency rates for the whole group of bypasses were 80% and 89% at 3 years, respectively (SE < 0.1). Between the AxBF and AxUF groups, there were no significant differences in either primary patency (80% for each group) or secondary patency (91% in AxBFs vs 85% in AxUFs) (SE < 0.1) at 2 years (Wilcoxon rank sum test). CONCLUSIONS: These data show no differences in the patency of externally supported PTFE AxBF and AxUF bypass grafts up to 2 years after implantation.

    Title Should All in Situ Saphenous Vein Bypasses Undergo Permanent Duplex Surveillance?
    Date June 1995
    Journal Archives of Surgery (chicago, Ill. : 1960)
    Excerpt

    OBJECTIVE: To evaluate the need for color duplex surveillance (CDS) for pure in situ bypasses beyond 6 months. DESIGN: We reviewed our in situ surveillance data from August 1987 to April 1994. Lower-extremity revascularization was performed using 245 pure in situ greater saphenous vein bypasses in 219 patients. The CDS of the entire bypass and inflow and outflow arteries was done prior to discharge, at 1 month, every 3 months in the first year, every 6 months in the second year, and annually thereafter. A peak systolic velocity of less than 45 cm/s throughout the bypass or a velocity ratio of greater than 3 (peak systolic velocity at the stenosis divided by peak systolic velocity at an adjacent normal bypass segment) were defined as abnormal during the review of this patient subset. The outcomes were analyzed. Patency and limb salvage rates were calculated by life-table analysis. PATIENTS: The mean age of this population (120 men and 99 women) was 67 years (range, 32 to 97 years). We analyzed all bypasses that were subjected to CDS for 6 months or more and identified 171 such bypasses. These bypasses were followed up for a mean duration of 30 months (range, 6 to 82 months). RESULTS: The primary and secondary patency and limb salvage rates at 5 years were 60.4%, 89%, and 92.1%, respectively (SE, < 10%). During the first 6 months of surveillance, 54 bypasses had abnormal CDS findings, and 117 had normal CDS findings. Arteriography was performed on 42 of these bypasses with abnormal CDS findings, and 37 had significant findings requiring direct surgical or endovascular intervention. Only two of 117 bypasses that had normal CDS findings for up to 6 months had to be revised later, compared with 43 of the 54 bypasses with abnormal CDS findings prior to 6 months, which were occluded or were revised (significantly different by chi 2 test [P < .001]). CONCLUSIONS: Vigorous CDS of pure in situ bypasses for up to 6 months is useful to detect bypass-threatening lesions. Continued CDS of a normal in situ bypass after 6 months may not be justifiable, as the incidence of lesions requiring later revision is minimal.

    Title Comparative Efficacy and Complications of Vena Caval Filters.
    Date March 1995
    Journal Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
    Excerpt

    PURPOSE: A variety of vena caval filters (VCFs) are available for usage. The choice of filter type depends on physician preference and certain patient variables. An evaluation of the different VCFs used in our institution was done to compare their efficacy and complication rates. METHODS: The medical records of all patients who underwent insertion of a VCF from January 1987 to June 1993 at the University of Iowa Hospitals & Clinics and the affiliated Veterans Administration Medical Center were reviewed. One hundred ninety-nine VCFs were placed in 196 patients (123 males, 73 females), with a mean age of 61 years (range 13 to 87 years). Thirty-five (18%) VCFs (30 stainless steel Greenfield filters [SGFs] and five titanium Greenfield filters with modified hook [TGF-MHs]) were inserted in the operating room via an open technique. The remaining 164 VCFs (82%) were inserted in the radiology suite by a percutaneous technique (38 SGF, 23 TGF-MH, 51 Vena Tech filters [VTFs], 48 Bird's nest filters [BNFs] and 4 Simon Nitinol filters). Thromboembolic risk factors in these 196 patients included malignancy (99), trauma (21), recent surgery (27), cerebrovascular accident with paralysis (6), and miscellaneous conditions (43). Indications for VCF placement included a contraindication to anticoagulation (92), complication of anticoagulation (44), failure of anticoagulation (26), prophylaxis (31), adjunct to pulmonary embolectomy (1), noncompliance (1), hemodynamically unstable patient (1), and prior VCF complication (3). Mean follow-up of the patients was 12 months (range 0 to 87 months). Because there were only four Simon Nitinol filters inserted during the study period, they were excluded from further analysis. RESULTS: A comparative analysis revealed that there was a significantly higher incidence of symptomatic IVC thrombosis with the use of the BNF (n = 7) (14.6%) versus the SGF (n = 0) (0%), TGF-MH (n = 1) (3.6%), or VTF (n = 2) (4%) (p < 0.05 by chi-squared testing). The VCF-related mortality rate was also higher with the BNF (n = 5) (10.9%) versus the SGF (n = 1) (1.5%), TGF-MH (n = 1) (3.6%), or VTF (n = 0) (0%) (p < 0.05 by chi-squared testing). However there was no significant difference in the occurrence of clinically apparent recurrent pulmonary embolism during follow-up between the four different filter types (2 [4.2%] BNF, 3 [4.4%] SGF, 1 [3.6%] TGF-MH, and 1 [2%] VTF). CONCLUSION: These data indicate that the use of the BNF was associated with increased morbidity and mortality rates compared with the use of the SGF, TGF-MH, and VTF filters.

    Title The Management of the Infected Aortic Prosthesis: a Current Decade of Experience.
    Date June 1994
    Journal Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
    Excerpt

    PURPOSE: Newer approaches to the patient with an infected aortic graft are available. We reviewed a recent 10-year experience with a more traditional approach to evaluate its outcome in the 1990s. METHODS: From January 1983 to January 1993, 27 patients with an aortic graft infection were treated at our institution. There were 18 paraprosthetic infections, eight graft enteric erosions, and one aortoduodenal fistula. The involved bypasses included 20 aortofemoral (74%), five aortoiliac (18%), and two aortic tube grafts (8%). Nineteen aortic replacements were done originally for aneurysmal disease (70%). We reviewed the outcome of each patient treated as it related to the method of management. The therapy for graft infection consisted of aortic graft removal and axillofemoral bypass in 20 patients (74%), treatment by an in situ method in four patients (15%), excision of an aortofemoral limb and extraanatomic bypass in two patients (7%), and extraanatomic bypass alone in one patient (4%). In the group treated by graft removal and extraanatomic bypass, four patients (20%) had staged operations (extraanatomic bypass followed by interval aortic graft removal), nine (45%) had single operations with extraanatomic bypass preceding graft removal, and seven (35%) had single operations with graft removal preceding extraanatomic bypass. RESULTS: The 30-day operative mortality rate was 3.7%. There were no instances of aortic stump blowout. The 3-year primary patency rate for axillofemoral bypass limbs was 80.2%, and the secondary patency rate was 87.4%. No limbs were lost as a result of ischemic complications. There was one late amputation for an unrelated problem. CONCLUSIONS: The results of alternate approaches to the management of patients with infected aortic grafts were equivalent both in terms of perioperative mortality and morbidity rates in this group of patients. Complete excision of the aortic graft with axillofemoral bypass provided a satisfactory long-term outcome and remains the standard with which other approaches must be compared.

    Title Does Iloprost Mediate Thromboxane Activity and Polymorphonuclear Leukocyte Sequestration in Ischemic Skeletal Muscle?
    Date December 1992
    Journal The Journal of Cardiovascular Surgery
    Excerpt

    Thromboxane is known to alter the endothelial cytoskeleton, thereby causing increased endothelial permeability and polymorphonuclear leukocyte (PMN) sequestration in the lungs. We investigated whether iloprost (a stable prostacyclin analog) can decrease thromboxane activity and consequently PMN sequestration because of its anti-platelet aggregation effect. This premise was investigated in a canine isolated gracilis muscle model using 18 animals. Six animals (group I) had the gracilis muscle subjected to 6 hours of complete ischemia followed by 48 hours of reperfusion. Group II (n = 6) received intravenous infusion of iloprost (0.45 micrograms/kg/hr) throughout the experiment (1 hour preischemia, 6 hours of ischemia and 1 hour of reperfusion) and boluses of 0.45 micrograms/kg 10 minutes before ischemia and reperfusion. Group III (n = 6) underwent a similar ischemic interval, but were given iloprost bolus of 0.45 micrograms/kg followed by intravenous infusion of 0.45 micrograms/kg/hr during 48 hours of reperfusion. Gracilis venous samples were obtained at preischemia (PI) and 1 hour of reperfusion (all 3 groups) and at 48 hours of reperfusion (groups I and III) to measure thromboxane (TXB2) levels. Muscle biopsies were taken at the same time to measure myeloperoxidase (MPO) activity, a marker of PMN infiltration. In group I, TXB2 level increased from a pre-ischemic value of 2983 +/- 1083 pg/ml to 9483 +/- 2218 pg/ml at 1 hour of reperfusion (p < 0.05) and then decreased to 2386 +/- 1533 pg/ml at 48 hours of reperfusion (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

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