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Graft Surveillance (graft + surveillance)
Selected AbstractsTransfer function index: is it a reliable method for vein graft surveillance?ANZ JOURNAL OF SURGERY, Issue 12 2003Chuan Ping Tan Introduction: Duplex ultrasound scanning is currently the best available non-invasive method for vein graft surveillance. However, it is expensive and its results are highly operator dependent. The aim of the present study is to compare, another non-invasive method of graft surveillance, the transfer function index (TFI), with duplex ultrasound scanning in identifying significant stenoses in infrainguinal saphenous vein bypass grafts. Methods: Initially a retrospective pilot study was carried out between 1 January and 30 June 2002. Patients were identified from the vascular surgical operation database. The ultrasound report and TFI result of each patient were reviewed. Then a prospective comparative study was carried out between 1 July and 31 December 2002. Duplex ultrasound and TFI studies were undertaken at the 3 month interval. Comparisons were made between the accuracy and predictive value of ultrasound versus TFI in assessing significant graft stenosis. Results: In the present retrospective study TFI measurement was significantly lower in the at-risk grafts than in the normal grafts (P = 0.001). In the prospective group TFI was again found to be significantly lower in the at-risk group (mean TFI 0.86) than in the normal group (mean TFI 1.064, P = 0.001). The sensitivity and specificity of the TFI were 92% and 97%, respectively. The accuracy of TFI was calculated to be 98%. Conclusion: TFI is an accurate non-invasive method of vascular graft surveillance. TFI can be carried out in the vascular clinic and is quick and inexpensive. Normally TFI could replace duplex ultrasound surveillance, with ultrasound being reserved for those with an abnormal TFI. [source] Management of complications of simultaneous kidney,pancreas transplantation with temporary venting jejunostomyCLINICAL TRANSPLANTATION, Issue 2003Kevin N Boykin Abstract:,Background/Aims: The majority of simultaneous kidney,pancreas (SPK) transplants are being performed with portal-enteric drainage, which does not allow easy access to the donor pancreas. By adding a temporary venting jejunostomy (TVJ) we have been able to closely monitor patients for bleeding, anastomotic leak and rejection. Methods: Retrospective chart review of 29 patients undergoing SPK with PE drainage from December 1996 to December 2001. Results: Median follow-up was 32 months. Patient, kidney and pancreas graft survival were 93%, 90% and 93%, respectively. The most common early complications were wound infections and bleeding. No patient suffered vessel thrombosis. The most common late (greater than 3 months post-transplant) complication was gastro-intestinal bleeding. Adequate tissue was obtained for biopsy in 100% of patients with suspected pancreatic rejection. The TVJ allowed one patient to undergo donor pancreas ERCP that demonstrated the site of a pancreatic duct leak. Duodenal stump leak and anastomotic bleeding were diagnosed in one patient each via the TVJ. The median time to takedown of the TVJ was 14 months. Conclusion: TVJ allows patients an easy method of graft surveillance, is well tolerated, and has an acceptable complication rate. The TVJ allows access to diagnose anastomotic leak, cauterize bleeding mucosa, perform ERCP and biopsy the pancreas allograft. [source] | ||||||||||