Document 0645
 DOCN  M9490645
 TI    Vascular prostheses.
 DT    9411
 AU    Manfredi RA; Allison EJ Jr; Department of Emergency Medicine, East
       Carolina University,; Greenville, North Carolina.
 SO    Emerg Med Clin North Am. 1994 Aug;12(3):657-77. Unique Identifier :
       AIDSLINE MED/94341227
 AB    The quest for an ideal vascular graft began in the early 1950s and
       continues at a steady pace. The perfect graft has yet to be designed. As
       a result, patients with vascular prostheses may suffer complications
       that range from minor to catastrophic. The emergency physician may be
       faced with the initial presentation of patients with these vascular
       graft complications. If he or she is not familiar with these
       possibilities, then the resulting morbidity and mortality could be
       devastating. Probably the most unnerving complication involving the
       failure of vascular prostheses is that of the aortoenteric fistula.
       Instantaneous decisions and interventions must be made when a patient
       presents in this state of pre-exsanguination. Massive GI bleeding is at
       one end of the spectrum with other less-severe GI complications
       involving aortoenteric erosions and small bowel obstructions due to
       graft migration at the other end of the spectrum. Infection of a
       vascular prosthesis is a complication much feared by vascular surgeons.
       A spectrum of presentation also exists here whereby a patient may
       present with an obvious draining wound or with subtle complaints of
       fever, weakness, and a minimally elevated white blood cell count. The
       function of the emergency physician is critical here but only if he or
       she is able to suggest the possibility of graft infection to the
       admitting physician. Fortunately, thrombosis of a vascular graft is an
       infrequent complication that may occur at any time postoperatively,
       although the frequency decreases with time. There are many different
       causes of graft occlusion of which the emergency physician should be
       aware. If the cause of the thrombosis is known, then the secondary
       vascular reconstruction can be optimized. The dialysis population has
       grown rapidly over the past two decades and as a result so have
       complications of renal dialysis grafts. Because the dialysis population
       now includes large numbers of older subjects as well as those with
       systemic diseases such as diabetes and HIV, recognition and prompt
       aggressive management of clinical complications is of paramount
       importance.
 DE    Adult  Aged  Blood Vessel Prosthesis/*ADVERSE EFFECTS  Case Report
       Child  Emergencies  Female  Gastrointestinal Diseases/ETIOLOGY  Human
       Male  Prosthesis-Related Infections/ETIOLOGY  Thrombosis/ETIOLOGY
       JOURNAL ARTICLE  REVIEW  REVIEW OF REPORTED CASES

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