564
Journal of VASCULAR SURGERY
Letters to the Editors
2. Collins PS, McDonald PT, Lira RC. Popliteal artery entrapment: an evolving syndrome. ~ VAscSURG1989; 10:48490. 3. Farina C, CavaUaroA, Schultz RD, Feldhaus R~, di Marzo L. Popfiteal anenrysms. Surg Gynecol Obstet 1989;169:713. 4. Price C, Jacocks MA, Tytle T. Thrombolytic therapy in acute arterial thrombosis. Am J Surg 1988;156:488-91. 5. Comerota AJ, White JV, Grosh JD. Intraoperative intraarterial thrombolytic therapy for salvage of limbs in patients with distal arterial thrombosis. Surg Gynecol Obstet 1989;169:283-9. 6. Ferguson LJ, Farris I, Robertson A, Lloyd W, Miller JH. Intraarterial streptokinase therapy to relieve acute limb ischemia. J Vmc Su~c 1986;4:205-10.
Clinical results o f axillobifemoral bypass using externally supported polytetrafluoroethylene To the Editors."
Fig. 2. Arteriogram after 12 hours ofstreptokinase therapy demonstrates significant thrombolysis; note the saccular aneurysm not visualized in the pretreatment study
(arrow). advanced ischemia, as compared to standard catheter thromboembolectomy techniques. 5'6 By using streptokinase in the treatment of our patient early restoration of blood flow to the ischemic limb was possible. The popliteal artery aneurysm was not suspected until after infusion of streptokinase. This additional information allowed better planning of the operative procedure. We conclude that the adjunctive use of streptokinase in the patient with acute ischemia and popliteal entrapment .allows better definition of the underlying vascular abnormalities, restores blood flow to distal small vessels, and thereby increases the chance of functional limb salvage. Frederick M. llgenfritz, M D Robert D. Fanelli, A4D
Michigan State University Department of Surgery B 424 Clinical Center East Lansing, MI 48824 REFERENCES
1. Hallett JW Jr, Greenwood LH, Robison JG. Lower extremity arterial disease in young adults. A systematic approach to early diagnosis. Ann Surg 1985;202:647-52.
I agree with Dr. Moore (discussant [J VAse SuRe 1990;12:416-21.]) that a 5-year (sic) primary patency ~ f 85% achieved by the Oregon group is extraordinary, bu~ would question the results based on standard life-table methods. Most patients (47 of 76 or 62%) were followed less than 1 year, and only two patients were alive with a patent graft at 4 years. Table I shows that 43 of 76 patients were withdrawn at less than 1 year; was this due to death, lack of follow-up, or were most of the operations performed in the last year of study? By using life-table methods, all of these patients are considered to be alive with patent grafts for the remainder of the study. I would like to know the reason for the large number of patients withdrawn from the study, and more importantly if the large number of patients that had been followed less than 1 year in 1988 are sill/alive with patent grafts. William H. Bell 127A4D
Coastal Surgical Speci~sts PA 800 Hospital Dr. New Bern, NC 28560-3489
Reply To the Editors:
Dr. Bell has raised several questions regarding the results of our study based on the choice of the life-table method for presentation of the patency results of the operations. The points raised by Dr. Bell include the following: (1) It is noted that 62% of the patients (47) were withdrawn from the life-table in the first year. (2) A request is made for clarification of the reason for withdrawal of the patients in the first year interval; that is, were they withdrawn because of death, because of being lost to follow-up, or because of being operated on recently. (3) It is stated that use of the life-table method implies that all the patients entered into the study are considered to be alive with patent grafts for the remainder of the study.
Journal of VASCULAR SURGERY
Letters to the Editors
2. Collins PS, McDonald PT, Lira RC. Popliteal artery entrapment: an evolving syndrome. ~ VAscSURG1989; 10:48490. 3. Farina C, CavaUaroA, Schultz RD, Feldhaus R~, di Marzo L. Popfiteal anenrysms. Surg Gynecol Obstet 1989;169:713. 4. Price C, Jacocks MA, Tytle T. Thrombolytic therapy in acute arterial thrombosis. Am J Surg 1988;156:488-91. 5. Comerota AJ, White JV, Grosh JD. Intraoperative intraarterial thrombolytic therapy for salvage of limbs in patients with distal arterial thrombosis. Surg Gynecol Obstet 1989;169:283-9. 6. Ferguson LJ, Farris I, Robertson A, Lloyd W, Miller JH. Intraarterial streptokinase therapy to relieve acute limb ischemia. J Vmc Su~c 1986;4:205-10.
Clinical results o f axillobifemoral bypass using externally supported polytetrafluoroethylene To the Editors."
Fig. 2. Arteriogram after 12 hours ofstreptokinase therapy demonstrates significant thrombolysis; note the saccular aneurysm not visualized in the pretreatment study
(arrow). advanced ischemia, as compared to standard catheter thromboembolectomy techniques. 5'6 By using streptokinase in the treatment of our patient early restoration of blood flow to the ischemic limb was possible. The popliteal artery aneurysm was not suspected until after infusion of streptokinase. This additional information allowed better planning of the operative procedure. We conclude that the adjunctive use of streptokinase in the patient with acute ischemia and popliteal entrapment .allows better definition of the underlying vascular abnormalities, restores blood flow to distal small vessels, and thereby increases the chance of functional limb salvage. Frederick M. llgenfritz, M D Robert D. Fanelli, A4D
Michigan State University Department of Surgery B 424 Clinical Center East Lansing, MI 48824 REFERENCES
1. Hallett JW Jr, Greenwood LH, Robison JG. Lower extremity arterial disease in young adults. A systematic approach to early diagnosis. Ann Surg 1985;202:647-52.
I agree with Dr. Moore (discussant [J VAse SuRe 1990;12:416-21.]) that a 5-year (sic) primary patency ~ f 85% achieved by the Oregon group is extraordinary, bu~ would question the results based on standard life-table methods. Most patients (47 of 76 or 62%) were followed less than 1 year, and only two patients were alive with a patent graft at 4 years. Table I shows that 43 of 76 patients were withdrawn at less than 1 year; was this due to death, lack of follow-up, or were most of the operations performed in the last year of study? By using life-table methods, all of these patients are considered to be alive with patent grafts for the remainder of the study. I would like to know the reason for the large number of patients withdrawn from the study, and more importantly if the large number of patients that had been followed less than 1 year in 1988 are sill/alive with patent grafts. William H. Bell 127A4D
Coastal Surgical Speci~sts PA 800 Hospital Dr. New Bern, NC 28560-3489
Reply To the Editors:
Dr. Bell has raised several questions regarding the results of our study based on the choice of the life-table method for presentation of the patency results of the operations. The points raised by Dr. Bell include the following: (1) It is noted that 62% of the patients (47) were withdrawn from the life-table in the first year. (2) A request is made for clarification of the reason for withdrawal of the patients in the first year interval; that is, were they withdrawn because of death, because of being lost to follow-up, or because of being operated on recently. (3) It is stated that use of the life-table method implies that all the patients entered into the study are considered to be alive with patent grafts for the remainder of the study.
