Prevent disaster--take a history

Abstract

DURING the past 20 years, cardiovascular surgeons have saved many lives and limbs by implanting prostheses into the heart and peripheral vessels. One would hope that following such implants, all would be well forever, but unfortunately this is not so. Serious iatrogenic complications may occur unless a careful and complete history has been taken. Prostheses such as axillofemoral and femorofemoral bypasses used to alleviate aortic and iliac obstruction may be sources of disaster if the urologist or gynecologist boldly incises the abdominal wall. Unless a vascular surgeon is immediately available to replace the divided prosthesis, arterial insufficiency will reappear. A subcutaneous pacemaker is usually obvious, but if surgery is subsequently necessary, care must be taken not to incise the wires leading to the heart. A second serious consideration is positioning patients for hemorrhoidectomy and cystoscopic examination in anything resembling the lithotomy position. One of my patients with early localized gangrene