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  • 1
    ISSN: 1436-2813
    Keywords: abdominal aortic aneurysm ; aortoduodenal fistula ; synthetic graft ; graft infection ; axillo-femoral synthetic bypass ; ligation of aortic stump ; aneurysmal dilation ; aortointestinal fistula ; modified Roux-Y jejunal plasty
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Two patients having the abdominal aneurysm with aortoduodenal fistula were treated surgically, but graft infection occurred. One patient died about 6 months after and the other about one year after the operation due to massive hemorrhage from the postoperative aortointestinal fistula. The difficulties in the treatment of the aortoduodenal fistula were discussed.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1436-2813
    Keywords: prosthetic arterial reconstruction ; graft infection ; skin sliding closure technique ; wound lavage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A clinical review of 400 prosthetic arterial reconstructions, carried out in the Second Department of Surgery of Kyushu University Hospital during a period from 1965 to 1981, revealed 10 graft infections (2.5 per cent). There were two out of 120 abdominal aneurysms (1.7 per cent) and 8 out of 260 aorto-femoral occlusive diseases (3.1 per cent). The contributing factors included intraoperative contamination with duodenal juice during surgery for abdominal aneurysms ruptured into the duodenum (2 cases), minor hematoma and/or lymphorrhoea at the groin or lower abdominal wall (5 cases), wound infection (1 case), compression necrosis of the sigmoid colon by the implanted graft (1 case) or perityphlitic abscess due to a perforating appendicitis (1 case). Bacteriologic examination revealed a predominance of a variety of staphylococcus at the groin or lower abdominal wall and E. coli in the abdominal cavity. Four patients expired. Limb amputation had to be done in 2, and 4 were cured. In the management of infected graft at the groin or lower abdominal wall, we used with success a skin sliding closure technique after continuous wound lavage in 3 patients.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1436-2813
    Keywords: vein allograft ; porosity ; intimization ; small arterial reconstruction ; elastase digestion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The ideal graft for peripheral arterial reconstruction has yet to be developed. We evaluated on the effectiveness of porosity to intimization of the graft. Modified vein allografts newly constructed through digestion of vein allografts with elastase, glutaraldehyde tanning and lyophilization were implanted in thirty-nine canine femoral arteries. These grafts had a higher porosity than conventional vein allografts and the overall patency rate was 70 per cent at 6 months after implantation. Microscopic examination showed that graft interstitial healing and subsequent intimization were completed by ingrowth of connective tissue from outside through the graft wall at 3 weeks and later. Aneurysmal change of the modified vein allografts was never evident. These results indicated that porosity of the graft is indeed an important factor for intimization and durability of grafts, even in bioderivative substitutes.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1436-2813
    Keywords: autovein graft ; late occlusion ; intimal hyperplasia ; intimal permeability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The etiology of intimal hyperplasia in autogenous vein grafts used for arterial replacement was experimentally studied in dogs. We previously developed an experimental model, which mimicked a human extremity with poor run-off of peripheral arteries. This model characterized the abnormal flow by a weak fluctuation of wall shear stress at the site adjacent to the vessel wall. In this model we found that an autogenous vein implanted into the femoral artery under such abnormal flow conditions exhibited remarkable intimal thickening; 200–400 μm at 1 month and 300–500μm at 6 months. A fluorescence microscopic study revealed that Evans blue-albumin complex entered the inner wall of vein grafts transplanted in abnormal flow conditions until about 2 weeks after implantation, after which further permeation was no longer observed. A similar observation was made in the fibrinogen distribution of subendothelial tissue. These results showed that abnormal flow conditions enhance the permeation of certain substances into immaturely repaired intimal tissues of autovein grafts. This phenomenon is thought to be responsible for the proliferation of smooth muscle cells, leading to hyperplasia of autovein grafts.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1436-2813
    Keywords: nonresectable hepatic tumor ; vascular accessgraft ; intraarterial chemotherapy ; liver cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1436-2813
    Keywords: flow wave pattern ; bidirectional doppler flowmeter ; peripheral arterial reconstruction ; prevention of late occlusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A prognostic flowmetric study on 80 reconstructed arteries of the lower extremity was carried out to assess the flow wave patterns detected using a bidirectional doppler flowmeter. In 21 of 80 arteries, changes in the flow wave pattern were noted. For 10 of 21 affected arteries, an immediate arteriography revealed localized stenotic lesions at the distal anastomosis in a short segment of the implanted autogenous vein graft or at the proximal host artery. Immediate repairs for the lesions were successfully performed by a minor surgery in 8 of 10 cases and the flow wave pattern reverted to normal. Two were not successful, as the occlusion was complete before attempting the repair. The remaining 11 are now under conservative management as these patients refused further surgery. The ultrasonically driven flow wave pattern proved to be a useful indicator to assess the patency of the reconstructed peripheral artery to detect possible stenosis and thereby to take proper corrective measures and hence prevent a late occlusion.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1436-2813
    Keywords: multiple organ failure ; elective operation ; liver cirrhosis ; esophageal carcinoma ; aortic aneurysm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A retrospective analysis was made of 58 patients who unexpectedly developed multiple organ failure (MOF) following elective surgery, and the results were compared with those of 168 control patients who did not develop MOF. In 33 patients with liver cirrhosis, MOF was related to poor liver function, a low albumin level, excessive blood loss, many transfusions, and a high incidence of hypotension. MOF, rather than liver failure alone, was featured by postoperative bleeding and infection. In 15 patients with esophageal carcinoma, MOF was correlated with many transfusions, anastomotic leakage, and postoperative infection. In 10 patients who underwent surgery for an aortic aneurysm, poor renal function and extended anesthesia time were associated with MOF. These results indicate that to prevent MOF following elective surgery, it is important to: (1) Select patients for liver surgery according to their liver function, and minimize the risk of bleeding and infection, (2) avoid too many blood transfusions, and minimize the risk of leakage and infection in esophageal surgery, and (3) select patients for aortic surgery based on renal function and reduce the anesthesia time as much as possible.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1436-2813
    Keywords: lymphangiography ; postoperative chylous fistula ; rectal cancer ; lipiodol ; Evans Blue
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a 61-year-old woman who underwent extensive retroperitoneal lymph node dissection for rectal cancer, postoperative chylous ascites developed. The site of the lymphatic leak was evident on the lymphangiogram with lipiodol taken prior to the surgical repair of the leak, and another site seen on the intraoperative lymphangiogram using Evans Blue. A direct surgical repair led to good results. Therefore, the combination of pre- and intraoperative lymphangiography facilitates the successful surgical management of rare but alarmingly dangerous postoperative chylous ascites.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1436-2813
    Keywords: flow waveform analysis ; autologous vein graft ; late graft failure ; prostacyclin ; endothelium-derived relaxing factor (EDRF)
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Late graft failure following arterial reconstructive surgery, especially after infrainguinal reconstruction, remains a major concern for vascular surgeons. To more effectively predict the outcome of reconstructed arteries, we herein propose an intraoperative flow waveform analysis which correlates well with the long-term patency rate of grafts. According to this flow waveform analysis, late graft failure was occasionally seen in grafts with type II waveforms when poor distal runoff vessels had been shown by the preoperative arteriogram. Next, to investigate which events occurring in autologous vein grafts under abnormal hemodynamics may contribute to late graft failure, a distal poor-runoff model was made in the canine femoral artery. In this review, we present the results of our investigation on autologous vein grafts using this poor-runoff model. We also relate our recent findings on the function of regenerated endothelium in autologous vein grafts.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To determine the role of Nd:YAG laser thermal angioplasty as the sole treatment for late stenoses of femorodistal artery bypass graft, the lasing effect of a larger size of hot-tip probe (3, 4, and 5 mm) was experimentally studied in vitro. For an adequate lasing effect, 30 watts of laser power output for 3 seconds was needed for the 3 mm probe, 40 watts for the 4 mm probe, and 50 watts for the 5 mm probe, respectively. Based on these results, we used Nd:YAG laser thermal angioplasty alone for 25 grafts, including 16 polytetrafluoroethylene (PTFE) grafts, eight saphenous vein grafts, and one externally supported (EXS) Dacron graft in which the stenotic lesions were detected by deterioration of the Doppler flow waveform pattern or a significant fall in the ankle/brachial pressure index (ABPI). Follow-up was from 3 to 24 months (average of 9 months) for PTFE grafts, from 5 to 21 months (average of 11 months) for saphenous vein grafts, and 13 months for the EXS Dacron graft following femorodistal artery reconstructions. Stenotic lesions were most common in the distal anastomotic sites: 11 PTFE grafts, three saphenous vein grafts, and one EXS Dacron graft. Among these, 13 grafts showed a type II flow waveform pattern at the time of surgery. Clinical success was achieved in 12 of the PTFE grafts (75%), in five of the vein grafts (62.5%), and in the single EXS Dacron graft. Four PTFE and three saphenous vein grafts failed subsequent to repeat intraoperative balloon angioplasty in three and graft extension in three and one graft interposition. Perforation occurred in only one vein graft. Continuing patency has now been maintained for up to 25 months after lasing. Nd:YAG laser thermal angioplasty using a 3 to 5 mm hot-tip probe is effective as the sole procedure for widening a stenotic lesion and improving patency after femorodistal artery reconstruction.
    Type of Medium: Electronic Resource
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