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This study investigated as a small diameter vascular replacement the tissue formed adjacent to an implanted cylindrical foreign body, heterologously transplanted. Grafts of 4 mm i.d. were grown in rabbits and transplanted to dogs as segmental carotid and femoral artery replacements. These maintained 50% patency after 3 weeks. Variables in the further development of this concept are discussed.
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New-lining endothelial cells in the neointimae of two types of synthetic vascular prostheses were examined by light- and electron microscopy. Examination was carried out at one to 846 days post implantation of the prostheses in the thoracic aortae of 57 canines. The surfaces of both types of prostheses were covered by a continuous layer of endothelial cells. The long axes of the cells were found to be parallel to the blood stream. This observation indicates that the arrangement pattern of endothelial cells in the neointimae is largely dependent on the direction of the blood stream rather than on the direction of the tension exerted on the vascular prostheses.
Successful carotid-axillary bypasses have been performed nine times at Walter Reed Army Medical Center during a six year period starting in 1970. Although this approach has been of particular value in patients with symptomatic posttraumatic subclavian arterial occlusions, in whom local fibrosis creates additional problems is dissection and identification of important structures, carotid-axillary bypasses can also be used for lesions of the subclavian and/or axillary artery including aneurysms, ulcerations with distal embolism, and extensive arteriosclerotic occlusive disease. Our experimental data corroborate the clinical impression that carotid-axillary by-passing can be a safe and successful approach to surgical management of subclavian arterial lesions without creating any major significant hemodynamic derangements.
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The frequent application of split thickness porcine skin grafts to cover an exposed vascular repair is a reasonable alternative to amputation in patients with severe extremity injury. It is essential that soft-tissue debridement be complete and at least one wall of the exposed vascular repair be supported by healthy, viable muscle. Limb salvage was achieved in seven of nine patients in whom this technique was used, including two patients with exposed Dacron grafts.
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An improved vascular graft was achieved by treating knitted Dacron prostheses with cross-linked albumin. Eight segments, each six centimeters in length, were coated and implanted in the canine thoracic aorta for periods ranging from 24 hours to six months. The results were compared with the eight untreated grafts implanted for similar periods as control experiments. Albumin coating resulted in a faster healing : cells appeared earlier and collagen development was greater. The most beneficial effect of that treatment was the reduction in embolization, as shown by the considerable decrease in kidney damage.
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An unusual complication of persistent lymph fistula occurred three months postoperatively following axillo-femoral and femoro-femoral bypass graft. The lymphangiograms demonstrated the precise site of lymph extravasation. Multiple aspirations and local drainage were of no avail and it finally responded to prolonged continuous local pressure over the area of lymph extravasation.
This study shows that arteriovenous fistulas created for vascular access to hemodialysis result in an increase in cardiac output and pulse rate, and a decrease in the total peripheral resistance. These changes are severe with bovine graft fistula; physicians should be aware of this potentially dangerous hemodynamic change in these patients.
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