Venous Autografts Research Articles

Venous autograft for hemodialysis. Operative technique, its systemic effects.

In keeping with the programs of periodic hemodialyses and renal transplants, 40 saphenous vein autografts have been performed according to a surgical procedure, which consists of a subcutaneous implantation of a ‘U’ shaped segment obtained from the great saphenous vein of the same patient, anastomosed to an artery and a vein in the forearm or thigh to facilitate the puncture for hemodialysis. We describe an original surgical technique and we evaluate the cardiovascular implications of these flstulae. The following studies were performed before the venous grafting was done: electrocardiogram, vectocardiogram, cardiac X-ray series, arterial pressures, cardiac output, blood volume determination, central venous pressure, and comparative plethysmography. After the surgical procedure, the same studies were repeated supplemented by fistular flow, and angiography, at intervals which varied from 10 to 310 days post-fistula. The postsurgical studies revealed no noteworthy changes of concern, though with an adequate flow to perform dialyses and satisfactory integrity of the venous by-pass. In our series, the magnitude of the hemodynamic changes was not sufficiently severe as to contraindicate the procedure and we concluded that the venous autograft by itself does not harm the patient, rather embodies a valuable help in carrying out the hemodialyses for as long as it is necessary.

Need for Controlled Study

To the Editor.— The article by Sheldon et al on venous autografts for myocardial revascularization ( 213 : 78, 1970) records a magnificent surgical series from the standpoint of concept and technical ability. Yet the very appealing evidence for success remains inconclusive. Where are the control patients? Surgery is a form of therapy, not a magical process. It must be evaluated like other treatments and by equally high standards, ie, by minimizing bias through random allocation of qualifying patients to control and treated groups. It is equally deplorable that in the same issue (QUESTIONS AND ANSWERS, p 135) Dr. Baue's evaluation of various forms of revascularization is devoid of any reference to the lack of control. My criticism of the surgical enthusiasts is not that they are wrong (or even probably wrong), but rather that they have not attempted to really prove themselves right. Their technical and professional expertise are not in

Reconstructive Coronary Artery Surgery

From May 1967 through May 1969, a total of 303 patients underwent venous autograft reconstructions for occlusive coronary artery disease, with an overall mortality of 5.6%. With subsequent experience the hospital mortality has been reduced to less than 5%. The first 100 patients have been followed-up for more than one year. Eighty-six percent of the survivors have had postoperative angiographic study, and in 86% of these the graft was demonstrated to be patent. Eighty percent had no significant residual obstruction in the artery operated upon and there was good correlation between the angiographic result and symptomatic improvement. The venous autograft technique offers immediate restoration of more effective myocardial perfusion, with attendant protection against myocardial infarction and improvement in symptoms of myocardial ischemia.

Reconstructive coronary artery surgery. Venous autograft technique

Reconstructive coronary artery surgery. Venous autograft technique

Evaluation of arteriovenous shunt to maintain patency of venous autograft

1. 1. Fifteen dogs had a 2 cm. segment of superficial femoral vein excised bilaterally and replaced with a jugular venous autograft. In six of these dogs (group I) a distal arteriovenous shunt was built into a K-shaped system using a total of three anastomoses. In the remaining nine dogs (group II) a distal H-shaped arteriovenous shunt was created. 2. 2. The autografts in the opposite leg without a distal arteriovenous shunt served as the controls. 3. 3. Serial venograms were used to determine patency. 4. 4. The shunts were closed at ten days in group I animals and after six weeks in group II. 5. 5. In group I (K-shunts) all grafts thrombosed three days after shunt closure. 6. 6. In the five survivors in group II, all grafts were patent at the time of shunt removal. One vein was inadvertently ligated at that time. All of the other four vein grafts were patent three weeks after shunt removal (100 per cent patency). Only three of the five control grafts remained patent at this time (60 per cent patency). 7. 7. These studies indicate that a temporary distal arteriovenous fistula may enhance patency of a small venous autograft. 8. 8. The first clinical case in the literature utilizing this principle is presented.

Experimental coronary artery surgery: Long-term follow-up, bypass venous autografts, longitudinal arteriotomies, and end-to-end anastomoses

Summary A follow-up study of 5½ years of 9 dogs undergoing experimental coronary artery surgical procedures has been presented. Bypass aorto-circumflex coronary grafts, employing the external jugular vein, have been found to undergo significant dilatation. Longitudinal arteriotomies and oblique end-to-end anastomoses of the coronary arteries were found to maintain long-term patency without stricture formation or histologic evidence of degenerative change.

The effect of partial portacaval transposition on the canine liver.

The influence of nonhepatic splanchnic venous blood on dog liver morphology and biochemical content was investigated by performing partial portacaval transposition, anastomosing the supra-adrenal inferior vena cava to either the right or left branch of the main portal vein. In the resulting preparation, nonhepatic splanchnic venous blood supplies one portion of the liver and systemic venous blood perfuses the remaining fraction. Seven dogs were studied for 70 to 94 days, 3 with right and 4 with left transposition. No clinical abnormalities were noted. Transient enzyme elevations were seen early after operation but reverted to normal. The most striking feature was the gross and microscopic atrophy and deglycogenation which occurred in the part of the liver receiving systemic venous blood. Blood flow studies were performed in 8 additional dogs with an electromagnetic square wave flowmeter. Flow was measured in both right and left portal vein branches before and 1 to 4 hours after partial transposition to either the right (4 dogs) or left (4 dogs) main branch. Flow rates were increased in 11 instances and remained essentially the same in 5. In 2 more dogs, a jugular venous autograft was placed between the abdominal aorta and the right or left main portal vein branch. Atrophy and deglycogenation in the portion receiving arterial blood was comparable to that described above in liver fractions perfused with systemic venous blood. The evidence from these and earlier experiments that splanchnic venous blood contains a hepatotrophic substance is discussed.

Evaluation of venous autografts and aortic homografts in canine intrathoracic venae cavae for periods up to eight years

Evaluation of venous autografts and aortic homografts in canine intrathoracic venae cavae for periods up to eight years

Vascularized venous autografts in common bile duct reconstruction.

THE SURGICAL correction of benign stricture of the common bile duct is one of the most technically challenging surgical problems. As emphasized by Cattell1and others, the best long-term results ensue when the ampulla of Vater's normal function is preserved. In the clinical setting, however, this is frequently not possible. The only recourse then is to implant the proximal duct into an adjacent portion of jejunum or duodenum. Considerable effort has been expended in the search for a suitable substitute for biliary ductal structures. Imaginative attempts using metal, rubber, and plastics2-5have uniformly been unsuccessful. Viable structures of all sorts have been tried. These have included autogenous vein, artery, appendix, fascia, peritoneum, jejunum, and skin,6-10as well as homografts of preserved common bile duct and artery.10None of these tissues so used has met with success in a significant percentage of cases. Failures in graft substitution

Resection of the Superior Mesenteric Vein and Replacement with a Venous Autograft During Pancreaticoduodenectomy

SIGEL, BEBNARD M.D.; BASSETT, JAMES G. M.D.; COOPER, DONALD R. M.D.; DUNN, MARVIN R. M.D. Author Information

Arteriotomy patching by means of intraluminal pressure sealing venous autografts. A preliminary technical report.

Arteriotomy patching by means of intraluminal pressure sealing venous autografts. A preliminary technical report.

REPLACEMENT OF THE DEEP VEINS OF THE LEG.

The many patients with chronically swollen and frequently ulcerated legs remain an eloquent testimony to the inadequacy of our present methods of treatment of the postphlebitic legs. The principles of vessel replacement which have been so effective in the surgical treatment of arterial insufficiency have usually been neglected and the modern principles of treatment of venous insufficiency are still mainly those of support, ligation, or excision. Of the various materials with which surgeons have attempted to replace the veins of the leg, satisfactory patency rates and continued valve function have been achieved only with venous autografts. The reported patency rates with venous autografts in the femoral vein of the dog have varied widely but in general have been less than those achieved when the graft was used to replace veins of similar size in other areas such as the renal vein or jugular vein.^1,2DeWeese and Niguidula,³and

VENOUS AUTOGRAFTS IN FEMOROPOPLITEAL ARTERIOPLASTY. OBSERVATIONS IN THE TREATMENT OF OCCLUSIVE DISEASE.

Although the causes of the generally disappointing late results of grafting operations in the treatment of femoropopliteal occlusive disease are complex, 1 the unsatisfactory behavior of plastic arterial substitutes in this anatomical region is one of the important contributory factors. In an attempt to improve our femoropopliteal grafting technique, 30 months ago we turned to the use of autogenous veins as implant material in a manner similar to that originally described by Kunlin, 2 and more recently advocated by Linton. 3 The purpose of this communication is to describe briefly the technical aspects of the operation and to assess its value on grounds of the clinical, angiographic, and pathologic observations gathered in 52 cases. Case Material During the past ten years, our indications for the surgical correction of femoropopliteal occlusive lesions have grown progressively narrower. At the time, about three years ago when our trial with venous autografts began, our

Surgical management of infected aneurysms

A complete series of eighty-four infected aneurysms obtained from the literature and personal experience, and by questionnaire has been analyzed for factors which influence the success of repair. Ligation of the artery and resection of the aneurysm are preferred whenever possible. Resection of the aneurysm and arterial anastomosis or aneurysmorrhaphy are preferred whenever arterial continuity must be restored. The necessity of substitution for the loss of arterial substance increases the likelihood of failure. Venous autografts are suggested as a suitable means of reconstruction whenever they may be reinforced by surrounding tissue. The term “infected aneurysm” appears preferable to the more limited term “mycotic aneurysm.” Infected aneurysms can be further subdivided into those previously called mycotic and those which result from an arterial suture line. This division seems important because of the specific problems represented by each.

Use of fibrinolysin in experimental inferior vena caval replacement.

Replacement of venous segments remains one of the unsolved problems in vascular surgery. In most instances, the failure is due to thrombotic occlusion of the graft, with the thrombosis originating at the suture line.⁴ This project was carried out in order to determine the value of fibrinolysin in the prevention of thrombotic occlusion of the inferior vena cava. Venous autografts and various prosthetic materials were compared in both control and test groups because these represent extremes of success and failure in venous replacement. Bryant²reports 8 of 10 successful venous autografts used for inferior vena caval replacement. He had no success when using freeze-dried arterial homografts, freeze-dried venous homografts, and a variety of prosthetic grafts. Egdahl⁵reports no success with Orlon prostheses. Much work has been done on superior vena caval replacement. Results are conflicting,⁴but, in general, fresh venous autografts are most successful, venous and

Replacement of venous defects by venous autografts.

At the present time there are few indications for the repair or replacement of venous defects. As the scope of surgery grows, however, reconstitution of the vena cava and other major veins will require the availability of suitable graft material. There is, at present, no definitive answer as to which type of replacement is most desirable for venous reconstruction. Indications for venous reconstruction presumably will include circumstances in which the superior vena cava, the inferior vena cava above the renal veins, the superior mesenteric veins, the portal vein, or one or both renal veins are involved by tumor, trauma, thrombosis or postinflammatory obliteration. Other indications might include instances in which major venous shunts are required, as in the surgery of congenital anomalies of the heart and great vessels, or in portal to systemic shunting procedures. The present study was undertaken first to compare autogenous with homologous vein grafts, and secondly

Reconstructive Arterial Surgery in Upper-Extremity Injuries

A plea is immade for primary restoration of arterial continuity in cases of upper-extremity traunma involving injury to major arteries. This is justified by the high incidence of limb loss in such injuries and is particularly important where there is conconmitant injury in the distal, relatively ischaemic portion of the extremity. Such efforts can be rewarding even in late and neglected cases. Excellent flow through the reconstructed vessel is essential to success. This requires scrupulous attention to the avoidance of stricture at the suture line and complete removal of distal thrombus in the artery. The latter can be accomplished by retrograde flushing or by the use of instruments from an unthrombosed point in the distal portion of the artery. Re-exploration in the event of postoperative thrombosis is urged since this frequently will convert failure to success if the reason for thrombosis is recognized and corrected. The free use of venous autografts is recommended. Extremes of heat and cold are to be avoided in the extremity with marginal circulation since both can cause serious tissue injury. The extremity should be warmed to a temperature of from 80 to 90 degrees Fahrenheit. Even severe degrees of ischaemic injury resulting from long periods of circulatory arrest will heal and allow salvage of a useful extremity if the circulation is restored. Conservatism is urged in the treatment of such cases.

Iliofemoropopliteal Arterial Reconstructions for Arteriosclerosis Obliterans

IT is more than eleven years since dos Santos1 reported his pioneer attempts at the reconstruction of arterial channels that had been closed by arteriosclerosis obliterans. He used a method of curettement called thrombendarterectomy, which removed the diseased central layers of the arterial segment, consisting of thrombus, degenerated intima and the part of the media, often varying in width at different levels, involved in the pathologic process.Venous autografts and arterial homografts had been known for some time to function in laboratory animals2 3 4 5 6 and in reconstructions of traumatic lesions7 , 8 and of aneurysms9 in man. Isolated examples of late results were . . .

Experimental replacement of short segments of veins.

Discouraging results have usually followed the insertion of replacement grafts into the vena cava of dogs. Deterling and Bhonslay 4 observed some success with aortic homografts in the superior vena cava, but their results with Ivalon (polyvinyl formalinized) sponge, taffeta of Dacron and nylon, woven nylon tubing, and venous autografts were discouraging. Egdahl and associates 5 and Daniel 2 observed limited, but better, results with tissue grafts than with plastic tubes or synthetic fabrics inserted into veins. Kay 9 was successful in 30% of dogs in which he inserted caval homografts. DeBakey 3 noted success in only 25% of the dogs which had an aortic homograft placed in the vena cava. Various authors 9,10,12 have frequently reported complete failure, or only partial success, with grafts inserted into the vena cava of patients, but isolated reports have indicated the successful clinical replacement of segments of the vena cava. 4,7,8 Inadequate clinical

Experiences with ivalon (polyvinyl formalinized) sponge prostheses for vascular replacements.

Until approximately one year ago, we had been fairly well satisfied with lyophilized homografts for use in vascular replacements for central artery defects. However, because of involved difficulties in procurement of homografts in our area (particularly regarding distal arteries) plus the failure on occasion of venous autografts, 1 the late suture line disruption in some homografts in our own and others' experience * and occasional aneurysm formation in homografts reported by others, 2 we undertook a search for other and more ideal prostheses where the problem of supply would not be ever-present. Our present solution to the problem is Ivalon (polyvinyl formalinized) sponge, as described by Shumway and his associates. 9 This sponge is strong, resilient, elastic when wet, and, when washed free of chemical contaminants, inert in tissue. 4,9 Ingrowth of fibrous tissues and capillaries into implanted sponge occurs in a regular noninflammatory fashion so that there is no true