Stenotic lesions in dialysis-access fistulas: treatment by transluminal angioplasty using high-pressure balloons.

Eighty-four balloon dilatations of dialysis-access fistulas have been performed over a five year period. Fifty-two were done with polyethylene balloons and the last 32 with high-pressure Olbert balloons. Initial success was significantly greater with the high-pressure balloons, but long-term patency rates were similar.

Arterialization of the portal vein for control of variceal bleeding. Clinical and angiographic follow-up.

Angiographic and clinical findings in 33 patients who underwent arterialization of the portal vein and end-to-side portacaval shunt over a seven-year period are reviewed. Both encephalopathy and postoperative bleeding were less frequent than in previous series. Major angiographic findings included stenosis or closure of the gastroepiploic artery-portal vein shunt, narrowing of the intrahepatic portal vein, aneurysm formation in the saphenous vein graft, shunt narrowing or thrombosis, and development of portosystemic collaterals.

Angiography of upper extremity access fistulas for dialysis.

One-hundred twenty-five cases of upper extremity internal arteriovenous and graft fistulas were reviewed. Clinical problems requiring study were poor fistula flow during dialysis, difficulty in cannulation, diminished graft pulsations, extremity edema or varicosities, the appearance of pulsatile or nonpulsatile masses in the graft or fistula, and distal ischemia. Angiography demonstrated venous occlusion (13 cases), venous stenosis at or near the anastomotic site (32 cases), thrombi within shunts (9 cases), venous aneurysms or pseudoaneurysms related to either proximal obstruction or traumatic dialysis (23 cases), distal venous overdistention due to proximal obstruction or overcirculation (15 cases), and radial artery steal of blood from the distal extremity (15 cases).

Influence of cadaver donor age on the success of kidney transplants.

To investigate the impact of donor age on the outcome of renal transplants, a retrospective analysis of 440 consecutive cadaver donor kidney transplants were performed by dividing the transplants into six groups, according to the decade of donor age. These groups were comparable with regard to recipient age, sex, race, and HLA matching grade, while the pediatric group received kidneys preferentially from the first and second decade donors. Although cadaver donor age, between 11 and 50 years, did not appear to influence the result of kidney transplants, the kidneys retrieved from the first and sixth or higher decades of donors fared significantly worse.

Evaluation of anterior extravesical ureteroneocystostomy in kidney transplantation.

We evaluated the anterior extravesical ureteroneocystostomy technique in 184 consecutive renal transplants done in 2 consecutive calendar years. Complications included 5 cases of ureteral and 1 of pelvic necrosis, and 2 of ureteral obstruction, with a ureteral complication rate of less than 4 per cent. All cases of pelvic or ureteral necrosis except 1 were seen in cadaver donor kidneys that were imported from other centers.

Arterialization of the portal vein in cirrhosis: the findings at celiac arteriography.

An angiographic study of a new operation for portal hypertension involving arterialization of the portal vein in combination with an end-to-side portacaval shunt is described. The angiographic appearances differ from those of end-to-side shunts alone. With the new operation there is, in particular, no significant change in the wedge pressure or in the hepatic artery size from preoperative to postoperative studies, and in the majority of patients, the liver size is also unchanged.

Arterialization of the portal vein in cirrhosis: the findings at wedge hepatic venography.

A new operation for the treatment of cirrhosis and portal hypertension has recently been described involving arterialization of the portal vein in combination with an end-to-side portacaval shunt. We present, for the first time, the appearances at wedge hepatic venography. No significant change is seen in the wedge hapatic pressure as a result of this technique, and the sinusoidal pattern is preserved.

Distribution of water between extracellular and intracellular compartments of incised wounds of rabbits.

The distribution of water between the extracellular and intracellular compartments in incised wounds of skin, muscle and stomach has been studied in healthy rabbits and the progress of healing monitored by the determination of tensile strength for 120 days. It has been shown that, after wounding, there is an immediate expansion of the extracellular space. The increase is most marked during the first 24 hours and is maximal by this time in wounds of the skin and the muscle.

Prognostic significance of portal pressure in patients with bleeding esophageal varices.

Portal pressure was determined in 76 patients during acute bleeding varices, and the degree of portal hypertension was related to the cessation or noncessation of hemorrhage with nonoperative management. A direct relationship between the severity of hemorrhage and the degree of portal hypertension was established. It is suggested that portal pressure be determined as soon as feasible when bleeding varices are suspected and that other causes of hemorrhage be carefully excluded.

Arterialization of the liver in combination with a portacaval shunt in the dog.

A dog preparation has been developed combining an end-to-side portacaval shunt with arterialization of the hepatic portion of the portal vein through an anastomosis between the inferior branch of the splenic artery and the stump of the portal vein. In this dog preparation, total hepatic blood flow, perfusion of the intrahepatic portal vein, and sinusoidal pressure remained within the preoperative range in the majority of the dogs. The data presented indicate that arterialization of the liver, under those conditions, resulted in no histologic damage or atrophy of the parenchyma of the liver and was effective in achieving significant prolongation of life and prevention of most of the adverse metabolic sequelae that follow a portacaval shunt in dogs.