Hemodialysis graft salvage.

Hemodialysis access procedures account for a large percentage of patients undergoing surgical treatment. Salvage procedures are frequently used to extend the life of a thrombosed graft and thereby maximize the limited available access sites. Factors that may influence the success of salvage procedures, as well as the financial risk to benefit comparison, may be of increasing importance in the era of aggressive medical cost containment.

Lower extremity revascularization via the lateral plantar artery.

Lower extremity bypass grafts to the tibial and crural arteries are commonly employed to treat patients with atherosclerotic limb-threatening ischemia. Although occasional series have mentioned bypasses to a plantar artery, few of these specifically examine the results of arterial reconstructions using these vessels. Six patients underwent femoral to lateral plantar artery (LPA) bypass within a 19-month period for gangrene of the forefoot.

Traumatic juxtarenal aortocaval fistula and pseudoaneurysm.

We discuss the treatment of a fistula located between the aorta and inferior vena cava which was caused by trauma. Fewer than 30 such cases have been reported in the English literature. A juxtarenal pseudoaneurysm and aortocaval fistula resulting from a gunshot wound, unrecognized upon the initial presentation of the patient, is reported herein.

Primary venous aneurysms.

Venous aneurysms are rare lesions. They may, however, be the source of pulmonary emboli and can result in death. We have recently treated several patients who had venous aneurysms of the upper extremity and jugular system.

A technique for reducing the size discrepancy between large reversed veins and small arteries.

Autogenous vein remains the conduit of choice for lower extremity revascularization. When a large or dilated vein is used in a reversed manner, there may occasionally be a large size discrepancy between it and a small tibial artery. A technique is presented that reduces this mismatch and facilitates anastomoses between large veins and small arteries.

Abdominal aortic aneurysmectomy without preoperative angiography. A prospective study.

In an attempt to analyze whether routine angiography is necessary prior to elective abdominal aortic aneurysmectomy (AAA), a prospective study was designed in which this examination was obtained only for specific indications. These included significant hypertension, renal dysfunction, symptoms of visceral ischemia, suprarenal extension of the aneurysm or a coexisting thoracic aneurysm, and diminished or absent femoral pulses. A consecutive series of 124 abdominal aortic aneurysms is reported, in which 110 procedures were performed electively.

Late results of preferential use of tube versus bifurcation grafts for abdominal aortic aneurysmectomy.

The advantages of tube versus bifurcation graft replacement of abdominal aortic aneurysms are well known, yet the risk of future development of iliac occlusive or aneurysmal disease still leads many to use bifurcation grafts routinely. Several studies have reported little risk of this development when patients are followed clinically. They suffer, however, from lack of an objective means of identifying iliac aneurysms.

Chronic perigraft seromas in PTFE grafts.

Well known complications of polytetrafluoroethylene (PTFE) grafts include thrombosis, infection, and pseudoaneurysms. Chronic perigraft seromas (CPS) associated with knitted dacron grafts are well described but only sporadic cases have been described in conjunction with PTFE grafts. In order to document the clinical history of PTFE associated CPS, 1674 PTFE grafts placed during the period from December 1982 through December 1984 were evaluated for the presence of CPS.

Fungal graft infections: case report and review of the literature.

Fungal intravascular graft infections are rare. In addition to our case, which forms the basis of this article, only 13 documented instances could be found in the literature in the 20-year period from 1966 to 1986. Three of these cases (21%) had both fungus and bacteria grown in culture.

Control of needle hole bleeding with ethyl-cyanoacrylate glue (Krazy Glue).

Needle hole bleeding from polytetrafluoroethylene (PTFE) grafts causes blood loss and prolongs vascular procedures. Past studies have shown the cyanoacrylate glues to polymerize rapidly and cause minimal tissue toxicity. This study was undertaken to evaluate the efficacy of ethyl-2-cyanoacrylate glue (Krazy Glue, KG) in obtaining prompt hemostasis in vascular anastomoses in a heparinized canine model.

Physiologic anatomy of the palmar circulation in 200 normal hands.

The functional capacity of the Superficial Palmar Arch (SPA) was evaluated in 200 normal hands by a non-invasive narrow beam ultrasonic technique. Peak systolic velocity of flow with radial artery occlusion increased in all SPAs except for 22 (11%) which were considered incomplete. Ulnar artery occlusion resulted in a more variable response including 89 (45%) SPAs with bidirectional flow.

Hemodynamic assessment of the circulation in 200 normal hands.

The frequent use of arterial puncture, cannulation, and A-V shunting has demonstrated a greater degree of safety than could be predicted from previous anatomic and angiographic studies. Using a noninvasive technique, the status of the superficial palmar arch (SPA) and relative contributions of radial and ulnar arteries were determined in 100 volunteers with no history of vascular disease. Although there was no significant difference in the diameter of the vessels at the wrist, the flows showed statistically significant ulnar dominance, suggesting that the difference is a factor of a lower distal resistance on the ulnar side.

Low-dose streptokinase in the treatment of celiac and superior mesenteric artery occlusion.

Selective delivery of low-dose streptokinase was effective in the treatment of embolic occlusion of the celiac and superior mesenteric arteries. The two-catheter technique resulted in complete lysis of clot in the celiac artery and improvement in patency of the superior mesenteric artery. The procedure restored effective mesenteric blood flow and provided an alternative to surgery in a very ill patient.

Simultaneous bilateral carotid endarterectomies.

Twelve patients with bilateral symptomatic lesions of internal carotid arteries have had bilateral carotid endarterectomy at single operations without complications. These were patients up to age 80 who had prior mycardial infarction, stroke with recovery, and hemispheric and nonhemispheric episodes. Neurologist's clearance and three- or four-vessel intracranial-extracranial angiography preceded all operations, which were performed with the patient under general anesthesia.