Intrathoracic lymphangioma.

Of 14 cases of intrathoracic lymphangioma, 4 occurred in the anterior, 5 in the superior, and 4 in the posterior mediastinum. One lesion was diffuse and associated with disappearing bone disease (Gorham's disease). The anterior mediastinal lymphangiomas occurred in adults and seemed to arise from the mediastinum.

Axillary-subclavian venous occlusion: the morbidity of a nonlethal disease.

To evaluate results of medical and surgical treatment of axillary-subclavian venous occlusion, the clinical courses of 95 patients were reviewed. Twenty-three patients had acute axillary-subclavian venous thrombosis, and 72 patients had chronic occlusion. Thirty-four patients with thoracic outlet syndrome and axillary-subclavian occlusion represented 3.

The natural history of microsurgical lymphovenous anastomoses: an experimental study.

Lymphovenous anastomoses have been suggested for the treatment of lymphedema, but the literature lacks evidence of late patency. To determine a method to verify patency, 57 lymphovenous anastomoses were performed in 34 dogs. In vivo cinelymphangiography gave convincing evidence of patency up to 8 months.

Lymphoscintigraphy in lymphedema: an aid to microsurgery.

The role of lymphoscintigraphy, performed with 99mTc-labeled antimony sulfur colloid, in the diagnosis of lymphedema and as a test for selection of patients for microvascular operation was evaluated in 32 patients with primary and secondary lymphedema and four patients with other causes of leg edema. Lymphoscintigraphy clearly demonstrated if edema was of lymphatic origin. Five different image patterns were identified; abnormal image patterns could not be predicted from clinical history or physical findings.

The importance of endothelial cells in the course of vascular surgical interventions.

Aorto-coronary bypass made by implanting the patient's own saphenous vein may exhibit a tendency to early and late occlusion. This phenomenon is influenced by a number of factors including intraoperative damages of the graft. To determine preferable techniques for preserving vein integrity, various human graft preparation techniques were compared.

Prevention of platelet deposition by ibuprofen and calcium dobesilate in expanded polytetrafluoroethylene vascular grafts.

This study was designed to evaluate the platelet-inhibiting effect of a new drug, calcium dobesilate, and to compare its efficacy to the known antiplatelet agent, ibuprofen. Five centimeter long expanded polytetrafluoroethylene grafts (internal diameter 4 mm) were used to replace 48 carotid arteries in 24 dogs. Autologous platelets were labeled with indium-111-labeled tropolone and reinjected into each animal 24 hours before operation.

Overcoming failure of venous vascular prostheses.

Thrombogenicity of graft material, low velocity of blood flow, and wall collapsibility have been cited as the main factors responsible for the high occlusion rate of vascular prostheses placed in the venous system. This study was performed to analyze the effects of measures taken to overcome each of these factors. The thrombogenicity of expanded polytetrafluoroethylene (ePTFE) was evaluated by determination of the 3-hour deposition of radionuclide-labeled platelets and fibrin on grafts placed in the infrarenal vena cava of 18 dogs.

Morphologic quantitation of pseudointima and effects of antiplatelet drugs on vascular prostheses in goats.

The natural process of endothelialization, pseudointimal formation, and connective tissue incorporation of the expanded PTFE grafts in the goat was documented through histologic examination of specimens harvested at 2, 4, 6, and 8 weeks. The goats demonstrated a progressive increase in pseudointimal pannus ingrowth from the anastomoses at a rate of 11.3 mm over a 12 week period.

The effect of preclotting on surface thrombogenicity and thromboembolic complications of Dacron grafts in the canine thoracic aorta.

Previous reports have advocated preclotting and autoclaving of Dacron grafts to prevent graft hemorrhage, yet no data delineate possible changes in surface thrombogenicity or thromboembolic risks. To assess these factors, preclotted and preclotted-autoclaved woven Dacron prostheses were implanted in the thoracic aorta of 31 dogs. Grafts were harvested 1 week to 1 month following implantation, and the thrombus-free surface of each graft was calculated by computerized morphometry.

Prognosis and management of lesions of the trunk in children with Klippel-Trenaunay syndrome.

The Klippel-Trenaunay syndrome is a congenital vascular anomaly consisting of the triad of soft-tissue and bony hypertrophy of the extremities, hemangiomas and/or lymphangiomas, and varicosities. From 1956 to 1983, 42 patients with the Klippel-Trenaunay syndrome were seen at the Mayo Clinic. Of the 42 patients, 16 had involvement of the trunk (thorax, abdomen and/or pelvis).

Ibuprofen in experimental vascular surgery.

Animal studies have been conducted to determine the effectiveness of ibuprofen in reducing early platelet deposition on small diameter (4 mm) Gore-Tex (polytetrafluoroethylene) arterial grafts and larger (10 mm) Gore-Tex grafts placed in the inferior vena cava. These studies demonstrated a significant reduction in platelet deposition at one and three hours. Additional studies of animals undergoing treatment with ibuprofen and subjected to arterial replacement with 1 or 4 mm Gore-Tex grafts demonstrated enhanced patency at 30 days.

Experimental replacement of the inferior vena cava: factors affecting patency.

To evaluate factors influencing graft patency in the venous system, we replaced the inferior vena cava (IVC) in 50 dogs. Expanded polytetrafluoroethylene ( ePTFE ) grafts with external support were implanted into 32 animals while autogenous, spiral jugular vein grafts were used to replace the IVC in 18 dogs. 111In-labeled autologous platelets and 125I-labeled canine fibrinogen were utilized to evaluate early thrombus formation.

Late survival after abdominal aortic aneurysm repair: influence of coronary artery disease.

To evaluate long-term survival in relation to preoperative risk factors, we reviewed 1112 patients undergoing abdominal aortic aneurysm (AAA) repair from 1970 to 1975. A 6-to 12-year follow-up was obtained on 1087 patients (97.7%) by chart review, death certificates, autopsy reports, and questionnaires returned by patients and referring physicians.

Quantitative evaluation of ibuprofen treatment on thrombogenicity of expanded polytetrafluoroethylene vascular grafts.

To evaluate the effect of ibuprofen on graft thrombogenicity and early patency, expanded polytetrafluoroethylene (ePTFE) (Gore-tex) grafts with an inside diameter of 4 mm and length of 5 cm were implanted into the femoral artery in 43 dogs. Autogenous vein bypass was performed on the contralateral side. 111In-labeled platelets were injected into 16 dogs 24 hours prior to operation, and eight of these received 12.

Inferior vena cava replacement: the role of antiplatelet therapy.

To evaluate the effect of ibuprofen on early thrombus formation following inferior vena cava (IVC) replacement, a 4-cm segment of IVC was replaced with a 5-cm (10-mm-i.d.) segment of reinforced polytetrafluoroethylene (PTFE) graft in 12 dogs.

Ultrastructural and electrophysiologic changes of experimental acute cardiac lymphostasis.

Experimental impairment of cardia lymph flow in dogs produced histologic and electrophysiologic changes in the heart. Interstitial edema, lipid swelling of myofibrils, dilatation of lymph vessels, and fibrinoid degeneration of small coronary arteries occurred in and near the sinus node and the atrioventricular conduction system. On electrical stimulation of the heart, significant shortening of the atrial and ventricular effective refractory periods, increases in the sinus node recovery time and in the atrioventricular conduction time, and ventricular extrasystoles and ventricular fibrillation were observed.

Quantitative effects of antiplatelet therapy on healing of the endarterectomized canine aorta.

This study was designed to quantitatively evaluate the effects of an antiplatelet agent, ibuprofen, on mural thrombus formation and pseudointimal development in the endarterectomized canine aorta. A 3 cm segment of abdominal aorta was endarterectomized in 18 dogs. Nine dogs served as controls and nine dogs were treated with ibuprofen (12.

Arteriomegaly: classification and morbid implications of diffuse aneurysmal disease.

Ninety-one patients with arteriomegaly and diffuse aneurysmal disease below the level of the renal arteries have been classified according to the extent and location of aneurysmal change. There exists a high incidence of thrombotic and embolic complications, and treatment entails increased rates of morbidity and mortality when compared to surgical treatment of simple abdominal aneurysms of peripheral artery aneurysms. Complete revascularization at the initial operation would appear to give the best result, but this approach must be tempered by the individual patient risk factors and the urgency of the mode of presentation of the patient.

Surgical implications of Klippel-Trenaunay syndrome.

Between January 1956 and July 1981, 40 patients with Klippel-Trenaunay syndrome were seen at the Mayo Clinic. Twenty male and 20 female patients presented with the classic triad of soft tissue and bony hypertrophy of the extremity, hemangioma, and varicosity without evidence of functional arteriovenous fistulae. The lower extremity was involved in 38 patients (95%), the upper extremity in six patients (15%).

Patency of polytetrafluoroethylene microarterial prostheses improved by ibuprofen.

Because of the increasing need for a reliable prosthetic microvascular graft, we investigated the patency of expanded PTFE with and without platelet inhibitor medication as an arterial prosthesis (1 by 10 mm) placed in the aorta of the rat using standard microsurgical technique. In 10 animals without platelet-inhibitor medication, one graft (10 percent) was patent at 30 days. When the platelet inhibitor ibuprofen was given for the initial 15 days to 10 animals, all 10 grafts (100 percent) remained patent at 30 days without further use of the drug.

Limb circulation in varicosity of various types.

Regulation of limb circulation was studied by the use of the venous isotope dilution technique in 35 patients with leg varicosities. The circulatory parameters of 54 patients with normal limb circulation served as control. The various types of varicosity revealed characteristic circulatory patterns.

Lymphatic cardiomyopathy: cardiac lymphostasis in the pathogenesis of arrhythmias.

Artificial lymphatic cardiomyopathy was produced in 30 dogs by ligating the regional lymph nodes and the efferent collecting lymph trunks of the heart. In the development of cardiac lymphostasis the appearance of arrhythmias and conduction disturbances was revealed by repeated ECG recordings. The arrhythmic condition of the heart increased and pacemaker function of the sinus node deteriorated in lymphatic cardiomyopathy.

The effect of cardiac lymphostasis on the microcirculation of the heart: effect of cardiac lymphoedema on the development of an arteriovenous shunt circulation.

The effect of cardiac lymphostasis on the microcirculation of the heart was studied in 18 dogs. By ligation of the main lymph trunks and regional lymph nodes of the heart, cardiac lymphoedema--lymphogenic cardiomyopathy--was induced in 9 dogs, while 9 served as control animals. For microcirculatory investigations: 1) gelatin Indian ink injection, 2 benzidine reaction, 3) PVC injection corrosion preparation was applied.

[Factors determining the patency of experimental anastomoses between lymphatic vessels and veins].

End-to-end anastomoses between lymph vessels and veins performed under microscopy (magnification lox--20 x) may be useful in the treatment of certain types of lymphoedema. End-to-end anastomosis of the vena profunda femoris and a deeply localized lymph vessel have been performed on the hind-legs of 10 dogs. Scanning electron microscopic investigation of the anastomosis has been carried out at 0h, 48h and 8 days respectively after the operation.