Use of von Willebrand diseased kidney as donor in a pig-to-primate model of xenotransplantation.

Background: The coagulation process in hyperacute and delayed xenograft rejection is essential and depends upon platelet adhesion and aggregation. The initial binding of platelets to the damaged endothelium is due to the interaction of the platelet receptor glycoprotein Ib with von Willebrand factor (vWF), which is present on activated endothelial cells and bound to the subendothelial matrix. We hypothesized that the use of organs from animals with homozygous von Willebrand disease (vWD), severely deficient in vWF, might prevent the thrombosis encountered in delayed xenograft rejection.

Removal of primate xenoreactive natural antibodies by extracorporeal perfusion of pig kidneys and livers.

Organ perfusion is one of the possible strategies to attenuate rejection of discordant xenografts by reducing the levels of the recipient's xenoreactive natural antibodies (XNA). Its efficacy in terms of XNA removal was studied in models of primate blood or plasma perfusion through porcine kidneys or livers, with special attention to haematological consequences and potential side-effects. We first perfused the blood of rhesus monkeys through pig kidneys and livers, and demonstrated that the perfusion of a pig liver resulted in higher XNA adsorption (72 +/- 13%) than the perfusion of a pig kidney (51 +/- 25%).

Albumin-impregnated prosthetic graft for infrarenal aortic replacement: effects on the incidence and volume of perioperative blood transfusion.

We retrospectively reviewed 290 cases in which an albumin-impregnated polyester prosthetic graft was used for surgical management of aortic bifurcation disease between November 1987 and December 1990. The purpose of this review was to determine the incidence and volume of blood transfusion and to evaluate the rate of patency and the incidence of infection achieved using this type of prosthesis. The indication for surgery was abdominal aortic aneurysm (AAA) in 218 cases (190 elective procedures and 28 emergency procedures) and occlusive disease of the aortic bifurcation (ODAB) in 72 cases.

The pig as a model in liver xenotransplantation.

Xenotransplantation is considered to be the best solution to the critical shortage of human donors. Despite its phylogenetic distance, the pig appears to be the most appropriate source of organs for transplantation in humans. Its anatomy and physiology are similar to that of man, it can be raised in specific pathogen free environments and it is available in large quantities.

[An original case of simultaneous cardiac, pancreatic and renal transplantation. Results over 6 years].

Combined transplantation is actually performed on specific and rare indications. We are presenting here the results of a combined heart-kidney and pancreatic graft. It was performed in a patient presenting an idiopathic cardiomyopathy in end-stage failure and a post-diabetic nephropathy on dialysis.

[Evaluation of a new technique of extracorporeal perfusion of the swine liver on a swine-primate model].

With the increasing success of liver transplantation there is an urgent need for developing an artificial liver support system to be used in patients with liver failure. An extracorporeal porcine liver perfusion machine was successfully tested in animals with experimental liver failure. Livers were flushed, removed from 35 kg pigs and placed in a heated sterile cassette.

Evolution of carotid restenosis after endarterectomy.

Some 176 consecutive carotid endarterectomies performed during 1987 were assessed after 11.5 and 44 months. There were four perioperative deaths.

Does carotid eversion endarterectomy and reimplantation reduce the risk of restenosis?

Two hundred twelve eversion endarterectomies of the internal carotid artery and reimplantation in the common carotid artery were performed between January 1985 and July 1990. A total of 206 patients with stenosis of 75% or more and with redundancy and tortuosity of the internal carotid artery underwent this procedure. Cumulative mortality and neurologic morbidity were 2.

[Transesophageal echography and peripheral arterial embolism. A new etiologic approach. Apropos of 87 cases].

This prospective study (September 1989 to November 1990) was undertaken to evaluate the utility of transesophageal echocardiography in acute peripheral ischaemic syndromes. After embolectomy or thrombolysis, 87 patients with an average age of 69.7 years underwent not only the usual investigations (conventional echocardiography, abdominal ultrasonography and Holter monitoring) but also transesophageal echocardiography within 2 days of the ischaemic events (lower limb 84%, multiple embolism 11%, recurrent embolism 13%).

Traumatic lesions of the thoracic aorta. A report of 73 cases.

In a 24 year period we treated 73 traumatic lesions of the thoracic aorta; 36 of these were acute ruptures and 37 post traumatic pseudo-aneurysms. All these cases were associated with violent, sudden deceleration and in 68 instances the cause of this was a traffic accident. Fifty two patients (70%) had severe associated lesions involving the cranium, abdomen, thorax or leg fractures and dislocations but in 5 patients the aortic rupture was the only injury observed.

What is the place of pulmonary embolectomy today?

From 1.1970 to 31.12.

[Surgery of gastrointestinal vessels, selective indications for revascularization in a syndrome suggestive of chronic small intestinal ischemia].

The authors present a critical review of the indications for revascularization of intestinal arteries in the presence of chronic ischaemia of the small intestine. They stress the extreme lability of the "chronic" clinical stage and emphasize the fundamental importance of establishing the diagnosis before the development of acute complications. Based on a personal experience of 92 intestinal revascularizations with a follow-up of one to 26 years, they stress the good quality of the results obtained after isolated revascularization of the superior mesenteric artery by direct or indirect reimplantation into the infrarenal aorta.

Percutaneous atherectomy with the Kensey catheter: early and midterm results in femoropopliteal occlusions unsuitable for conventional angioplasty.

Forty-six femoropopliteal occlusions in 44 patients (aged 45-95 years) were recanalized with the percutaneous rotating tip atherectomy catheter completed by balloon dilatation. Thirty-one patients had tight intermittent claudication of the lower limbs, five had resting pain and 10 had skin disorders. The length of the occlusion ranged from 2 to 24 cm.

Aortic reimplantation of the superior mesenteric artery for atherosclerotic lesions of the visceral arteries: sixty cases.

We report the results of a series of patients who had isolated or associated reimplantation of the superior mesenteric artery directly into the infrarenal aorta. Between 1967 and 1988, a total of 91 revascularizations for atheromatous lesions of the visceral arteries were performed in 89 patients. The superior mesenteric artery was reconstructed in 87 instances, 60 of which were direct or indirect reimplantations into the juxtarenal aorta.

Superior mesenteric artery embolism: eighty-two cases.

Eighty-two consecutive patients with superior mesenteric artery embolism were treated between 1966 and 1988. Abdominal pain was atypical or absent in 19 (23%) patients. Except for two instances of intraoperative embolism, emergency mesenteric arteriography was diagnostic in all cases.

[Peripheral arterial recanalization using a Kensey catheter].

Between June 6 1988 and September 30 1989, 46 superficial femoral obliterations in 44 patients were treated by rotary atherectomy, completed by conventional dilatation in 40 patients. The 44 patients (27 males and 17 females), mean age over 66.5 years (45 to 90), presented symptomatic superficial femoral obliterations (17 tight stage, two occlusions, 5 stage III, and 10 stage IV occlusions), with mean length of 9.

[Is Trendelenburg's procedure still useful in 1990? Apropos of 3 cases of massive pulmonary embolism surgically treated successfully in a general surgery department].

The authors report about 3 cases of massive pulmonary embolism operated successfully in a context of general surgery. As they discuss the data given by the literature, they establish the remaining indications of Trendelenburg's procedure, as well as the problems encountered today to perform it without the help of extracorporeal circulation.

[Surgical therapy of acute mesenteric artery occlusion].

Only early diagnosis and vascular surgery during the period of ischemic tolerance (about 12 hours) will improve the results of treatment of acute splanchnic artery occlusion. From 1966 to 1989, 98 patients were treated: 81 underwent operations (65 emboli of the SMA, 16 arteriosclerotic obstructions). Of the 47 patients who were treated at the stage of reversible acute mesenteric ischaemia 12 died (25.

[Embolectomy in massive lung embolism].

Pulmonary embolism was first described by Laennec in 1819. After introduction of the Trendelenburg surgical technique, Kirschner, in 1925, performed the first successful embolectomy. In a review of the literature, in 42 patients, survival rate was 45% on use of a modified Trendelenburg method employing cross-clamping of the vena cava.