Evolution of staples and clips for vascular anastomoses.

Because of the development of less invasive surgical techniques, there is an increasing demand for vascular anastomosing techniques that require less exposure of the operating field. This paper reviews the most important representatives of staples, clips, and other mechanical devices for vascular anastomosing described over the last five decades. This report is organized in three parts: (1) the history of clipping and stapling devices, (2) development of the Vessel Closure System (VCS) clips, and (3) current and potential status of mechanical vascular anastomotic devices.

Causes of limited survival of microencapsulated pancreatic islet grafts.

Successful transplantation of pancreatic tissue has been demonstrated to be an efficacious method of restoring glycemic control in type 1 diabetic patients. To establish graft acceptance patients require lifelong immunosuppression, which in turn is associated with severe deleterious side effects. Microencapsulation is a technique that enables the transplantation of pancreatic islets in the absence of immunosuppression by protecting the islet tissue through a mechanical barrier.

Five years' world experience with nonpenetrating clips for vascular anastomoses.

Background: A new sutureless technique has been introduced clinically to facilitate the process of vascular reconstruction and improve patency. The Vessel Closure System (VCS) is nonpenetrating, creates an elastomeric everted anastomosis, and is easily and reproducibly applied. The objective of this report is to review the published world experience that has accrued regarding these clips with attention to the assets, liabilities, and pitfalls associated with the new technology.

Macrophage overgrowth affects neighboring nonovergrown encapsulated islets.

Background: Encapsulation significantly prolongs islet graft survival in the absence of immunosuppression. However, encapsulated islet graft survival is limited to periods of several months. Part of the encapsulated islet graft is affected by a nonprogressive pericapsular overgrowth.

Brain death induces apoptosis in donor liver of the rat.

Background: A difference in short- and long-term function between living-related and cadaveric donor organs is consistently shown in kidney- and liver-transplant studies. We hypothesize that this is caused by induction of apoptosis and inflammation of the potential graft because of the phase of brain death (BD) in the cadaveric donor that predisposes for additional transplant injury. Previously, we have shown inflammation in the liver of brain-dead donors by increased expression of cell adhesion molecules and influx of leukocytes.

Effective removal of alginate-poly-L-lysine microcapsules from pancreatic islets by use of trypsin-EDTA.

Although the transplantation of alginate-poly-L-lysine-alginate encapsulated islets of Langerhans usually is successful, graft survival is still limited. Molecular analysis by RT-PCR of the encapsulated islets may provide insight into the mechanisms that affect islets during graft failure. However, RT-PCR on encapsulated islets is not possible because the poly-L-lysine of the capsule interferes with both cDNA synthesis and PCR amplification.

Relationship between duration of brain death and hemodynamic (in)stability on progressive dysfunction and increased immunologic activation of donor kidneys.

Background: Consistent difference in graft survival after renal transplantation has been shown when cadaveric transplants are compared to the living related donor situation, in favor of the latter. Recently, evidence has been put forward that brain death has significant effects on the donor organ quality. In this study, we aimed to assess the relation between brain death-induced hemodynamic instability in combination with the duration of brain death on the function and immunogenicity status of potential donor kidneys.

Endovascular repair of acute AAAs under local anesthesia with bifurcated endografts: a feasibility study.

Purpose: To evaluate endovascular repair of abdominal aortic aneurysms (AAA) under local anesthesia in the acute setting.

Methods: Between 1998 and 2001, 47 patients with an acute AAA were evaluated for endovascular repair after informed consent, provided they were in a stable, albeit hypotensive condition. The patients underwent urgent computed tomography to assess suitability for endovascular repair; 16 were eligible for stent-graft repair: 9 were frank ruptures and 7 were symptomatic aneurysms.

Factors predictive of failure of Brescia-Cimino arteriovenous fistulas.

Objective: To evaluate patency rates of Brescia-Cimino fistulas and to find out which independent factors were predictors of failure.

Design: Retrospective clinical study.

Setting: University hospital, The Netherlands.