Faculty Bibliography

A technique for occluding the supraceliac aorta through the abdomen is described. Although the procedure must be carried out without visual control, it can be accomplished safely and rapidly. It is recommended for use in patients in whom previous operations or disease processes make dissection of the infrarenal aorta without prior proximal control difficult and dangerous

Polytetrafluoroethylene grafts were used for 175 femoropopliteal reconstructions with a cumulative 3 year life table patency rate of 77%. Reoperation for early or late failure was required in 27 patients to achieve this patency rate. If these 27 failures were calculated as nonpatent grafts, 3 year patency would be 62%. Thirty month life table patency rates were 94 and 91% for polytetrafluoroethylene axillofemoral and femorofemoral bypasses, respectively. Twenty-two polytetrafluoroethylene axillopopliteal bypasses were performed because of infection in the groin, previously failed reconstructions or unavailability of femoral vessels due to disease. The 2 year life table patency rate was 69%, with nine of the grafts patent for more than 1 year. Forty polytetrafluoroethylene bypasses to arteries at the ankle or in the foot resulted in a 2 year life table patency rate of 48%. Thus, polytetrafluoroethylene grafts show early promise as a vascular prosthesis. Although further study will be required to define the exact role of this new arterial substitute, it already can facilitate the performance of otherwise difficult or impossible limb salvage procedures

Wound infections after transplant nephrectomy were analyzed retrospectively. When prophylactic antibiotics were not used, 20% of the closed nephrectomy wounds became infected. Eighty-one percent of the infections were due to staphylococcal organisms. Wounds containing a preexisting focus of infection or those reoperated on more than once within a month prior to nephrectomy are at such high risk for infection that these wounds should be left open for secondary healing. With the use of prophylactic cefazolin sodium, in the immediate preoperative and postoperative period, no wound infections have occurred in 18 closed transplant nephrectomy wounds

In a series of 175 polytetrafluorethylene (PTFE) femoropopliteal bypasses for limb salvage, nine thrombosed within the first montha after operation and 22 thrombosed from 1 to 23 months after operation. With reoperation (four simple thrombectomies and five graft extensions) all nine early closures are patent 3 to 27 months (mean 16 months) later. Four of the late thromboses did not jeopardize the limb, and viability has persisted 4 to 14 months. Eighteen of the late thromboses placed the limb in jeopardy. Appropriate reoperation after preoperative angiography restored graft patency for 2 to 27 months in 14 of 18 cases. Six grafts were patent more than 1 year after reoperation. The operations performed for late thrombosis were incision and patch angioplasty for intimal hyperplasia (25%), graft extension for distal disease (42%), and simple thrombectomy when no cause of thrombosis was identified (33%). These findings justify an aggressive approach with appropriate reoperations when PTFE femoropopliteal bypasses thrombose in the early or late postoperative period. Important additional limb salvage can thereby be obtained

Seven hypertensive patients underwent percutaneous transluminal angioplasty (PTA) for relief of arterial stenosis complicating renal allotransplantation. Four had end-to-end anastomosis of the donor renal artery to the recipient hypogastric artery; all PTA's were successful. Three patients had end-to-side anastomosis of the donor renal artery to the recipient external iliac artery; 2/3 PTA's were successful. Prior to PTA, all patients were using several antihypertension medications. Following successful PTA, the mean blood pressure fell from 190 +/- 10/120 +/- 5 to 132 +/- 16/86 +/- 9 mm Hg (p less than 0.01) and remained at that level for up to six months (average follow-up 2.85 months) with decreased or no antihypertension medications. Since surgical correction of arterial stenosis is difficult and may endanger the transplant kidney, PTA should be attempted first

The incidence and management of infections in 80 polytetrafluoroethylene (PTFE) grafts is reviewed. In a follow-up period of 12 to 30 months, the overall incidence of infection was 19%. In functioning grafts the majority of infections occurred after dialysis puncture or reoperation. With appropriate management, by incision, drainage, and packing of wounds with povidone-iodine solution, it was possible, even in the face of positive blood cultures, to treat four of five localized infections successfully without loss of graft function. Prophylactic antibiotics may be useful in reducing the high incidence of infection associated with secondary operations