Faculty Bibliography

Two groups of dogs underwent light and electron microscopic examination of both lungs up to five years after left lung autotransplantation. In one group of four dogs that had undergone ligation of the right pulmonary artery at the time of left lung autotransplantation, no generalized or consistent lesions were present in the transplant except for slight distension of net capillaries and slight capillary basement membrane thickening. Aside from theseminor changes which were probably of no functional significance, most areas of lung examined up to five years after transplantation were normal. In the second group of four dogs that did not have contralateral pulmonary artery ligation at the time of left lung autotransplantation, no consistent abnormality was present in either the transplanted left or nontransplanted right lung. In three animals in this group, widespread normal areas were present bilaterally up to five years after transplantation. One animal in this group had focal changes consistent with chronic pulmonary disease in both of its lungs. Thus, transplanted lungs do not necessarily develop significant late pathologic lesions

Four dogs underwent autotransplantation of the left lung with immediate ligation of the right pulmonary artery and survived up to five years. Mean pulmonary artery pressures increased from 15 +/- 2 mmHg preoperatively to 23 +/- 4 mmHg immediately after operation and remained at the level (24 +/- 3 mmHg) up to five years operation. Arterial and venous blood gas values, determined while the animals were breathing ambient air spontaneously under light anesthesia, did not deteriorate with time and were within the normal range. The vascular resistance of the transplanted lungs up to five years after operation were not significantly different from those determined immediately after operation and remained lower than preoperative values, indicating that transplanted lungs retain indefinitely the ability to vasodilate with increased blood flow. Periodic angiography performed from 3-5 years after operation confirmed that the right lungs received no pulmonary blood flow and revealed normal vascular morphology except for moderate dilatation of the large arteries in the transplanted left lung. Thus, single transplanted lungs can provide total respiratory function while carrying the entire pulmonary blood flow at tolerable arterial pressures for at least five years without evidence of functional deterioration

Preoperative saphenous venography was performed in 100 extremities in 60 patients to evaluate the saphenous vein for use as an arterial bypass graft. In 18 of the patients (30%), venography demonstrated vein abnormality, disease, or small size, which significantly influenced the management of the patient or the conduct of the operation. Good correlation was observed between venographically determined saphenous vein anatomy and diameter and those observed at operation in 52 patients. The average diameter of the saphenous veins on preoperative venograms was 3.4 mm (range, 1.0 to 6.0 mm). These veins dilated to an average diameter 73 +/- 5% greater than that observed venographically, so that the average diameter of harvested, dilated saphenous veins was 5.5 mm (range, 3.0 to 10.0 mm). All veins measuring 2.0 mm or more on the venograms dilated to 4.0 mm or more at operation and were suitable for femoropopliteal or small vessel bypass grafts. Four saphenous veins measuring 1.0 mm or more on the venograms dilated to 3.0 mm or more at operation and were suitable for small vessel bypasses. Thus preoperative saphenous venography can be of value in lower extremity arterial reconstructions. The procedure allows detection of anomalies and disease processes that would prevent the use of one or both saphenous veins as arterial bypass grafts and identifies the best available venous segment thereby obviating unnecessary incisions and minimizing operating time

In a retrospective study of 66 PTFE arteriovenous fistulae and 71 BCH arteriovenous fistulae for dialysis access, PTFE had a higher patency rate than BCH at 12 months (62.4 versus 32.5%). PTFE was easier to work with and easier to handle in the face of infection. The lateral upper arm approach to placement of the PTFE graft is desirable in patients who have had multiple previous access procedures because this area is usually free from scarring, is distant from neurovascular structures, and provides a greater length of graft for needle punctures