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Advances in prosthetic devices led to our analysis of revascularization in patients presenting with gangrene of the lower extremity. Between 1966 and 1976, 99 grafts were performed on 96 of the 249 patients treated by lower extremity revascularization who presented with the above criteria. Their mean age was 66 years; 46 (48%) were diabetic, 53 (55%) were over the age of 65, and 38 (40%) had angiographically proven disease with one vessel runoff. Initial therapy consisted of intravenous antibiotics and local debridement to control sepsis, followed by detailed arteriography. Femoral-popliteal bypass was performed in 87 patients, and a more distal vessel was utilized in 9. There were 5 in-hospital deaths. Of these, 4 patients had come to major amputation. Four died as a result of myocardial infarctions, and 1 as a result of a cerebrovascular accident. Immediate graft patency was achieved in 93 of 99 patients (93%). Minor amputations were required in 44 patients. Early graft failure resulted in major amputations in 7 patients. A late major amputation (mean 13 months) was required in an additional 28 patients, 15 because of graft failure and 13 because of nonhealing minor amputations. Extremity salvage at 2 years was achieved in 72 of the 99 patients (72%). [ABSTRACT FROM AUTHOR]

Presets a study that examined the results of debanding and ventricular septal defect closure in an attempt to set a standard with which to compare primary closure. Materials and methods; Results; Discussion.

Ten pairs of mongrel dogs had bilateral femoral artery reconstruction using the femoral veins from the other of each pair. Four grafts failed in the first two weeks and 16 grafts failed in pairs within two to four weeks of each other up to 15 months. Five dogs died with patent grafts between 15 and 42 months and five dogs were sacrificed at 42 months with patent grafts. Aneurysmal degeneration did not occur. Normal architecture of the vein was destroyed by fibrous replacement, hut a few smooth muscle cells and adventitial elastic fibers persisted. Gross and microscopic mural thromhi were present in half the grafts indicating continued endothelial instability at 42 months. Osseous metaplasia was found in five grafts. Allogenic vein is an acceptable substitute when autogenous vein is lacking for femorotibial bypass and urgent femoropopliteal bypass. [ABSTRACT FROM AUTHOR]

Patients having coronary bypass for stable angina pectoris were grouped on the basis of the two hour plasma sugar of the glucose tolerance test: Group I. 120 mgs% (159 grafts): Group II. 120-150 (93 grafts); Group III. 150-200 (131 grafts) and Group IV. 200 (57 grafts) or patients receiving therapy tor diabetes mellitus (10 patients, 21 grafts). Five of 10 diabetic patients had genetic evidence of diabetes and an average duration of therapy of 6.5 years. Blood flow was measured in 461 grafts with an electromagnetic flow probe after discontinuation of cardiopulmonary bypass in a stable state, after a 30 second graft occlusion and after injection of 15 mg of papaverine into the graft. Mean arterial pressure, graft flow and coronary resistance for each succeeding group did not vary significantly when compared with Group I. Analysis of phasic flow in 10 grafts to the left anterior descending indicates that the same proportion of flow occurs during systole and diastole in the basal state and after papaverine. Coronary flow and resistance in patients with abnormal glucose metabolism and maturity onset diabetes do not provide evidence for the existence of myocardial microangiopathy. [ABSTRACT FROM AUTHOR]

Advances in prosthetic devices led to our analysis of revascularization in patients presenting with gangrene of the lower extremity. Between 1966 and 1976, 99 grafts were performed on 96 of the 249 patients treated by lower extremity revascularization who presented with the above criteria. Their mean age was 66 years; 46 (48%) were diabetic, 53 (55%) were over the age of 65, and 38 (40%) had angiographically proven disease with one vessel runoff. Initial therapy consisted of intravenous antibiotics and local debridement to control sepsis, followed by detailed arteriography. Femoral-popliteal bypass was per formed in 87 patients, and a more distal vessel was utilized in 9. There were 5 in- hospital deaths. Of these, 4 patients had come to major amputation. Four died as a result of myocardial infarctions, and 1 as a result of a cerebrovascular accident.Immediate graft patency was achieved in 93 of 99 patients (93%). Minor amputations were required in 44 patients. Early graft failure resulted in major amputations in 7 patients. A late major amputation (mean 13 months) was required in an additional 28 patients, 15 because of graft failure and 13 because of nonhealing minor amputations. Extremity salvage at 2 years was achieved in 72 of the 99 patients (72%). [ABSTRACT FROM PUBLISHER]

Thirty-one fresh and 22 frozen canine femoral veins were placed in the femoral arterial system as bypass homografts and followed 20 to 30 weeks with au over-all patency rate of 69 per cent. Similar patency rates were obtained in the fresh and frozen grafts. The fact that aneurysmal degeneration of these grafts did not occur is thought to be related to fibroblastic proliferation involving all layers of the graft. The higher incidence of mural thrombi and thrombosis than seen in similarly autografted veins probably has an immunologic basis. [ABSTRACT FROM AUTHOR]

Double tibial artery saphenous vein bypass graft has been successfully performed to relieve disabling claudication. When a tibial graft is indicated, patency of both peroneal and posterior tibial arteries produces a favorable local situation for simultaneous grafting of both vessels from a single long venous graft with a short venous branch. [ABSTRACT FROM AUTHOR]

Crossover femoral-popliteal bypass has been used in three instances where it was thought that the profunda femoris artery provided inadequate outflow and that proximal origin of the graft from the aorta would be technically difficult. Although all three grafts were successful early, one developed two stenoses at five months requiring vein patch grafting and a third stenosis at eight months that led to amputation. One failed at eight months due to proximal prosthesis failure. This type of reconstruction is occasionally useful when aorto-femoral bypass is contraindicated and the profunda femoris artery provides inadequate outflow. [ABSTRACT FROM AUTHOR]

Four instances of mediastinal wound infection occurred in 100 patients who underwent bilateral internal mammary artery (IMA) mobilization for coronary bypass. Debridement of 3-5 mm of the sternal edges was performed 6-18 days after the primary operation, and 2 patients required additional, anatomically limited debridement. Wounds were allowed to heal by secondary intention. The wounds of 3 patients healed by 4, 7, and 16 months; they had patent grafts at the postoperative or 1-year catheterization; and they returned to work and are free of angina. The fourth patient died of renal and respiratory failure 3 months after the operation; his wound was healing and had not required additional debridement. These observations indicate that bilateral IMA mobilization does not result in avascularity of the sternum, which required only limited debridement and quickly formed granulation tissue from the periosteum and marrow. [ABSTRACT FROM AUTHOR]