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The negatively charged glutaraldehyde-tanned vascular graft was developed to determine the utility of grafts of biologic origin to provide satisfactory revascularization for ischemic limbs with advanced arteriosclerotic peripheral vascular disease. The bovine carotid artery was modified under a number of conditions using a large number of variables and evaluated in the carotid artery and aorta of dogs. Eventually ficin-digested carboxylated glutaraldehyde-tanned grafts were selected as being most antithrombotic and most resistant to aneurysm formation. Under an Investigational Device Exemption with the Food and Drug Administration, 146 grafts were evaluated in 108 patients with patency approaching 67 percent for all grafts at 5 years and 59 percent at 9 years plus. Total aneurysm formation has been 4 percent (six grafts) occurring only in hypertensive patients. The graft is now undergoing clinical use and evaluation worldwide.

DURING the period from August 1965 through January 1968, one hundred and twenty seven patients on the combined vascular surgical services of the State University were subjected to peripheral gas endarterectomy. Of these, there were 83 femoralpopliteal reconstructions, 21 bilateral aortofemoral reconstructions, and 23 carotid artery reconstructions. The procedure has been shown technically feasible and advantageous in each of these areas. We have found that the technique offers results equivalent to those available in the hands of other groups who have long practiced endarterectomy as their primary method of vascular reconstruction. History In 1961, the vascular surgical services at Downstate Medical Center cared for approximately 14 patients with aortic dissection. Though most of these patients died, a few survived, either because of formal reentry procedures or as a result of related conservative management. During this same period, it was suggested by one of us that a hydraulic ram, equivalent to

Mechanical devices which maintain viability during periods of reduced or absent mechanical cardiac function have permitted the utilization of a variety of surgical techniques for the treatment of acquired and congenital cardiac disease. In addition, many advances in cardiac pharmacology have improved the treatment of abnormal mechanical and electrical cardiac function. Despite a variety of therapeutic approaches, survival rate of hospital patients in cardiogenic shock remains between 10% to 20%.1Malach and Rosenberg2reviewed 264 consecutive cases of acute myocardial infarction at this institution and found the frequency of cardiogenic shock to be 9.4%. Those patients in shock were treated with several pharmacologic and volume replacement regimens with no survivors. More recently, Eichna3reported on the treatment of 26 cardiogenic shock cases at this institution using intravenously administered isoproterenol hydrochloride as the major pharmacologic agent. The death rate was 72%. Drugs remain the most frequent means of

In an attempt to salvage patients inacute cardiogenic shock, intra-aortic balloon pumping was instituted in selected patients. Selective coronary angiography, left ventricular pressures, myocardial me

M techniques have been used in an attempt to revascularize the heart. In 1929, Beck 1 developed poudrage 2 techniques in an attempt to increase myocardial blood flow. In 1951, Vineberg and Miller 3,4 described the internal mammary artery implantation into the myocardium as a technique for revascularization of the heart. There rapidly followed omentopexy, endarterectomy, and endarterotomy, with dilatation of the vessel. By 1959, selective coronary arteriography was proven possible in large numbers of patients providing anatomical information about sites of occlusion and their severity. Sones 5 at the Cleveland Clinic did the first large number of these and with Effler 6 showed the feasibility of attacking a small percentage of the observed coronary occlusions. Because of the tedious nature of mechanical endarterectomy and the poor results obtained (Bailey, 7 Sabiston, 8 Cannon and Longmire 9 ) when it was necessary to endarterectomize more than 2 to 3 cm, vascular