Robert Batson - Academia.edu (original) (raw)
Papers by Robert Batson
Journal of Vascular Surgery, 2015
Annals of Vascular Surgery, 1989
Obturator bypasses with nonreversed translocated saphenous veins were performed In two patients w... more Obturator bypasses with nonreversed translocated saphenous veins were performed In two patients with femoral graft Infections. There were no deaths, 11mb loss, or graft occlusions at two and one-half years of follow-up In the first case and one and one-half years of follow-up In the second case. The non reversed translocated saphenous vein Is a versatile graft that allows for extraanatomlc autogenous reconstruction In the face of Infection. In both cases, small-caliber distal saphenous veins precluded performing reversed saphenous vein grafts.
Annals of Vascular Surgery, 1989
Obturator bypasses with nonreversed translocated saphenous veins were performed in two patients w... more Obturator bypasses with nonreversed translocated saphenous veins were performed in two patients with femoral graft infections. There were no deaths, limb loss, or graft occlusions at two and one-half years of follow-up in the first case and one and one-half years of follow-up in the second case. The nonreversed translocated saphenous vein is a versatile graft that allows for extraanatomic autogenous reconstruction in the face of infection. In both cases, small-caliber distal saphenous veins precluded performing reversed saphenous vein grafts.
Southern Medical Journal, 1997
Revascularization for arterial stenosis in varied anatomic sites exposed to therapeutic radiation... more Revascularization for arterial stenosis in varied anatomic sites exposed to therapeutic radiation has been well described. In most circumstances, symptomatic end organ ischemia has been the indication for surgical intervention. We report the case of a patient who had symptomatic carotid stenosis 40 years after having ipsilateral neck dissection with radiation therapy. We did a saphenous vein graft interposition and free flap reconstruction of the overlying damaged skin.
Annals of Thoracic Surgery, 1994
Journal of Vascular Surgery, 1986
Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin ma... more Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin masses caused by ruptured abdominal aortic aneurysms. A palpable abdominal mass was present in 33%. All patients eventually underwent abdominal aortic aneurysmectomy with a resultant mortality rate of 50%. Delayed diagnosis, preoperative hypotension, advanced age, poor nutritional status, and excessive intraoperative blood loss were factors contributing to this high mortality rate. In this unusual clinical presentation of ruptured abdominal aortic aneurysm, a high index of suspicion by the emergency room staff and prompt surgical intervention are mandatory to improve mortality rates. The anatomy of the retroperitoneal space and the phylogenetic development of a channel between the scrotum and the kidney are important factors in the development of this symptom complex.
Annals of Surgery, 1980
Both the literature and this experience support host vessel degeneration as the primary etiologic... more Both the literature and this experience support host vessel degeneration as the primary etiologic factor in femoral anastomotic aneurysms. Associated factors that produce increased "intra-anastomotic tension," such as hypertension, superficial femoral artery occlusion, and flow turbulence, appear to contribute to vessel deterioration. Other factors, much less prevalent in present-day vascular surgery, such as rigid grafts, deficient suture material, inappropriate angle of incidence, and excessive tension on the graft can contribute to anstomotic disruption. Certain guidelines may be helpful in the management of femoral pseudoaneurysm. 1) Redo the entire anstomosis, rather than simply resuturing a disrupted edge. 2) Use minimal dissection to avoid injury to outflow vessels and to limit disruption of supportive tissue. 3) Use braided synthetic suture material. 4) Avoid tension by interposing a segment of graft between the proximal graft limb and the host vessel. 5) Use knitted Dacron for the interposed segment so the new anastomosis to the host vessel will be with softer, more pliable fabric. 6) Assure smooth adequate outflow by end-to-end anastomosis with a patch angioplasty or distal bypass. These guidelines should lead to a safe, reliable solution to one of the vexing complications of aortofemoral bypass procedure.
Annals of Surgery, 1985
The in situ saphenous vein (ISSV) graft has shown promise in distal bypass. Although improved pat... more The in situ saphenous vein (ISSV) graft has shown promise in distal bypass. Although improved patency has been attributed to preservation of vasa vasorum, there is no direct evidence to support this hypothesis. Femorodistal bypass was done in 33 patients using ISSV grafts (21) or nonreversed saphenous vein (NRSV) grafts (12) during an 18-month period. The NRSV were completely removed from the vein bed but were otherwise prepared in an identical fashion to the ISSV. Immediate complications including incomplete valvulotomy (one), intimal laceration (one), persistent AV communication (two), and extrinsic graft compression (one) were identified and corrected. Two grafts of 2.5 mm diameter occluded acutely. There were no deaths. Of 30 patients discharged with a patent graft, there was one late occlusion (ISSV) at 10 months. No difference in patency between ISSV and NRSV grafts was noted during follow-up extending to 24 months. Overall limb salvage was 94%. In a canine model, 60 vein segments were interposed in the carotid artery using in situ, reversed, and nonreversed techniques. Ultrastructural studies 1, 2, 3, and 6 months after implantation reveal no differences in in situ and nonreversed grafts. New vasa vasorum were identified in NRSV within 1 month. Both ISSV and NRSV grafts demonstrate excellent patency and maintenance of smooth muscle cell architecture. Factors including reduced size disparity at the proximal and distal anastomoses, physiologic distension under arterial pressure, careful handling, and meticulous technique appear to be more important than the theoretic advantages of preserving vasa vasorum.
Annals of Vascular Surgery, 1989
Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and ... more Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and distal anastomotic intimal hyperplasia are known etiologic factors of late graft failure, its occurrence is frequently encountered in the late graft occlusion. Forth-two canine PTFE iliofemoral grafts (all with end-to-side distal anastomosis) were studied. Computer digitization revealed that distal anastomotic intimal hyperplasia occurred exclusively at the heel and the toe of the graft and the floor of the host artery. The distal anastomotic intimal hyperplasia was 80-130 cells thick. Light microscopy and transmission electron microscopy revealed a similar architecture of interlamination of cellular elements and extracellular matrix in the hyperplastic cells. Transmission electron microscopy further defined a gradual cell transformation and orientation from the graft to the lumen. The cells near the graft were characterized by a gradual reduction of rough endoplasmic reticulum with a concomitant acquisition of myofilaments, transforming ovoid mesenchymoid cells to slender myofibroblasts. The orientation of cells in distal anastomotic intimal hyperplasia was embodied by random cell distribution at the periphery to a well-organized interlamination of myofibroblasts and extracellular matrix near the lumen. Distal anastomotic intimal hyperplasia is a biologic entity with active cellular and subcellular events. Its biogenesis appears to be influenced by the hemodynamics of blood flow at the distal anastomosis.
European Journal of Vascular Surgery, 1988
Anastomotic intimal hyperplasia occurred exclusively at the heel and the toe plus the floor of th... more Anastomotic intimal hyperplasia occurred exclusively at the heel and the toe plus the floor of the distal end-to-side anastomosis of canine autologous femoro-femoral bypass (n = 14) and not in the end-to-end carotid or femoral interposition graft (n = 14). The occurrence of anastomotic intimal hyperplasia in the absence of compliance mismatch in an autologous bypass suggests that the geometry of the end-to-side anastomosis is primarily responsible for intimal hyperplasia formation. It is believed that because an end-to-side distal anastomosis is not a natural occurrence it is conductive to turbulent flow. The latter causes endothelial injury which in turn allows platelet growth factor to incite subendothelial myoblasts in extracellular matrix synthesis and intimal hyperplasia formation. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) identify myofibroblasts and fibrocollagenous matrix as the dominant cellular and extracellular substances in anastomotic intimal hyperplasia.
Southern Medical Journal, 1997
Revascularization for arterial stenosis in varied anatomic sites exposed to therapeutic radiation... more Revascularization for arterial stenosis in varied anatomic sites exposed to therapeutic radiation has been well described. In most circumstances, symptomatic end organ ischemia has been the indication for surgical intervention. We report the case of a patient who had symptomatic carotid stenosis 40 years after having ipsilateral neck dissection with radiation therapy. We did a saphenous vein graft interposition and free flap reconstruction of the overlying damaged skin.
Annals of Vascular Surgery, 1989
Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and ... more Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and distal anastomotic intimai hyperplasia are known etiologic factors of late graft failure, its occurrence is frequently encountered in late graft occlusion. Forty-two canine PTFE iliofemoral grafts (all with end-to-slde distal anastomosis) were studied. Computer digitization revealed that distal anastomotic intimai hyperplasia occurred exclusively at the heel and the
Journal of Vascular Surgery, 1989
Journal of Vascular Surgery, 1986
Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin ma... more Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin masses caused by ruptured abdominal aortic aneurysms. A palpable abdominal mass was present in 33%. All patients eventually underwent abdominal aortic aneurysmectomy with a resultant mortality rate of 50%. Delayed diagnosis, preoperative hypotension, advanced age, poor nutritional status, and excessive intraoperative blood loss were factors contributing to this high mortality rate. In this unusual clinical presentation of ruptured abdominal aortic aneurysm, a high index of suspicion by the emergency room staff and prompt surgical intervention are mandatory to improve mortality rates. The anatomy of the retroperitoneal space and the phylogenetic development of a channel between the scrotum and the kidney are important factors in the development of this symptom complex.
Journal of Vascular Surgery, 1986
Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin ma... more Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin masses caused by ruptured abdominal aortic aneurysms. A palpable abdominal mass was present in 33%. All patients eventually underwent abdominal aortic aneurysmectomy with a resultant mortality rate of 50%. Delayed diagnosis, preoperative hypotension, advanced age, poor nutritional status, and excessive intraoperative blood loss were factors contributing to this high mortality rate. In this unusual clinical presentation of ruptured abdominal aortic aneurysm, a high index of suspicion by the emergency room staff and prompt surgical intervention are mandatory to improve mortality rates. The anatomy of the retroperitoneal space and the phylogenetic development of a channel between the scrotum and the kidney are important factors in the development of this symptom complex.
The Journal of Trauma: Injury, Infection, and Critical Care, 1987
Nonreversed translocated saphenous vein (NTSV) bypasses were performed for 17 acute arterial inju... more Nonreversed translocated saphenous vein (NTSV) bypasses were performed for 17 acute arterial injuries. The technique involved controlling hemorrhage, inserting indwelling shunts, perfusing the harvested saphenous vein with papaverine solution, placing the vein in a nonreversed orientation over the shunt, performing valvulotomy under arterial pressure with a modified Mills' valvulotome and completing the distal anastomosis just before removing the shunt. Followup ranged from 2 to 36 months. There were no graft occlusions. The advantages of using NTSV graft for reconstruction of arterial injuries include autogenous reconstruction, reduced size discrepancy between graft and artery at both the proximal and distal anastomosis, improved hemodynamics when spasm compromises distal runoff, and increased vein utilization. NTSV provides increased versatility with both large and small vessel trauma and may improve patency rates.
Annals of Vascular Surgery, 1989
Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and ... more Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and distal anastomotic intimal hyperplasia are known etiologic factors of late graft failure, its occurrence is frequently encountered in the late graft occlusion. Forth-two canine PTFE iliofemoral grafts (all with end-to-side distal anastomosis) were studied. Computer digitization revealed that distal anastomotic intimal hyperplasia occurred exclusively at the heel and the toe of the graft and the floor of the host artery. The distal anastomotic intimal hyperplasia was 80-130 cells thick. Light microscopy and transmission electron microscopy revealed a similar architecture of interlamination of cellular elements and extracellular matrix in the hyperplastic cells. Transmission electron microscopy further defined a gradual cell transformation and orientation from the graft to the lumen. The cells near the graft were characterized by a gradual reduction of rough endoplasmic reticulum with a concomitant acquisition of myofilaments, transforming ovoid mesenchymoid cells to slender myofibroblasts. The orientation of cells in distal anastomotic intimal hyperplasia was embodied by random cell distribution at the periphery to a well-organized interlamination of myofibroblasts and extracellular matrix near the lumen. Distal anastomotic intimal hyperplasia is a biologic entity with active cellular and subcellular events. Its biogenesis appears to be influenced by the hemodynamics of blood flow at the distal anastomosis.
Journal of Vascular Surgery, 1985
cell Venous injury following mechanical distension and its late sequelae were studied in a canine... more cell Venous injury following mechanical distension and its late sequelae were studied in a canine model. Jugular vein segments distended without and with papaverine (60 rag/100 ml) were compared with nondistended vein segments after they had been placed into the arterial circulation for 1 to 12 months. Arteriography showed no significant statistical discrepancy in luminal diameter of the three vein segments. Complete reendothelialization had occurred in all vein grafts at the time of harvesting. Similar histocytologic features existed in the nondistended segments and in the portion distended with human plasma protein fraction (Plasmanate) plus papaverine (150 to 300 nun Hg). The intimal-medial hyperplasia was characterized by an increase in fibrocellular layers with an elaboration of vasa vasorum. Conversely, collagen and extracellular matrix replaced the myocyte, producing medial fibrosis in vein mechanically distended with Plasmanate alone. Papaverine prevented mechanical stimulation of smooth muscle cells to overproduce extracellular connective tissue elements. Mechanical stretching of intimal and medial myocytes induced fibrogenesis and fibroplasia. Papaverine is useful in vein preparation; it protects the endothelium and smooth muscle cells in the intima and media and prevents leukocyte infiltration and medial fibrosis. (J VASC SURG 1985; 2:834-42.)
The Annals of Thoracic Surgery, 1994
Journal of Vascular Surgery, 2015
Annals of Vascular Surgery, 1989
Obturator bypasses with nonreversed translocated saphenous veins were performed In two patients w... more Obturator bypasses with nonreversed translocated saphenous veins were performed In two patients with femoral graft Infections. There were no deaths, 11mb loss, or graft occlusions at two and one-half years of follow-up In the first case and one and one-half years of follow-up In the second case. The non reversed translocated saphenous vein Is a versatile graft that allows for extraanatomlc autogenous reconstruction In the face of Infection. In both cases, small-caliber distal saphenous veins precluded performing reversed saphenous vein grafts.
Annals of Vascular Surgery, 1989
Obturator bypasses with nonreversed translocated saphenous veins were performed in two patients w... more Obturator bypasses with nonreversed translocated saphenous veins were performed in two patients with femoral graft infections. There were no deaths, limb loss, or graft occlusions at two and one-half years of follow-up in the first case and one and one-half years of follow-up in the second case. The nonreversed translocated saphenous vein is a versatile graft that allows for extraanatomic autogenous reconstruction in the face of infection. In both cases, small-caliber distal saphenous veins precluded performing reversed saphenous vein grafts.
Southern Medical Journal, 1997
Revascularization for arterial stenosis in varied anatomic sites exposed to therapeutic radiation... more Revascularization for arterial stenosis in varied anatomic sites exposed to therapeutic radiation has been well described. In most circumstances, symptomatic end organ ischemia has been the indication for surgical intervention. We report the case of a patient who had symptomatic carotid stenosis 40 years after having ipsilateral neck dissection with radiation therapy. We did a saphenous vein graft interposition and free flap reconstruction of the overlying damaged skin.
Annals of Thoracic Surgery, 1994
Journal of Vascular Surgery, 1986
Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin ma... more Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin masses caused by ruptured abdominal aortic aneurysms. A palpable abdominal mass was present in 33%. All patients eventually underwent abdominal aortic aneurysmectomy with a resultant mortality rate of 50%. Delayed diagnosis, preoperative hypotension, advanced age, poor nutritional status, and excessive intraoperative blood loss were factors contributing to this high mortality rate. In this unusual clinical presentation of ruptured abdominal aortic aneurysm, a high index of suspicion by the emergency room staff and prompt surgical intervention are mandatory to improve mortality rates. The anatomy of the retroperitoneal space and the phylogenetic development of a channel between the scrotum and the kidney are important factors in the development of this symptom complex.
Annals of Surgery, 1980
Both the literature and this experience support host vessel degeneration as the primary etiologic... more Both the literature and this experience support host vessel degeneration as the primary etiologic factor in femoral anastomotic aneurysms. Associated factors that produce increased "intra-anastomotic tension," such as hypertension, superficial femoral artery occlusion, and flow turbulence, appear to contribute to vessel deterioration. Other factors, much less prevalent in present-day vascular surgery, such as rigid grafts, deficient suture material, inappropriate angle of incidence, and excessive tension on the graft can contribute to anstomotic disruption. Certain guidelines may be helpful in the management of femoral pseudoaneurysm. 1) Redo the entire anstomosis, rather than simply resuturing a disrupted edge. 2) Use minimal dissection to avoid injury to outflow vessels and to limit disruption of supportive tissue. 3) Use braided synthetic suture material. 4) Avoid tension by interposing a segment of graft between the proximal graft limb and the host vessel. 5) Use knitted Dacron for the interposed segment so the new anastomosis to the host vessel will be with softer, more pliable fabric. 6) Assure smooth adequate outflow by end-to-end anastomosis with a patch angioplasty or distal bypass. These guidelines should lead to a safe, reliable solution to one of the vexing complications of aortofemoral bypass procedure.
Annals of Surgery, 1985
The in situ saphenous vein (ISSV) graft has shown promise in distal bypass. Although improved pat... more The in situ saphenous vein (ISSV) graft has shown promise in distal bypass. Although improved patency has been attributed to preservation of vasa vasorum, there is no direct evidence to support this hypothesis. Femorodistal bypass was done in 33 patients using ISSV grafts (21) or nonreversed saphenous vein (NRSV) grafts (12) during an 18-month period. The NRSV were completely removed from the vein bed but were otherwise prepared in an identical fashion to the ISSV. Immediate complications including incomplete valvulotomy (one), intimal laceration (one), persistent AV communication (two), and extrinsic graft compression (one) were identified and corrected. Two grafts of 2.5 mm diameter occluded acutely. There were no deaths. Of 30 patients discharged with a patent graft, there was one late occlusion (ISSV) at 10 months. No difference in patency between ISSV and NRSV grafts was noted during follow-up extending to 24 months. Overall limb salvage was 94%. In a canine model, 60 vein segments were interposed in the carotid artery using in situ, reversed, and nonreversed techniques. Ultrastructural studies 1, 2, 3, and 6 months after implantation reveal no differences in in situ and nonreversed grafts. New vasa vasorum were identified in NRSV within 1 month. Both ISSV and NRSV grafts demonstrate excellent patency and maintenance of smooth muscle cell architecture. Factors including reduced size disparity at the proximal and distal anastomoses, physiologic distension under arterial pressure, careful handling, and meticulous technique appear to be more important than the theoretic advantages of preserving vasa vasorum.
Annals of Vascular Surgery, 1989
Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and ... more Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and distal anastomotic intimal hyperplasia are known etiologic factors of late graft failure, its occurrence is frequently encountered in the late graft occlusion. Forth-two canine PTFE iliofemoral grafts (all with end-to-side distal anastomosis) were studied. Computer digitization revealed that distal anastomotic intimal hyperplasia occurred exclusively at the heel and the toe of the graft and the floor of the host artery. The distal anastomotic intimal hyperplasia was 80-130 cells thick. Light microscopy and transmission electron microscopy revealed a similar architecture of interlamination of cellular elements and extracellular matrix in the hyperplastic cells. Transmission electron microscopy further defined a gradual cell transformation and orientation from the graft to the lumen. The cells near the graft were characterized by a gradual reduction of rough endoplasmic reticulum with a concomitant acquisition of myofilaments, transforming ovoid mesenchymoid cells to slender myofibroblasts. The orientation of cells in distal anastomotic intimal hyperplasia was embodied by random cell distribution at the periphery to a well-organized interlamination of myofibroblasts and extracellular matrix near the lumen. Distal anastomotic intimal hyperplasia is a biologic entity with active cellular and subcellular events. Its biogenesis appears to be influenced by the hemodynamics of blood flow at the distal anastomosis.
European Journal of Vascular Surgery, 1988
Anastomotic intimal hyperplasia occurred exclusively at the heel and the toe plus the floor of th... more Anastomotic intimal hyperplasia occurred exclusively at the heel and the toe plus the floor of the distal end-to-side anastomosis of canine autologous femoro-femoral bypass (n = 14) and not in the end-to-end carotid or femoral interposition graft (n = 14). The occurrence of anastomotic intimal hyperplasia in the absence of compliance mismatch in an autologous bypass suggests that the geometry of the end-to-side anastomosis is primarily responsible for intimal hyperplasia formation. It is believed that because an end-to-side distal anastomosis is not a natural occurrence it is conductive to turbulent flow. The latter causes endothelial injury which in turn allows platelet growth factor to incite subendothelial myoblasts in extracellular matrix synthesis and intimal hyperplasia formation. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) identify myofibroblasts and fibrocollagenous matrix as the dominant cellular and extracellular substances in anastomotic intimal hyperplasia.
Southern Medical Journal, 1997
Revascularization for arterial stenosis in varied anatomic sites exposed to therapeutic radiation... more Revascularization for arterial stenosis in varied anatomic sites exposed to therapeutic radiation has been well described. In most circumstances, symptomatic end organ ischemia has been the indication for surgical intervention. We report the case of a patient who had symptomatic carotid stenosis 40 years after having ipsilateral neck dissection with radiation therapy. We did a saphenous vein graft interposition and free flap reconstruction of the overlying damaged skin.
Annals of Vascular Surgery, 1989
Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and ... more Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and distal anastomotic intimai hyperplasia are known etiologic factors of late graft failure, its occurrence is frequently encountered in late graft occlusion. Forty-two canine PTFE iliofemoral grafts (all with end-to-slde distal anastomosis) were studied. Computer digitization revealed that distal anastomotic intimai hyperplasia occurred exclusively at the heel and the
Journal of Vascular Surgery, 1989
Journal of Vascular Surgery, 1986
Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin ma... more Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin masses caused by ruptured abdominal aortic aneurysms. A palpable abdominal mass was present in 33%. All patients eventually underwent abdominal aortic aneurysmectomy with a resultant mortality rate of 50%. Delayed diagnosis, preoperative hypotension, advanced age, poor nutritional status, and excessive intraoperative blood loss were factors contributing to this high mortality rate. In this unusual clinical presentation of ruptured abdominal aortic aneurysm, a high index of suspicion by the emergency room staff and prompt surgical intervention are mandatory to improve mortality rates. The anatomy of the retroperitoneal space and the phylogenetic development of a channel between the scrotum and the kidney are important factors in the development of this symptom complex.
Journal of Vascular Surgery, 1986
Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin ma... more Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin masses caused by ruptured abdominal aortic aneurysms. A palpable abdominal mass was present in 33%. All patients eventually underwent abdominal aortic aneurysmectomy with a resultant mortality rate of 50%. Delayed diagnosis, preoperative hypotension, advanced age, poor nutritional status, and excessive intraoperative blood loss were factors contributing to this high mortality rate. In this unusual clinical presentation of ruptured abdominal aortic aneurysm, a high index of suspicion by the emergency room staff and prompt surgical intervention are mandatory to improve mortality rates. The anatomy of the retroperitoneal space and the phylogenetic development of a channel between the scrotum and the kidney are important factors in the development of this symptom complex.
The Journal of Trauma: Injury, Infection, and Critical Care, 1987
Nonreversed translocated saphenous vein (NTSV) bypasses were performed for 17 acute arterial inju... more Nonreversed translocated saphenous vein (NTSV) bypasses were performed for 17 acute arterial injuries. The technique involved controlling hemorrhage, inserting indwelling shunts, perfusing the harvested saphenous vein with papaverine solution, placing the vein in a nonreversed orientation over the shunt, performing valvulotomy under arterial pressure with a modified Mills' valvulotome and completing the distal anastomosis just before removing the shunt. Followup ranged from 2 to 36 months. There were no graft occlusions. The advantages of using NTSV graft for reconstruction of arterial injuries include autogenous reconstruction, reduced size discrepancy between graft and artery at both the proximal and distal anastomosis, improved hemodynamics when spasm compromises distal runoff, and increased vein utilization. NTSV provides increased versatility with both large and small vessel trauma and may improve patency rates.
Annals of Vascular Surgery, 1989
Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and ... more Although thrombogenicity of the prosthetic graft, progression of the atherosclerotic disease and distal anastomotic intimal hyperplasia are known etiologic factors of late graft failure, its occurrence is frequently encountered in the late graft occlusion. Forth-two canine PTFE iliofemoral grafts (all with end-to-side distal anastomosis) were studied. Computer digitization revealed that distal anastomotic intimal hyperplasia occurred exclusively at the heel and the toe of the graft and the floor of the host artery. The distal anastomotic intimal hyperplasia was 80-130 cells thick. Light microscopy and transmission electron microscopy revealed a similar architecture of interlamination of cellular elements and extracellular matrix in the hyperplastic cells. Transmission electron microscopy further defined a gradual cell transformation and orientation from the graft to the lumen. The cells near the graft were characterized by a gradual reduction of rough endoplasmic reticulum with a concomitant acquisition of myofilaments, transforming ovoid mesenchymoid cells to slender myofibroblasts. The orientation of cells in distal anastomotic intimal hyperplasia was embodied by random cell distribution at the periphery to a well-organized interlamination of myofibroblasts and extracellular matrix near the lumen. Distal anastomotic intimal hyperplasia is a biologic entity with active cellular and subcellular events. Its biogenesis appears to be influenced by the hemodynamics of blood flow at the distal anastomosis.
Journal of Vascular Surgery, 1985
cell Venous injury following mechanical distension and its late sequelae were studied in a canine... more cell Venous injury following mechanical distension and its late sequelae were studied in a canine model. Jugular vein segments distended without and with papaverine (60 rag/100 ml) were compared with nondistended vein segments after they had been placed into the arterial circulation for 1 to 12 months. Arteriography showed no significant statistical discrepancy in luminal diameter of the three vein segments. Complete reendothelialization had occurred in all vein grafts at the time of harvesting. Similar histocytologic features existed in the nondistended segments and in the portion distended with human plasma protein fraction (Plasmanate) plus papaverine (150 to 300 nun Hg). The intimal-medial hyperplasia was characterized by an increase in fibrocellular layers with an elaboration of vasa vasorum. Conversely, collagen and extracellular matrix replaced the myocyte, producing medial fibrosis in vein mechanically distended with Plasmanate alone. Papaverine prevented mechanical stimulation of smooth muscle cells to overproduce extracellular connective tissue elements. Mechanical stretching of intimal and medial myocytes induced fibrogenesis and fibroplasia. Papaverine is useful in vein preparation; it protects the endothelium and smooth muscle cells in the intima and media and prevents leukocyte infiltration and medial fibrosis. (J VASC SURG 1985; 2:834-42.)
The Annals of Thoracic Surgery, 1994