The long term behaviour of autogeneou vein by-pass grafts.

The results of the follow-up of 50 consecutive atuogeneous vein bypass grafts during 1958-65 are described. Arteriography was performed at regular intervals throughout the follow-up lasting from 8-15 years. 11 grafts failed in less than 2 years and were considered technical failures. Thereafter, of the 37 cases on whom arteriographic information is available, a further 5 grafts failed. Deterioration of the graft itself occurred in 19 percent, proximal anastomosis dilatation it 16 percent, and distal anastomosis narrowing in 25 percent. Improvement of flow to the lower leg vessels did not accelerate progression of the long saphenous vein at the time of operation is the limiting factor in longterm graft deterioration. The majority of grafts remained patient without degeneration for up to 15 years.

Long term behavior of reversed saphenous vein grafts for advanced femoropopliteal disease.

Fifty consecutive long saphenous vein graft operations for limb salvage performed between 1958 and 1965 were observed by periodic arteriography. Of 50 grafts, 11 failed within two years, and at the time of the final review, two patients had defaulted. Extended observations of the remaining 37 grafts up to 15 years showed three main complications. First, graft degeneration affected seven grafts with earliest evidence of elongation, tortuosity, irregular dilation or aneurysmal formation at four years. It did not affect any graft after eight years. One graft required replacement because of degeneration. Second, proximal dilation was seen in six grafts, but it did not compromise patency or function and had a maximal incidence at four to six years. Third, the site of the distal anastomosis was narrowed in eight patients, but the narrowing was severe in four. This complication occurred at six to eight years and affected 25 per cent of the surviving patients. The narrowing was caused by thrombus formation within the area of anastomosis and was amenable to further arterial reconstruction.

Problems of resistant thrombolysis and early recurrent thrombosis in streptokinase therapy.

Problems of resistant thrombolysis and early rethrombosis during and immediately after streptokinase therapy have been studied with sequential phlebography in 39 patients. Early rethrombosis and resistant thrombolysis were found to correlate with the behavior of plasminogen and fibrinogen to streptokinase. Anticoagulants given during streptokinase therapy do not seem to affect these problems in a dramatic way.