Assessment of connective tissue fibres in walls of allogenic arterial grafts preserved by the method of cold ischemia--a preliminary report.

The aim of the study was to evaluate microscopic changes in the wall structures of allogenic arterial grafts, preserved by the method of cold ischemia in relation to the storage period and to test the possibility of the storage period prolongation by allograft freezing at -70 degrees C. The middle layer ultrastructure is well preserved till 30 days from allograft harvesting, however, allograft freezing results in total destruction of elastic and collagen fibres in the arterial wall. An application of allogenic arterial grafts, preserved by the method of cold ischemia till 30 days from their harvesting, seems an efficient therapeutic method in the treatment of patients with synthetic vascular graft infection. Further prolongation of the storage period at -70 degrees C made the allograft useless for implantation.

Use of external iliac artery in renal revascularization surgery: long-term angiographic assessment.

PURPOSE: The external iliac artery has physical characteristics, in particular, caliber and length, similar to those of the renal artery and would thus seem to be an ideal substitute for it. However, there are no studies in the literature designed to confirm this possibility. The present study was designed to demonstrate the feasibility of use of the external iliac artery as a substitute for the renal artery in surgical revascularization of renal artery fibrodysplasia and to assess the long-term biologic behavior of the external iliac artery so used. METHODS: Twelve patients (11 female, 1 male), ages 1 to 43 years (mean, 24.4 years), with severe hypertension underwent aortorenal bypass grafting with use of the external iliac artery to treat preocclusive stenotic lesions (n = 7), complete occlusion (n = 3), or aneurysm (n = 2) of the renal artery. It was considered unnecessary to reestablish circulation in the donor limb in 2 patients (young children), and transposition of the ipsilateral internal iliac artery was performed in 9 patients; in the remaining patient circulation was reestablished with insertion of an iliofemoral prosthesis. RESULTS: There were no operative deaths. In 1 patient nephrectomy was necessary because of occlusion of the graft as a consequence of technical complications. In 8 patients there was immediate normalization of blood pressure without aid of medication, and in the remaining 3 patients an antihypertensive drug was prescribed. Two patients were lost to follow-up; the other 9 were assessed with angiography at a mean of 8.8 years after the operation. All grafts were found to be in excellent condition, with no evidence of dilatation, kinking, twisting, anastomotic fibroplasia, or wall irregularities. CONCLUSION: On the basis of this experience, the external iliac artery is confirmed as a substitute for the renal artery, and the excellent long-term results would seem to make it particularly useful in young patients with long life expectancy, such as those with renal artery fibrodysplasia.

Indications and long-term assessment of 10 cases of cross-leg free DCIA flaps.

Compound fractures of the lower limb with skin and bone loss are difficult repair problems, especially in multiple level injuries. With bone loss between 6 and 12 cms, the deep circumflex iliac artery (DCIA) flap is usually the flap of choice in reconstruction; the aim is to carry out microvascular anastomosis of the flap vessels to vessels on the damaged leg. However, this may be difficult or even impossible. Experience of 10 cross-leg DCIA flaps is outlined, with indications and surgical technique. The long-term bone healing is compared with 13 cases with anastomosis based on the same leg. There appears to be no difference in callus formation and remodelling of bone, indicating that despite subsequently dividing the original main vascular supply the bone in the DCIA flap remains vascularized and behaves as such.

Aortorenal arterial autografts: long-term assessment.

Ninety-four iliac arterial autografts were placed in 86 hypertensive patients (age range, 7 to 57 years) during a 16-year period for renal artery reconstruction of nonatherosclerotic lesions. Ten patients were children, and nine patients had a solitary kidney. Ex vivo repair was used in 21 patients. There were no early postoperative deaths; one patient died three months postoperatively of unrelated disease. Two grafts occluded in the early postoperative period. Follow-up of one to 16 years (mean, 5.6 years) was available in 77 patients (93%). Forty-one patients underwent late arteriography at an average of 5.7 years postoperatively. Fifty-one patients (66%) were regarded as cured of their hypertension, the conditions of 25 patients (32%) improved, and the condition of one patient (1.2%) was unchanged. There were no late autograft occlusions. Atherosclerotic anastomotic stenosis developed in one autograft 13 years postoperatively and was relieved by reoperation. Dilation of one autograft was observed seven years postoperatively but did not increase on subsequent arteriograms. In five children, follow-up angiograms showed that the size of the autograft paralleled that of the contralateral renal artery. These results support the preferential use of an autograft during reconstruction of nonatherosclerotic lesions that cause renovascular hypertension.