Advances in the management of acute popliteal vascular blunt injuries

This report evaluates critical points in the managemant of 30 consecutive blunt traumatic popliteal vascular injuries. All arterial injuries were diagnosed both clinically and by Doppler and PVR examinations. Twenty-eight of the 30 arterial reconstructions required interposition bypass grafts, nine of which were PTFE and the remainder were autogenous saphenous veins. In 19 patients the distal anastomosis was made to the distal popliteal artery and in nine patients to the tibial-peroneal arteries. In ten patients in whom limb survival was threatened, the ischemic time was shortened by the use of temporary silastic shunt for rapid restoration of arterial flow. Nine patients had associated venous injuries which were repaired. Nine of the first 14 patients required fasciotomy but the last 16 patients were treated with hypertonic mannitol and only two of them required fasciotomy. There were no amputations, but in four limbs there were functional losses. In spite of the more extensive damage of blunt trauma, prompt and aggressive management aided by vascular laboratory tests, indewelling shunt, and hypertonic mannitol is rewarded with preservation of limbs following acute popliteal vascular injuries.(AU)

Treatment of infra-renal aorto-iliac aneurysms by total exclusion

A new approach to the treatment of abdominal aortic aneurysms is described. This technique decreases the morbidity of surgery by minimising haemorrhage and reducing fluid and electrolyte loss (AU)

Relationship between vasa vasorum and blood flow to vein bypass endothelial morphology

In order to define the respective roles of the vasa vasorum blood supply and intraluminal arterial blood flow in maintaining the endothelial integrity of in situ vein bypasses, we have carried out two separate but interrelated experiments in a canine model. In vivo studies on eight dogs demonstrated that even in the absence of intraluminal blood flow the vasa vasorum maintained endothelial integrity and also showed that the endothelium was very sensitive to the loss of the vasa vasorum blood supply. In a second group of experiments on 14 in situ vein by passes we studied the effect of division of the vasa vasorum immediately after arterialization of the bypass. This experiment showed that arterialization of the vein maintained endothelial integrity despite division of the vasa vasorum.(AU)