J.Harold Conn

Combining intra-abdominal arterial grafting with gastrointestinal or biliary tract procedures

Summary Twenty-two patients in whom intra-abdominal vascular procedures were performed concomitantly with gastrointestinal or biliary tract operations are reported on. No graft infections occurred. There were two deaths, a mortality of 9 per cent. One death clearly was not related to the associated procedure, and the other was probably due to several factors including the length of the operative procedure and the underlying cardiovascular and respiratory disease. These results agree with those reported in the literature. It is concluded that necessary gastrointestinal or biliary tract procedures can be performed concomitantly with intra-abdominal arterial procedures without significantly increasing the risk of infection of the arterial graft.

Isolated chylopericardium. Lymphographic findings and surgical treatment.

An occurrence of isolated chylopericardium in a 27 year old man is described. The asymptomatic nature of this disease in some patients is emphasized to reveal the chronic course of the process. No cause was found for the development of the chylopericardium. However, lymphangiography of the lower limbs demonstrated the communication between the branches of the thoracic duct and the pericardial sac and the point of obstruction of the thoracic duct at the level of the fistulous communication. To our knowledge, this is the first demonstration of a communication between the lymphatic vessels of the thoracic cavity and the pericardium associated with the development of chylopericardium. External drainage of the pericardial sac by means of a pericardial window using the subxyphoid route resulted in complete relief of the pericardial effusion. No recurrence of the chylopericardium was observed in this patient up to 8 months after the external drainage.

Technic for the creation of a thoracic fistula in the dog

Abstract Creation of a thoracic duct fistula in the dog is a frequently used experimental procedure. A method of creating such a fistula is described that utilizes the segment of vein draining the thoracic duct as a drainage conduit to the exterior. This method is simple and easier to perform than are other technics presently in use.

Arterial homografts: Experience with end-to-side vascular anastomosis☆

Abstract Analysis of the short term results following end-to-side anastomosis of five arterial homografts is presented. Our immediate results indicate a high percentage of patency with excellent blood flow distally, as demonstrated by bounding peripheral pulses and postoperative arteriograms. Symptomatology of intermittent claudication, rest pain, etc., is either markedly reduced or completely eliminated. As demonstrated by one of our cases, even though the extremity may not be completely restored to normal function if gangrene is present, the level of amputation may be markedly lowered so that a digital removal can be effected instead of an above-the-knee amputation. Performance of end-to-side anastomosis preserves the collateral circulation, which is a safety factor if thrombosis of the graft occurs. It permits placement of the proximal anastomosis at a much higher level so that a greater blood flow under higher pressure is assured. By the utilization of a side of the host artery which is soft and pliable and free from atheromatous plaques, better tissue can be used to fashion the anastomosis without performing an endarterectomy. It is recommended that end-to-side anastomosis to the aorta be used for bifurcation grafts for all the foregoing reasons. Of particular importance is the preservation of essential collaterals such as those originating from the inferior mesenteric and hypogastric arteries which are usually sacrificed by replacement technics.