Michael E. De Bakey

Cells grown on isolated intravascular dacron hub: An electron microscopic study☆

Abstract Dacron hubs anchored by polyethylene sutures in the center of vascular prostheses were placed in the thoracic aortas of growing young pigs and adult dogs. This permitted cells in the blood-stream to settle, grow, and differentiate on the hub. The nature of the cells was studied by special histologic techniques and electron microscopy. Endothelial cells covered the hub. Between the endothelium and the dacron, and close to the dacron, there were giant cells of the foreign body type. Beneath the endothelium there were fibroblasts and smooth muscle cells. The covering of the hub was identical to the inner lining of the dacron vascular prosthesis to which the hub was anchored.

Surgical Treatment of Dissecting Aneurysm of the Aorta Analysis of Seventy-Two Cases

Dissecting aneurysm of the aorta is an extremely serious condition that pursues a rapidly fatal course in more than 75 per cent of cases. Follow-up data on 72 patients surgically treated indicate that effective surgical treatment significantly alters the course of the disease and in the majority of instances removes the threat of death by rupture. The operative mortality rate in these 72 patients was 26 per cent. For lesions occurring distal to the left subclavian artery, resection of the descending thoracic aorta with replacement by aortic graft utilizing hypothermia or the bypass pump was successful in 80 per cent of cases. Most patients surviving operation have been able to resume previous activities with minimal risk of sudden death from rupture of the aneurysm or failure of the aortic graft. The importance of recognizing the characteristic clinical manifestations, of making precise roentgenographic diagnosis, and of instituting effective surgical treatment in the management of dissecting aortic aneurysm has been stressed.

Surgical Treatment of Atherosclerotic Occlusive Lesions in Patients with Cerebral Arterial Insufficiency

Cerebral vascular disease, according to the results of arteriography, may be caused by extracranial arterial lesions in one third of the cases. Observations in 174 cases are described. The results of surgical treatment in 63 patients are presented and evaluated on the basis of restoration of circulation, clinical improvement, and survival. The implications regarding diagnosis and indications and contraindications for surgery are discussed.

Arterial Homografts for Peripheral Arteriosclerotic Occlusive Disease

Sympathectomy and thrombo-endarterectomy have been largely unsatisfactory in the treatment of patients with arterial insufficiency of the lower extremities. In this paper the results are analyzed of a large experience with the use of lyophilized arterial homografts to bridge occlusive lesions below the aortic bifurcation. The criteria for selection of patients for operation, the simplified procedure of end-to-side by-pass of the obstruction, and the excellent results in 145 operations are presented.

Endothelial Lining of Dacron Prostheses of Porcine Thoracic Aortas.

Summary Prostheses of knitted, crimped dacron, some with and some without gelatin impregnation, were placed in the thoracic aortas of 17 young pigs. The prostheses replaced excised segments of aortas, 4 to 6 cm long, and were left in place for 7 to 139 days. “En face” and pellicle silver preparations revealed complete endothelial covering of the surface of a prosthesis after 7 days.

LINING OF AUTOGENOUS VEIN PATCH GRAFTS OF SMALL CANINE ARTERIES.

Summary The inner lining of autogenous vein patch grafts placed into small canine arteries by microsurgical techniques was studied. The grafts placed in 22 femoral arteries of 13 dogs were kept in place from 2 days to 76 weeks. Aortography disclosed patency of all the arteries grafted with no or slight dilatation at the site of operation. En face silver preparations disclosed that the intimal surfaces of the grafts were covered with endothelium after the 4th day. Endothelial cells were demonstrated in pellicle preparations. The patch contributed its own substance, particularly elastic fibers, to the repair of the arterial wall.

Experimental Evaluation of a Marlex Vascular Prosthesis.

Summary A vascular prosthesis of Marlex was implanted as a long aortic bypass graft in dogs and left in place up to 12 months. After 3 months of implantation, the inner surface of the prosthesis had a smooth lining and was firmly attached through the interstices to the periprosthetic tissue. None of the implanted prostheses exhibited stenosis, aneurysm or plaque formation. The inner and outer surfaces of the fabric were covered by a band of hyalinizing fibrous connective tissue. Plaques of osteoid were numerous on the intimal surface. Although the Marlex prosthesis functions adequately as a vascular substitute, unsatisfactory physical properties of this material limit its clinical use.