Morio Kina

Ultrasonic flow wave pattern as a prognostic indicator in peripheral arterial reconstruction

A prognostic flowmetric study on 80 reconstructed arteries of the lower extremity was carried out to assess the flow wave patterns detected using a bidirectional doppler flowmeter. In 21 of 80 arteries, changes in the flow wave pattern were noted. For 10 of 21 affected arteries, an immediate arteriography revealed localized stenotic lesions at the distal anastomosis in a short segment of the implanted autogenous vein graft or at the proximal host artery. Immediate repairs for the lesions were successfully performed by a minor surgery in 8 of 10 cases and the flow wave pattern reverted to normal. Two were not successful, as the occlusion was complete before attempting the repair. The remaining 11 are now under conservative management as these patients refused further surgery. The ultrasonically driven flow wave pattern proved to be a useful indicator to assess the patency of the reconstructed peripheral artery to detect possible stenosis and thereby to take proper corrective measures and hence prevent a late occlusion.

Five-year clinical evalution of the St. Jude medical valve prosthesis in 136 patients

One hundred and thirty-six patients (June 1979, through May 1984) underwent mitral, aortic or double valve replacement and apico-aortic bypass with the St. Jude Medical (SJM) prosthesis, at Ryukyu University Hospital, Okinawa. Operative mortality for the entire group was 4.4 per cent. Late mortality from 1979–1984 was 6.1 per cent. There were no deaths related to mechanical failure. Warfarin anticoagulation was recommended for all patients. The incidence of thromboembolism was 0.76/100 patient years. Post operative catheterization studies in 21 patients one year after operation showed a satisfactory recovery of cardiac function. The SJM valve seems to be the satisfactory artificial valve in present use.

Skin sliding closure technique is effective for management of infected prostheses in cases of arterial reconstruction with synthetic grafts

A clinical review of 400 prosthetic arterial reconstructions, carried out in the Second Department of Surgery of Kyushu University Hospital during a period from 1965 to 1981, revealed 10 graft infections (2.5 per cent). There were two out of 120 abdominal aneurysms (1.7 per cent) and 8 out of 260 aorto-femoral occlusive diseases (3.1 per cent). The contributing factors included intraoperative contamination with duodenal juice during surgery for abdominal aneurysms ruptured into the duodenum (2 cases), minor hematoma and/or lymphorrhoea at the groin or lower abdominal wall (5 cases), wound infection (1 case), compression necrosis of the sigmoid colon by the implanted graft (1 case) or perityphlitic abscess due to a perforating appendicitis (1 case). Bacteriologic examination revealed a predominance of a variety of staphylococcus at the groin or lower abdominal wall and E. coli in the abdominal cavity. Four patients expired. Limb amputation had to be done in 2, and 4 were cured. In the management of infected graft at the groin or lower abdominal wall, we used with success a skin sliding closure technique after continuous wound lavage in 3 patients.

Long-term results of reconstructive surgery for femoro-popliteal arterial occlusive lesions.

A retrospective review of 156 reconstructions performed for femoro-politeal arterial occlusive lesions in 141 patients was carried out in terms of the reconstructive procedure and the degree of out-flow in the distal vessel. The cumulative patency rate for 95 autogenous vein grafts was 60.7 per cent at 12 years and higher than the 27.4% patency rate for 50 endarterectomies (p<0.001). All of 11 synthetic bypass prostheses failed with late thrombosis within 3 years after operation.The cumulative patency rate in cases with good distal run-off vessel and those with fair distal run-off vessel were 77.1% at 11 years and 57.3% at 12 years, respectively, and these values were significantly superior to 10.3% in cases with poor distal run-off vessel. The patency rate for 41 in situ grafts was 72.2%, being superior to 65.5% for 42 free grafts.