Robert R. Linton

Durability of femoropopliteal reconstructions: Endarterectomy versus vein bypass grafts☆

Abstract Eighty-seven endarterectomies and 345 saphenous vein bypass grafts were carried out from 1955 to 1967 because of atherosclerotic femoropopliteal occlusive disease. The follow-up period ranged from three to fifteen years and accumulative patency rates were calculated by the life table method. Patency rates at three, five, and seven years for vein grafts were 74 per cent, 68 per cent, and 63 per cent, respectively. The patency rates for endarterectomy at these periods were 38 per cent, 33 per cent, and 23 per cent, respectively. In our experience once a vein bypass graft has been successfully implanted, the long-term success rate is little altered by pre-existing disease of the outflow vessels.

Surgical management of mycotic aneurysms and the complications of infection in vascular reconstructive surgery

Abstract A series of seventeen mycotic aneurysms treated over the past fifteen years at this institution has been reported. Thirteen of these involved the abdominal aorta and four involved peripheral vessels. Rupture of the aneurysm occurred in ten. There were no survivors in the seven patients with ruptured aneurysms that involved the aorta, four of whom underwent emergency surgery. There were two survivors among the three patients with peripheral ruptured mycotic aneurysms. There were five survivors of the seven with nonruptured aneurysms treated surgically. Four of the six patients with mycotic nonruptured aneurysms of the aorta treated surgically survived and are well at periods of nineteen months to nine years. Three additional successfully managed cases of infection complicating vascular reconstructive procedures have been presented, emphasizing the technics of management. The following factors appear to be of importance to the successful management of mycotic aneurysms or infection complicating vascular reconstructive surgery: (1) early diagnosis and prompt surgery; (2) appropriate pre- and intraoperative antibiotic therapy and postoperative intravenous antibiotic therapy for a period of at least six weeks; (3) resection of infected tissue, foreign material, and adequate drainage; (4) placement of the new graft reconstruction through clean tissue planes; (5) use of wide drainage and local antibiotic irrigation in addition to systemic antibiotics in rare situations in which resection and reconstruction does not seem possible; (6) careful long-term follow-up study.

Critical comparative analysis of early and late results of splenorenal and direct portacaval shunts performed in 169 patients with portal cirrhosis.

Critical Comparative Analysis of Early and Late Results of Splenorenal and Direct Portacaval Shunts Performed in 169 Patients with Portal Cirrhosis ROBERT LINTON;DANIEL ELLIS;JOSEPH GEARY; Annals of Surgery

Segmental stenosis of saphenous-vein autografts. Preventable cause of late occlusion in arterial reconstruction.

SAPHENOUS-vein femoral popliteal bypass autograft has been demonstrated clinically to be an effective long-term vascular reconstructive procedure in many patients with arteriosclerotic occlusion of...

Portacaval shunts in the treatment of portal hypertension with special reference to patients previously operated upon.

A NEW chapter is being written on the treatment of portal hypertension with bleeding esophageal varices. Eck,1 in 1877, was the first to demonstrate that the portal vein can be anastomosed to the i...

Intrasaccular Wiring of Abdomixalarterio- Sclerotic Aortic Aneurysms By the "Pack" Method

Surgical Department, Massachusetts General Hospital, Boston, Massachusetts. Presented at the first meeting of the International Society of Angiology, Atlantic City, N. J., June 9, 1951. Aneurysm of the abdominal aorta is a fatal disease if untreated. Death occurs in the majority of patients from rupture of the aneurysmal sac. This disease of the major blood vessel of the body has been considered relatively uncommon; thus as recently as 1936, Kampmeier (11) was able to collect from the records

Surgical Management of Popliteal Aneurysms

Ninety-eight popliteal aneurysms are reported that occurred in 82 patients who were treated surgically during a 16-year period from 1948 to 1963. The presence of acute or chronic arterial occlusive symptoms prior to operation significantly influenced the results of surgical management. Arterial reconstruction salvaged more than one half of the limbs presenting with limb-threatening ischemia, but early and late results recommend excision and grafting of all asymptomatic popliteal aneurysms before such complications develop. In our opinion saphenous vein autografts are preferable to prosthetic replacement in the surgical management of popliteal aneurysms.

Peripheral Vascular Disease

THIS report considers peripheral vascular disease under the two main divisions of diseases of the arteries and diseases of the veins. Diseases of the Arteries The surgical treatment of peripheral v...

The postphlebitic varicose ulcer

I N GENERAL there are two types of ulceration of the lower leg associated with varicose veins. This was pointed out originally by Homans,l in 1917. The first type is the simple varicose ulcer which is found in association with a varicose and incompetent condition of the long or short saphenous veins. They are readily healed by the obliteration of the varicose veins by multiple injections of a sclerosing solution into the involved veins, or better by high ligation of the long or short saphenous veins in addition to the injections. The second type, the postphlebitic varicose ulcer, is the ulceration which may develop on the lower leg from one to twenty years after a thrombophlebitis that has involved the deep veins of the leg. In contradistinction to the simple varicose ulcer, this type is characterized by its chronicity and the difficulty of obtaining a cure. The long or short saphenous veins or both of them are usually found incompetent in the postphlebitic leg. In addition, some or all of the communicating veins of the leg which connect the deep system of veins with the superficial ones are found to be incompetent. Thus, if the Trendelenburg test is carried out it will be found that the superficial veins of the lower leg fill rapidly from the deep veins through the communicating veins as well as from superficial ones. It is felt that the incompetence of the communicating veins explains the difference between these two types of ulcers. An antecedent history of deep phlebitis cannot be elicited in all patients with this type of ulceration. However, in most cases one gets a history that at some time previous to the appearance of the ulcer the patient developed a swollen leg following pregnancy, an operation, a serious illness, or severe trauma to the extremity. The appearance of the ulceration and the skin surrounding it is very characteristic. Frequently the actual ulceration will be only a few centimeters in diameter, although in long-standing cases it may completely encircle the leg. When the patient seeks medical treatment the ulcer is covered with a dirty exudate from which a variety of organisms may be cultured. Sometimes hemolytic streptococci are present, but as a rule they are not. The skin about the ulcer for a distance of 5 to 10 cm. presents a purplish cyanotic hue when the leg is in a dependent position. A dark brownish pigmentation

Oliguria following diagnostic translumbar aortography; report of a case.

TRANSLUMBAR aortography has assumed increasing importance in clinical medicine as a diagnostic aid for a variety of conditions. This technic has been of particular importance in elucidating the pat...