Internal jugular venous autograft in extrahepatic portal hypertension.

A 26 year old female with repeated episodes of upper gastrointestinal bleeding, secondary to extensive extrahepatic portal and superior mesenteric venous obstruction, was surgically treated by interposing an internal jugular vein autograft between a collateral channel and the inferior vena cava. The follow-up observation during a seven and one-half year period has shown no recurrence of bleeding, disappearance of esophageal varices and a widely patent graft with normal portal vascular pressures. The internal jugular vein is a readily accessible autogenous graft of adequate caliber that can maintain patency under rigorous conditions. Its use is recommended in constructing portal-systemic venous shunts in those instances of extrahepatic portal hypertension in which conventional shunts cannot be established or, if they can be established, are liable to closure.

Presence of endothelium in an axillary-femoral graft of knitted Dacron with an external velour surface.

An axillary-bilateral common femoral graft of knitted Dacron with an external velour surface was examined within one hour after the patient's death from non-graft-related causes. The prothesis, implanted for 20 months, was patent and was completely healed over 32% of the flow surface--that is, full wall fibrous tissue encapsulation of the graft had occurred, and 32% of the flow surface was endothelialized. The remaining flow surface was formed of fibrin, but fibrous tissue healing had reached the inner surface of the graft material, and the fibrin overlay was very thin. The healed protions of the graft included not only the areas adjacent to the anastomoses, but were scattered throughout the 45 cm length of the prosthesis. To our knowledge, this is the first report of complete healing (fibrous tissue encapsulation and endothelialization) documented at points beyond the plannus ingrowth at the prosthesis-artery anastomosis.