[First non-autologous vascular access for hemodialysis: PTFE fistula]. / Primer acceso vascular no autólogo para hemodiálisis. Prótesis de PTFE humero-antecubital curva de antebrazo.

INTRODUCTION: Since 1999 to 2003 we have tried to perform an antebraquial "loop" PTFE fistula (PTFEa) as first vascular access for hemodialysis in patients without suitable superficial venous system. MATERIAL AND METHODS: We have performed a prospective study to analyze the results (permeability and complications) with this approach. RESULTS: We could perform 44 PTFEa in 46 consecutive patients (in two cases we used the axillary vein as return vessel). Early failure was 0%. One year primary and secondary permeability were 66% and 90% respectively. CONCLUSIONS: PTFEa is a good solution as first vascular access in patients without a suitable superficil venous system.

Chronic perioperative steroids and colonic anastomotic healing in rats.

OBJECTIVE: To develop a rat model of long-term high-dose perioperative steroids and to evaluate the effects of these steroids on a colonic anastomosis in this model. DESIGN: Prospective randomized. METHODS: Twenty-six male Sprague-Dawley rats, weighing 270 to 330 g, were randomized into two groups. The first group (steroid group) (13 rats) received a time-release drug pellet (200 mg cortisone acetate in a 60-day release form) placed in the subcutaneous tissue of the posterior neck for an average daily dose of 3.3 mg. The second group (control group) (13 rats) received a placebo. At 6 weeks, blood cortisol levels were measured, and a colonic anastomosis was performed 2.5 cm distal to the cecum. Steroid group animals also received cortisone acetate (5 mg intramuscularly) immediately before surgery. Colonic bursting strength (mmHg) was measured at the anastomosis site and in the normal distal left colon using a saline infusion system at 8 and 12 days postoperatively. RESULTS: Blood cortisol levels were significantly higher in the rats in the steroid group than in the rats in the control group. The anastomotic bursting strength was significantly lower in the steroid group at Days 8 and 12. The bursting pressure of the unoperated left colon was not significantly different when the groups were compared. Also, in the steroid group, healing of the pellet insertion wounds in the neck was impaired. CONCLUSION: The time-release drug pellet is a reliable method of administering long-term steroids. Long-term perioperative steroids impaired colonic anastomotic healing, while normal tissue strength (left colon) was not significantly changed.

Renal transplantation without sutures using the vascular clipping system for renal artery and vein anastomosis--a new technique.

A cadaveric renal transplant was performed on a 63-year-old woman. The donor renal artery and vein were anastomosed to the recipient external iliac vessels using the vascular clipping system. These vascular anastomoses were performed with four stay sutures and several clips for each anastomosis, without a continuous vascular suture. The time taken was 8 min for each anastomosis. There were no postoperative complications and the patient went home after 6 days in the hospital. At 1 month follow-up her serum creatinine was 1.3 mg/dl. We conclude that cadaveric renal transplantation can be performed using clips for the vascular anastomoses. This technique permits an expeditious, interrupted anastomosis. Since the arcuate legged clips are nonpenetrating, there is minimum trauma to the vascular intima. In pediatric transplantation this interrupted technique may be of special importance, since it should allow the anastomoses to grow with time. The ability to quickly perform this type of anastomosis may reduce warm ischemia time as well. The safety and technical ease of this technique should allow its application in the anastomosis of other tubular structures as well. This might further improve the currently excellent outcomes of solid organ transplantation.