[Venous grafts as arterial substitutes. Immediate and medium-term development]. / Le greffon veineux utilisé comme substitut artériel. Evolution précoce et à moyen terme.

This study, based on the authors' experiments in dogs and on data from the literature, describes the immediate and mediumterm histological development of autologous vein grafts. Dissection alone results in extensive endothelial cell desquamation, which may be aggravated by distension and preservation of the graft in an inappropriate medium. Immediately after re-establishment of the arterial blood flow the inner surface of the graft is covered by a fibrinoerythrocytic membrane. Endothelialization begins 10-15 days later but remains incomplete in dogs after 9 months; it is not limited to the suture lines but proceeds by islets disseminated over the surface. As early as the 15th post-operative day, a myo-intimal layer of myofibroblastic cells develops; the origin and control of these cells are still unknown. A better knowledge of the histological development of vein grafts and underlying mechanisms appears to be essential to improvements in surgical procedures and subsequent long-term functional performance of the grafts.

[Rupture of the left subclavian artery associated with fracture of the 1st rib]. / Rupture de l'artère sous-clavière gauche associée à une fracture de la première côte.

Treatment in a case of partial rupture of the subclavicular artery, provoking subacute ischemia of the upper limb and associated with a fracture of the first rib, was by sternoclavicular disinsertion and resection-suture. The importance of systematic investigation of possible subclavicular lesions in patients with fractured first ribs is emphasized, both during the initial and follow-up examinations. The presence of a fracture of this type has little influence on the classical surgical attitude adapted, apart from the possible need for resection of the first rib.

Immediate and long-term evolution of the blood-venous graft interface. Experimental study in dogs.

Endothelial damage and repair in autogenous saphenous vein grafts was evaluated serially from 30 s to 9 months after implantation into the femoral arteries of 25 dogs. Light and scanning electron microscopy, quantitative morphometry and cytochemistry with specific rabbit antidog factor VIII-related antigen were used. These studies demonstrate: (1) early complete endothelial cell desquamation both on the venous graft and adjacent artery apparently related to dissection and suture; (2) differing early platelet activation on the venous and adjacent arterial wall, platelet aggregates were noted on the adjacent artery, whereas only adhesive platelets are noted on the exposed vein graft; (3) endothelial reconstitution being initiated after 10-15 days but not reaching completion even 9 months after implantation; (4) a mediointimal proliferation which is a constant feature. A unique cell possessing both fibroblastic and myocytic characteristics takes part in the process.