Dacron or PTFE for above-knee femoropopliteal bypass. a multicenter randomised study.

OBJECTIVES: To compare polytetrafluorethylene (PTFE) and polyester grafts (Dacron) for above knee femoropopliteal bypass. DESIGN: Multicenter randomised clinical trial. MATERIAL AND METHODS: 427 patients were randomised between 6mm Dacron (Uni-Graft, B. Braun Melsungen AG, 34212 Melsungen, Germany) and PTFE (Goretex, W. L. Gore & Ass. Inc., Newark DE 19711, USA) above-knee femoropopliteal bypass grafts within 13 centres in Denmark (n=261), Norway (n=113) & Finland (n=53) between 1993 and 1998. Fourteen (3%) patients were excluded, leaving 413 patients with 208 Dacron and 205 PTFE grafts for analysis. Age, gender, indication (claudication: 65%), run-off (2 or 3 vessels: 76%), diabetes (17%) and hypertension (31%) as well as cerebrovascular (9%) and cardiac (33%) risks were evenly distributed. Patients were followed postoperatively at 1, 12 and 24 months. Patency assessment was based on ankle-brachial pressures or imaging in case of doubt. RESULTS: The two-year primary patency rates for Dacron and PTFE were 70% and 57% (p=0.02), whereas the secondary patency rates were 76% and 65% (p=0.04), respectively. Primary patency at two years was significantly influenced by the number of patent crural vessels (two or three 67%, one 50%, p=0.01). Amputations at two years, major in 4% and minor in 3%, 30-days mortality and complications (wound infections: 3% and other wound complications: 13%) occurred equally frequent in both groups. At two years, patients treated for critical limb ischemia had a major amputation more often than patients operated on for intermittent claudication, 10 and 3 respectively (p=0.003), and had higher mortality rates, 20% and 8% respectively (p=0.001). CONCLUSION: This trial confirms that Dacron is at least as durable as PTFE for above-knee bypass procedures, and might even be superior.

Aortic dissection: natural course of disease? Report of two cases representing the extremes of the condition.

OBJECTIVE: In a time when diagnostic methods and above all, surgical as well as interventional radiological treatment for aortic aneurysms and aortic dissections have reached a point nobody could think of a few years back, the present authors feel that it is worth while to remind oneself of the natural course of disease in these conditions. Taking into consideration the high morbidity and mortality rate in surgically treated patients with aortic dissection, and the high complication rate per- and postoperatively, it also seems right to ask if a more expectative and conservative approach to the condition sometimes perhaps may be justified. METHODS AND MATERIAL: Two case reports are given. One was a 15-year-old boy with Stanford (Daily) type B dissection who statistically ought to have a good prognosis, but who died within 2 h after onset of symptoms. The other patient, a middle-aged woman with Stanford type A dissection, survived for 25 years without operation. CONCLUSION: These two cases, though not unique viewed separately, we consider to represent the extremes of the condition and also a natural course of disease, while none of them was operated on.

[Ureteral obstruction and hydronephrosis. A complication after aortic bypass surgery]. / Ureterobstruksjon og hydronefrose. En komplikasjon etter bypasskirurgi på aorta.

Ureteral obstruction is a rarely reported complication of reconstructive surgery on the aorta. It is often an asymptomatic condition seen several years after the initial operation. The true incidence is unknown, but is estimated to 1%. As delayed hydronephrosis appears to be a marker of present graft complications, the patients should be closely evaluated. Two cases of ureteral obstruction are described and the management of this complication is discussed.

Traumatic rupture of the thoracic aorta. A clinicopathological study.

In a county hospital serving a population of roughly 240,000, the hospital records from the period 1982 to 1987 included 27 patients who presented with traumatic rupture of the thoracic aorta. Eighteen patients died instantaneously, one was dead on admission, five died in hospital and three survived operation. Two patients had direct cross clamping of the aorta and Dacron interposition graft soon after admission; both survived. The third patient had a Gott shunt and Dacron interposition graft the day after the accident and survived with paraplegia. In all patients who died in hospital except one, the condition was not diagnosed before death. We conclude that traumatic rupture of the thoracic aorta occurs more frequently than is generally thought. Although most patients die at the scene of the accident, a liberal use of angiography is indicated in all trauma cases admitted to hospital with a history of a forceful deceleration or acceleration injury.

Early complications with a new bovine arterial graft (Solcograft-P).

In three separate centers of vascular surgery in Norway, a total of 26 patients underwent implantation of a new bovine arterial graft (Solcograft-P) for femoropopliteal or femorotibial bypass or arterial patch-plasty. Serious complications--graft deterioration and formation of aneurysm or pseudoaneurysm--arose in eight patients, all within 4 months after the implantation. In central Europe only four anastomotic pseudoaneurysms have been reported after about 700 Solcograft implantations, even with longer observation time. Possible causes of the difference in complication rates are discussed.

Acute gastric volvulus with necrosis of the stomach and the left lower pulmonary lobe.

Acute gastric volvulus in a young patient with a known chronic torsion of the stomach is reported. Unfamiliarity with the condition resulted in delayed admittance for surgery where a necrotic stomach and left lower pulmonary lobe were removed. The pathogenesis and treatment of this uncommon disorder is discussed.

Visceral ischaemia following coeliac- and superior mesenteric artery occlusion. Report of a case.

A patient with acute ischaemia of the abdominal organs after coeliac- and superior mesenteric artery occlusion is reported. Following vascular reconstruction and resection of gangrenous colon and ileum the main early postoperative problem was hepatic failure. A grave malabsorption syndrome developed necessitating periodic i.v. hyperalimentation. The patient showed no improvement of intestinal function and died 5 months postoperatively from peritonitis.