Intraoperative flow measurements in gastroepiploic grafts using pulsed Doppler 1

Abstract Objective: The patency of a pedicled right gastroepiploic artery (RGEA) graft can be compromised by intraoperative twists, kinks or spasms. Therefore, a systematic flow assessment was made in RGEA grafts and was compared with similar measurements made in other types of bypass conduits. Methods: Intraoperative pulsed Doppler flowmeter measurements obtained in a series of 556 consecutive patients undergoing at least one coronary bypass grafting onto the right coronary system were studied. Eighty-five RGEA grafts were compared with 1427 bypass grafts implanted in the same group of patients and consisted of the following conduits: 442 left internal mammary (LIMA), 149 right internal mammary (RIMA), 831 greater saphenous vein (GSV) and five inferior epigastric (EPIG) grafts. Sequential grafts were excluded from the analysis. Results: Flow measurements and Doppler waveforms were abnormal and required graft repositioning, and the addition of a distal graft or intragraft papaverine injection (only in GSVs) in 29 cases (2.0% of all grafts). These graft corrections were necessary in 5.9% RGEAs, 3.4% LIMAs, 2.0% RIMAs, and 0.7% GSVs (P Ͻ 0.001). The relative risk for graft correction was eight times higher for RGEAs than for GSVs (P = 0.002). Flow increased from 8 ± 2 to 54 ± 5 ml/min (P Ͻ 0.0001). Flow data were significantly influenced by the type of run-off bed (P Ͻ 0.001), the measurements obtained in grafts implanted onto the right coronary artery and the left anterior descending artery being superior. Flows in RGEAs, however, were comparable with values obtained in other grafts implanted onto the same recipient coronary artery. Conclusions: A significantly higher incidence of graft malpositioning caused inadequate flows in RGEAs. However, normal flow values could be restored simply by assigning a better graft orientation under pulsed Doppler flowmeter control. Overall flow capacity of the RGEA did not differ from values obtained in other arterial and venous grafts implanted onto the same recipient arteries

La constitution d'une banque d'homogreffes de veines saphènes strippées est-elle possible?

The long-term cryopreservation of viable human venous allografts is discussed. The preservation technique includes immersion in a 15 p. cent Dimethylsulfoxide solution, followed by deep hypothermia in liquid nitrogen at - 196 degrees C. The veins studied were preserved for a period of 1 week to 24 months. Histological and scan electron microscopy examination does not show any specific alteration resulting from the freezing technique. Tissue enzymes assays, titration of the fibrinolytic activity and the rate of prostaglandins synthesis, are not affected by the duration of the preservation period. This cryopreservation technique respects the venous structure and functions; therefore, its clinical use is possible. Strict selection of the stripped veins according to morphological criteria seems therefore absolutely necessary

Programme for detecting chronic venous insufficiency in Belgium.

OBJECTIVE: Epidemiological study related to the detection of chronic venous disease (CVD) in a Belgian population and gathering of a maximum amount of epidemiological data on CVD. METHOD: Survey based on a questionnaire completed by a general practitioner during consultation. RESULTS: In total 3813 files of patients with CVD were completed and analysed. Of these patients suffering from CVD, 70% were women with a mean body mass index of 26.2 and a clinical, aetiological, anatomical and pathological elements classification as follows: C0 = 10%; C1 = 19%; C2 = 29%; C3 = 19%; C4 = 16%; C5 = 4%; C6 = 3%. Risk factors, clinical signs, complications and therapeutic approach are analysed and described. CONCLUSION: High level of statistically analysable data could be obtained within a reasonable period. The study confirms the socioeconomic importance of CVD. For example, an industrial disablement of an average duration of 23.6 days is found in 6% of patients

Douleurs de membre sur piège congénital de l'artère poplitée.

Two patients with popliteal artery entrapment including one bilateral were operated on in the Cardiovascular and Thoracic Surgery Unit at the UCL between January 1987 and February 1988. Both patients complained of severe intermittent claudication. One of the entrapments resulted from internal deviation of the vessel. The two others were secondary to excessively external insertion of the medial head of the gastrocnemius muscle. These preoperative findings correlated with preoperative CT scan. A section of the medial head of the gastrocnemius resulted in complete liberation of the popliteal artery in each case. In addition, a popliteal thromboendarterectomy was performed in one patient and a lumbar sympathectomy in the other