Cooke, Francis N

Kurzweg, Frank Turner

Starzl, Thomas E

PubMed

Cooke, FN

Kurzweg, FT

Starzl, TE

Name not available

Blood vessel bank: Organization and function

D-Scholarship@Pitt

I *Ii Blood Vessel Bar& Organization and Function I The vessel segmer. secting table and with The vessel is next was: clots cling to the intirr or atherosclerosis and For the ~ a s t  two ). T HE recent advances in  cardiovascular surgery emphasize the ne- cessity for the establishment and maintenance of a blood vessel bank in  all hospitals where the  management of cardiovascular problems are undertaken or where such a n  undertaking is contemplated. Elaborate and expensive equipment is not a necessary prerequisite for the func- tion of a satisfactory blood vessel bank. An arterial graft bank has been in  operation a t  Jackson Memorial Hospital for over three. years and the first graft from the bank was used in February of 1954 to recon- struct aortic continuity after resection of a n  abdominal aortic aneurysm. Procurenlent This is one of the most difficult facets of the undertaking and requires diligence and perseverance best appreciated by those who have attempted such a venture. Since routine autopsy usually includes the  removal of the thoracic and abdominal aorta, these are available a t  most postmortem examinations. We have attempted to procure all grafts within the 12 hours following death; however, where bodies are re- frigerated in the morgue this time may be extended. Small vessel grafts from the femoral arteries, for example, require the specific permission from the next of kin since removal of these necessitate extra incisions in  the thighs. There are few people, however, who understand humani- tarian objectives who will refuse to grant this extension of the autopsy. The vessels are removed under unsterile conditions in the post- mortem room. The thoracic aorta and arch are excised as  a unit. The abdominal aorta is removed from the  diaphragm to beyond the bifurca- tion of the iliacs. All large vessels cut across are tied distally for the benefit of the mortician. When t h e  femoral arteries are obtained, ail incision is made on the anterior thigh over Hunter's canal from the inguinal ligament just above the knee. After removal of the vessel, a small rubber catheter is tied i n  the  distal popliteal artery and led out through the femoral triangle for later use by the mortician. It is important that  all vessels be removed with a minimum of trauma and that  sufficient surrounding tissue be included so that  branches are not cut off flush with the  parent vessel. 'Clinical Assistant Professor, Associate Professor ond Resident, respectively, Department of Surgery. :pecially pukfied Beta and associates.1 This 1 following sterilization The chemical sol1 program are: 1. Beta-Propiolactc must be handled with 2. Buffered saline 16 E 5 - This solution is n several months. 3. Molar phosphat 0.2 M anhydrc 0.2 M anhydrc 808 ml. of sodil phosphate pH is taken o: Place 700 ml. 45 min. at 1. Because the BP centrated solution in 1 to 25 cc. of ice cold di 2. Place 225 cc. of mouth jar such as th  red indicator and sho: 3. Pour the diluti The solution should nc 4. Place the graft One graft to each sol?. tissue mass. If the gra solution. I 5. The jar is next placed in a water bath for two hours a t  370 C. During the two hours, the so1ution.i~ gently agitated and care must be taken to see that  the grafts are completely covered by solution. At the end of this two-hour period the solution will have assumed a salmon pink color. I Buffer Washing and Packaging This step must be done under the strictest aseptic conditions. A table is prepared with a sterlle pack containing a small saline basin, sterile scissors and long forceps. Two or three large pyrex test tubes (a  good size is a 1% inch diameter and 8 inch length) with rubber stoppers to  match, plus two or three sterile rubber condoms, are added to this equipment. The operator next puts on sterile rubber gloves and with the long forceps places the grafts in the  saline basin. The graft is then washed two or three times with the 0.2 molar phosphate buffer solution. A small piece of the vessel is then snipped away and placed in a thioglycolate culture tube for culture. The vessel is now placed with the long forceps into the large pyrex test tube and the rubbei. stopper applied. Starting at the capped end the rubber condom is rolled on the tube and fixed in position with two or three encircling rubber bands. All subsequent steps may now be done without aseptic pre- cautions. 1 Quick-Freezing Three or four pounds of dry ice are pulverized and placed in a flat pan. The pan we have used is 8 x 12 x 2 inches. I t  is advantageous but not essential to have this insulated. Seventy per cent ethyl alcohol is gradually added to the dry ice dust. This mixture is constantly stirred until it forms a viscous liquid, with a temperature of minus 70 to minus 740 C. DE UNIVERSITY BLOOD VESSEL GRAE DO~OR: Name .......... Age ................. Cause of De Date of Dea No. of hours No. of hours . No. of hours Name of doc' Name of doc Culture repor GRAFT: Diagram Measurement RECIPIENT: Name .... Age ..... .. Date of L Place of Diagnosis The prepared stoppered tubes with enclosed grafts are placed in the alcohol-dry ice mixture. The pyrex tubes are rotated gently until well embedded in the solution and the flat pan is covered with towe!s for insulation. This quick-freezing process continues for 20 minutes. The tubes are then removed, labeled and placed in a standard deep freeze refrigerator which has a temperature of minus 300 C. The tag on the graft tube contains all the essential information about the configuration, size, source, date of procurenlent and condition of the graft. This information and records concerning the operative use of the grafts are kept in a vessel registry for purposes of long range follow-up. The vessel registry form is shown in Figure 1. FOLLOW UP: (As re1 Labo 1. Discharge from hc 2. Three months post 3. One year postop. The Use of the Crafts at Surgery I I Los recientes av: i i  After an adequate exploration has been accomplished a t  the necesidad de estab~ 1 operating table, a suitable graft is selected and removed from the i todos 10s hospitale' ) freezing compartment. In  a few mlnutes it will have thawed enough en aquellos donde to allow it  to be rolled around in the  pgrex tube. Under aseptic con- cad0 y car0 no es I ditions, the rubber covering and rubber stopper are removed, and the satisfactorio de un ( graft is placed in a sterile saline basin on a sterile side table. The basin personal habitual : I : contains 150 cc. of normal saline, 1 gram streptomycin and 1,000,000 insignificante. Refri 1 units of aqueous penicillin. After a few minutes the graft assumes the den utilizar sin m: ) supple characteristics of a normal artery. micas. estudios bac. , All branches of the graft are ligated with 000 silk or, if they have b poco costo de 10s dl I been cut flush with the vessel, they are sutured with 5.0 arterial silk. Metodos de obtel-I detalle. I The vessel is then occluded a t  one end and t he  saline solution is in- I jected under mild pressure from the other end to test the graft for t I leakage. The graft is now ready for use. Since all grafts are of necessity I I tailored to fit a particular situation, the portion of the blood vessel I not used is sent. to  the bacteriology laboratory for culture. I Comments The grafts preserved in this manner have been easy to work with and in our experience have been entirely satisfactory.2 Grafts processed in this manner we believe to be satisfactory a t  least one year and probably two years after the initial freezing. If equipment and personnel common to most hospitals are used, the cost will be negligible. Refrigerators, water baths, and the like are already in use and can be utilized without inconvenience or extra ex- pense. Chemical solutions, bacteriologic studies and sterile supplies can be obtained a t  little expense from the appropriate hospital department. References 1 .  S L I I . ~ G I .  1). E., O V E R I ~ L ~ L S E ,  1'. R., SHOSXARD, C. P., and LOGRIPPO. G. )I. "Stcr~liratio~~ of IIuman .irtcrial IIomografts \\it11 Bcta.Propiolactone," Surg. Forurn 4 :  144, 1954. 1. COOKE, I7rc.%sc~s 9. "Blood \fessel Replacement Illerapy," Iouri~trl of t l ~ c  Florida .lJedical Association. To be published. 

Blood Vessel Bank: Organization and Function.

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Blood Vessel Bank: Organization and Function.

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