Angiosarcoma of the Aorta Associated with a Dacron Graft

The case report of a patient with an angiosarcoma arising near a Dacron aortic graft is presented with a review of the literature. Antemortem diagnosis of primary malignancies of the aorta and large arteries is seldom attained. The tumorigenic potential of plastic grafts is an etiological consideration.     

Paracolostomal hernia: Repair with use of a Dacron prosthesis

Several surgical procedures have been described for the repair of paracolostomal hernia. We describe a local technique approach using stoma relocation with insertion of a Dacron prosthesis. Among 14 patients operated on for paracolostomal hernia, this technique was used in 10 patients. There was no mortality or morbidity (no prosthesis infection). During follow-up there was one recurrence, which was reoperated with a good final result. This technique can be recommended for the few patients in whom a surgical repair is mandated.

---

Resumen Varios procedimientos quirúrgicos han sido descritos para la reparation de la hernia paracolostomal. Los autores describen una técnica local que utiliza la reubicación del estoma con inserción de una prótesis de Dacrón; la técnica fue utilizada en 10 de un total de 14 pacientes operados por hernia paracolostomal. No hubo mortalidad ni morbilidad (no se presentó infección de la prótesis). En el curso del seguimiento, se presentó una recurrencia, que fue reoperada con buen resultado final. La técnica puede ser recomendada para los pocos pacientes en quienes es mandatoria la reparación quirúrgica.

---

Résumé La relative tolérance des hernies paracolostomiales, dont certaines sont cependant invalidantes, la notion de rédicives fréquentes après traitements chirurgicaux les plus divers font que peu de patients sont traités chirurgicalement. Les auteurs décirivent, à propos d'une expérience de 14 patients, une technique de cure de hernie parastomiale par changement de site de la colostomie associée à l'insertion d'une prosthèse de Dacron perforée. Dans le suivi, il n'y a eu ni morbidité (en particulier pas d'infection de prothèse), ni mortalité. Il y a eu une récidive, réopérée par le même procédé, avec un bon résultat final. Cette technique peut être recommandée pour le lot de patients porteurs de hernies paracolostomiales invalidantes ou gênantes.

     

Graftula: A Composite Access Consisting of a Graft Used to Repair a Dysfunctional Hemodialysis Fistula

Nonmaturing or dysfunctional hemodialysis fistulas are often repaired with interposition grafts placed either within the fistula (fistula‐to‐fistula configuration), or connected to another vein (fistula‐to‐vein configuration). The goal of this study was to compare the survival and usefulness of the composite accesses thus created, which we call “graftulas,” with upperarm grafts. This was a retrospective study wherein we determined the survival and thrombosis rates of graftulas (n = 24) and upper arm grafts (n = 31) placed 1/1/07 through 12/31/09 and followed through 11/30/10. Graftulas resembled grafts as most (96%) were successfully cannulated in 65 ± 43 days. Survival of graftulas was also similar to grafts (58%, 47%, and 32% vs. 56%, 47%, and 39% at 1, 2, and 3 years respectively, p = 0.60). However, graftulas had a lower thrombosis rate than grafts (0.5 vs. 1.2 per patient year, p = 0.04), and in the fistula‐to‐fistula configuration, a 2‐year thrombosis‐free survival of 78%. Total survival of the access site (fistula + graftula) was 92%, 73%, and 42% at 1, 3, and 5 years, respectively. Graftulas possess certain beneficial properties of fistulas and grafts that allows for continued use of the original access site.     

Surgical Management of a Graftenteric Fistula: A Modified Method of In Situ Reconstruction

Between December 1989 and May 1998, we performed a modified method of in situ reconstruction on three of seven patients with graftenteric fistulas (GEFs) at the Kurume University Hospital. The modification involved performing an anastomosis of the infrarenal abdominal aorta and running a new prosthesis through the left side of the descending colon in the retroperitoneal cavity, and wrapping the proximal anastomosis and the proximal site of the prosthesis in the greater omentum. Good results were achieved in all three patients. We describe herein this modified method of in situ reconstruction for a GEF and summarize the case reports of these three patients. Received: February 2, 2000 / Accepted: July 25, 2000     

Aortoentric Fistula Following Ruptured Abdominal Aortic Aneurysm Surgery: Aortobifemoral Dacron Bypass Graft is Detected by Colonoscopy

Abstract   Aortoenteric fistula is a dramatic and rare complication, which may occur following abdominal aortic surgery. In this report, we present images of a 65-year-old patient who presented with acute peritonitis two months after aortobifemoral bypass grafting operation with a bifurcated dacron graft. Colonoscopy clearly showed the pathology leading to acute abdomen: Intestinal fistulization of the graft.     

涤纶血管胶原蛋白涂层的实验及临床研究

提取牛皮Ⅰ型胶原蛋白,以4mg/ml的胶原蛋白溶液涂层苏州涤纶人工血管,经过0.3％戊二醛交联,涤纶血管渗水量由383±28ml·min~(-1)/cm~2降至2.8±0.5ml·min~(-1)/cm~2。将胶原蛋白涂层涤纶血管移植犬腹主动脉下段,以白蛋白涂层涤纶血管移植为对照。在肝素化状态下均不渗血。术后30天和90天观察显示,胶原涂层涤纶血管内壁覆盖一层完整光滑的内膜,光镜显示为纤维结缔组织,表面有内皮细胞被覆并与自体动脉内膜延续。而白蛋白涂层涤纶血管血栓形成率高,内壁纤维素沉积。临床采用胶原涂层涤纶血管为4例马凡综合征病人行主动脉根部替换,术中涤纶血管不渗血,随访3个月无不良反应。本研究显示胶原涂层涤纶血管机械性能良好,不渗血,尤其能促进涤纶血管的愈合。作为主动脉移植材料可广泛应用于临床,若用于中小血管移植可望提高远期通畅率。     

Repair of Achilles tendon ruptures with Dacron vascular graft

A technique has been developed for the repair of Achilles tendon ruptures that allows for early mobilization of the patient. A Dacron vascular graft is woven from distal to proximal and across the site of the rupture in a Bunnell-type fashion. The patients are immobilized in a short-leg cast for two weeks and are then fitted for a posterior fiberglass splint. Seven patients with acute ruptures who were treated with repair with the Dacron graft were followed for a period ranging from ten to 38 months. They were allowed to return to their normal level of activity approximately five months after surgery. There have been no reruptures. This technique also holds particular promise for the late reconstruction of an Achilles tendon rupture as well as for the treatment of partial tears in the severely degenerated tendon.     

Endovascular Stent Graft Treatment of a Traumatic Aortocaval Fistula

Aortocaval fistula (ACF) is an infrequently reported sequela of trauma. Most ACF have been repaired via an open approach. During the past 10 years, there has been one reported case of spontaneous ACF and two cases of traumatic ACF repaired using an endovascular technique. We present a third case of traumatic ACF repaired with an endovascular stent graft. A 40-year-old male sustained two gunshot wounds to the right chest and one to the right upper abdomen. He was taken from the emergency department directly to the operating room, where an exploratory laparotomy was performed. Through-and-through injuries to the stomach and transverse colon were repaired primarily. Subsequently, the patient developed abdominal compartment syndrome. An urgent exploratory laparotomy was performed, revealing a nonbleeding hematoma on the posterior lateral surface of the right lobe of the liver, which was left undisturbed. Open abdominal management was instituted with vacuum pack closure. On the nineteenth hospital day, the patient again had a significant decrease in hematocrit. An aortogram was performed in order to evaluate the patient for intrahepatic arterial bleeding amenable to transcatheter embolization. There was no evidence of hepatic arterial bleeding. However, a supraceliac ACF was identified. The patient was taken to the operating room, and an AneuRx aortic extension cuff was advanced under fluoroscopy and deployed to cover the fistula. Completion angiography revealed total obliteration of the ACF and appropriate placement of the stent graft. Postoperatively, the patient was returned to the intensive care unit, where his hospital course was complicated by ventilator-associated pneumonia and sepsis. Repeat computed tomographic scanning 6 months and 1 year following this repair demonstrated patency of the graft without evidence of graft migration or aortocaval communication. Further research and experience are necessary with this technique regarding long-term outcome and technical aspects. In particular, the sizing problems associated with repair of acute traumatic ACF in emergency situations should be addressed. The endovascular approach provides an attractive and exciting alternative to traditional methods for repair of ACF.