Plastic storage bags designed to optimize O2 and CO2 transfer to preserve platelets for 7 days prior to transfusion were studied in vivo and in vitro. Platelets stored 7 days in second-generation CLX bags were compared to platelets stored 3 days in standard (CL-3861) 3-day storage bags and platelets transfused within 24 hours of collection. The CLX bags maintained concentrate pH at a mean of 6.85 +/- 0.03 (SEM) after 7 days, while in standard bags after 3 days of storage, the mean pH was 6.46 +/- 0.03. A smaller proportion of platelets stored 7 days in CLX bags were discarded because of a pH less than 6.0 compared to those stored 3 days in CL-3861 bags (10 vs 21%). Poststorage pH showed strong correlation with concentrate platelet count and weak correlation with concentrate white cell count in both bag types. There was no significant difference in the mean corrected platelet count increments between platelets stored 7 days in second generation CLX bags and those stored 3 days in CL-3861 bags (10,000 and 12,200 at 1 hour, and 7000 and 7500 at 24 hours, respectively) following transfusion to 16 thrombocytopenic recipients. However, transfusion of fresh platelets achieved mean corrected increments at both 1 and 24 hours posttransfusion that were higher than seen with either group of stored platelets (20,100 at 1 hour and 10,800 at 24 hours). Platelets can be stored 7 days in second-generation CLX blood bags with results comparable to those of platelets stored 3 days in standard bags.

Blood Donors↗

PubMedDate not supplied

Uninfected anastomotic false aneurysms following arterial reconstruction with prosthetic grafts.

Thirteen men, aged 49 to 76 years, average 60, were treated at the Little Rock, Arkansas Veterans Administration Hospital between January 1, 1969 and January 1, 1974 for 1-3 false aneurysms, a total of 18, following prosthetic arterial grafting. Most (ten patients, 15 aneurysms) had aorto-femoral bifurcation grafts for Leriche syndrome. Dacron prostheses were employed in ten, Teflon in three. The interval between the initial operation and the appearance of the aneurysms averaged six years. The end-to-side femoral anastomosis broke down in all ten patients with Leriche syndrome. Six of the eight unilateral aneurysms were on the right side, two had bilateral aneurysms and one patient had three. Five patients died some months or years after repair from vascular accidents. Three other patients required amputations sometime later because their grafts clotted. Silk sutures were employed in only two patients. Plastic sutures in the others were found to have pulled out of the recipient vessels. The aneurysms were all uninfected and were repaired by local stitching in four and the addition of further plastic grafting in nine. We conclude that false aneurysms occur with plastic sutures and they relate primarily to disruption of the end-to-side femoral artery attachment from the stresses of movement at the hip joint.

Aged↗

PubMedDate not supplied

Plasma catecholamine concentration during and after aorto-femoral bypass grafting.

Mean arterial plasma concentration of norepinephrine and epinephrine [NE + E], increased from 2.84 nM (post-induction) to 7.50 nM at the end of an approximately 4-hour operation for aortofemoral bypass grafting (plus unilateral lumbar sympathectomy) in 13 men. It increased to 18.25 nM during the first hour of recovery, and fell to 9.58 nM by the next morning. Thus during recovery, arterial [NE + E], by exceeding the minimum of 10.6 nM [NE] necessary for vasoconstriction, is a probable contributor to postoperative vasospasm as previously hypothesized.

Adult↗

PubMedDate not supplied

Vasospasm in the lower extremities during and following arterial reconstruction.

Foot temperatures of 36 patients were recorded continuously in the operating room and in the surgical intensive care unit (SICU) for 1-3 days. Operations included aortofemoral endarterectomy, arterioplasty, and bypass grafting. Regardless of severity of the operation, all had cold extremities on entering the SICU. The subsequent warming of the big toes, which started after 4-12 hours in the SICU, if at all, was classified according to a scheme of 6 deviations from a basic trend. This latter was a bilateral, continuous increase in 1-2 hours to 34 degrees C or higher where it remained with minor oscillations. Unilateral deviations were either diminished warming or no warming on one side. Bilateral deviations included stepwise increments to 34 degrees C, diminished increments, and no warming. Neurogenic vasospasm appeared to be the principal factor diminishing blood flow, with circulating vasoconstrictors and organic blocks as additional less important factors. Subsequent amputations of nine limbs were partially correlated with the categories of digital warming.

Aged↗

PubMedDate not supplied

Operative correction of proximal blocks of the subclavian or innominate arteries.

Ninety-four operations were performed on 90 individuals with occlusive disease of the subclavian or innominate arteries during the past 17 years. The left subclavian was occluded in 71, the right in 10, and the innominate in 9. Presenting symptomatology was neurological in 34, arm ischemia in 30 and combined in 26. Blood pressure was reduced by 30 mmHg on the involved side in all. An extrathoracic approach was used in 78 and a transthoracic approach in 16. Early mortality 18.7% and morbidity 18.7% was associated with the transthoracic approach. Long subcutaneous axillo-axillary and axillo-carotid are prone to thrombosis and skin erosion. Carotid-subclavian grafts used in 64 remain patent, occasionally become infected (4.7%), are associated with a low mortality and do not develop "carotid steal". When associated with vascular insufficiency of the lower extremity (44%) the brachiocephalic lesion should be corrected first.

Adult↗

PubMedDate not supplied

The role of primary and secondary profundaplasty in the treatment of vascular insufficiency.

Profundaplasty has been performed on 58 limbs (45 primary and 13 secondary) in 45 men. Thirty-four of these had incapacitating claudication, 14 rest pain, and 10 either gangrene or ischemic ulceration. In 19 treated by profundaplasty alone there were no deaths but three subsequently had amputation for ischemic pain. In 39 with profundaplasty plus a proximal operative augmentation there were two (6.7%) operative deaths and one (3.4%) late death but only one extremity had to be amputated. Radionuclide flow studies confirmed physical and arteriographic findings. After profundaplasty alone and profundaplasty plus aortofemoral bypass there was moderate increase in calf blood flow but in only those with a patent superficial femoral did the flow studies return to normal. Profundaplasty is an important addition to the armamentarium of the vascular surgeon in dealing with arteriosclerotic insufficiency of the lower extremities.

Aged↗