In view of the extreme sensitivity of the human liver to ischaemic damage, the organization of clinical transplantation is of necessity complicated. From our preliminary experience of five human liver allografts we feel that active collaboration between hospitals is essential in order to practise human liver transplantation. It is unnecessary and undesirable to interfere in any way with potential liver donors. Nevertheless, the nature of the surgical technique requires that the liver is cooled within 15 minutes of death if satisfactory function is to result in the grafted organ.This report describes technical difficulties that were encountered which can limit successful liver transplanta. tion. The first patient was in severe liver failure and had an accessory liver graft in the splenic fossa after splenectomy. This liver suffered irreversible ischaemic damage, which led to an uncontrollable haemorrhagic state with exsanguination that resulted in death the day after operation. The second patient, a 10-month-old infant with biliary atresia and liver failure, died from cardiac arrest shortly after the operation.The remaining three transplants developed good initial function. One patient survived 11 weeks, and one has returned to work on 15 July 2020 by guest. Protected by copyright.
Background-Fenestrated endovascular repair of abdominal aortic aneurysms has been proposed as an alternative to open surgery for juxtarenal and pararenal abdominal aortic aneurysms. At present, the evidence base for this procedure is predominantly limited to single-center or single-operator series. The aim of this study was to present nationwide early results of fenestrated endovascular repair in the United Kingdom. Methods and Results-All patients who underwent fenestrated endovascular repair between January 2007 and December 2010 at experienced institutions in the United Kingdom(Ͼ10 procedures) were retrospectively studied by use of the GLOBALSTAR database. Site-reported data relating to patient demographics, aneurysm morphology, procedural details, and outcome were recorded. Data from 318 patients were obtained from 14 centers. Primary procedural success was achieved in 99% (316/318); perioperative mortality was 4.1%, and intraoperative target vessel loss was observed in 5 of 889 target vessels (0.6%). The early reintervention (Ͻ30 days) rate was 7% (22/318). There were 11 deaths during follow-up; none were aneurysm-related. Survival by Kaplan-Meier analysis was 94% (SE 0.01), 91% (0.02), and 89% (0.02) at 1, 2, and 3 years, respectively. Freedom from target vessel loss was 93% (0.02), 91% (0.02), and 85% (0.06), and freedom from late secondary intervention (Ͼ30 days) was 90% (0.02), 86% (0.03), and 70% (0.08) at 1, 2, and 3 years.
Conclusions-In
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