No abstract

Fungal intravascular graft infections are rare. In addition to our case, which forms the basis of this article, only 13 documented instances could be found in the literature in the 20-year period from 1966 to 1986. Three of these cases (21%) had both fungus and bacteria grown in culture. Candida and Aspergillus species constituted most of the infecting organisms (79%). There was no obvious difference in the clinical presentations between fungal and bacterial infections. In two cases (14%), there was a strong predisposition toward fungal infection: one in a patient with pulmonary histoplasmosis and one in a patient with leukemia. Appropriate intervention appears to be graft excision and extra-anatomic bypass with concomitant therapy with amphotericin B. Survival with this approach was 84%, whereas other methods yielded a survival rate of 20%.

The frequent use of arterial puncture, cannulation, and A-V shunting has demonstrated a greater degree of safety than could be predicted from previous anatomic and angiographic studies. Using a noninvasive technique, the status of the superficial palmar arch (SPA) and relative contributions of radial and ulnar arteries were determined in 100 volunteers with no history of vascular disease. Although there was no significant difference in the diameter of the vessels at the wrist, the flows showed statistically significant ulnar dominance, suggesting that the difference is a factor of a lower distal resistance on the ulnar side. The lower resistance across the ulnar bed probably is responsible for the clinically observed ease of sacrifice of the radial artery contribution to palmar flow. The SPA was found to be incomplete in 11.0% of the hands.

Needle hole bleeding from polytetrafluoroethylene (PTFE) grafts causes blood loss and prolongs vascular procedures. Past studies have shown the cyanoacrylate glues to polymerize rapidly and cause minimal tissue toxicity. This study was undertaken to evaluate the efficacy of ethyl-2-cyanoacrylate glue (Krazy Glue, KG) in obtaining prompt hemostasis in vascular anastomoses in a heparinized canine model. KG effected complete hemostasis in a significantly shorter time than oxidized cellulose and digital pressure in 18-gauge needle holes in PTFE grafts, graft to graft end-to-end anastomoses, and end of graft to side of artery anastomoses. The only limitation of KG was the development of a glue-adventitia plaque on the arterial side of some of the PTFE-artery anastomoses, causing the need for regluing. KG is an ideal agent for sealing defects in PTFE grafts.