A Study of Inverted Intestinal Graft in the Major Veins

* Presented at the Eleventh Annual Meeting of the American College of Angiology, New York, N. Y., June 16 to 19, 1965. Replacement of major veins, particularly the superior vena cava and inferior vena cava, is a relatively infrequent surgical problem, but there is a definite need for suitable graft material for surgery on the venous defects caused by thrombosis, injury and radical cancer surgery. Only limited information is available on which to base the selection of a graft suitable for use in the major vein.1-8 Homografts have been unsuccessful, while prostheses give only good short-term results. 9-14 The ideal replacement for the vena cava would be a large autogenous vein graft,l~-18 but these grafts are difficult to obtain. When a large caliber autograft was constructed by suturing together several venous segments, the autograft functioned poorly. The pericardium, atrium and trachea were also used without success. 19-21 Some favorable results were obtained with the simultaneous creation of a distal arteriovenous fistula.22 Previously no attempt has been made to replace a segment of the vein with small bowel; yet, autografts of small bowel are readily available and the length of the graft needed presents no problem. The following experiments were undertaken in an effort to determine the fate of small bowel grafts inserted into the superior and inferior vena cava in circumstances involving essentially normal venous pressure.