Courtesy: Medical Miracles, from Readers Digest 1981.
November.
From the frontiers of science and the far horizons of
personal courage, these stories of medical triumphs and miracles will reaffirm
your faith in the awesome powers of the human spirit. Dramatic victories and
human triumphs.
Selected and edited by the editors of Readers Digest
Madison Gay, a spry veteran of 40 years’ service in
Birmingham, Alabama, steel mill, squinted into the white-hot throat f a
reheating furnace, then clanged the door shut.
He glanced at the gauges on the control platform, turned a lever a few
degrees, then stepped briskly to the next furnace. His was not a job requiring heavy physical
exertion, but it was an active one for a man of 56 who just 12 months earlier
had had a segment of his most important heart artery, the aorta, removed.
After the operation Mr. Gay wora a new aorta of tough,
braided nylon. This artificial trunk
line artery, flexible and non-kinking, carried blood from his heart to the
lower part of his body, replacing a section of his own aorta which had weakened
and was about to burst.
For half a century surgical researchers have been trying to
find durable substitutes with which to replace worn-out arteries. They have used many things: metal, glass and plastic
tubes, pieces of patient’s own veins, arteries from deceased donors, strips of
nylon petticoat stitched into shape.
Today this kind of blood vessel ‘plumbing,’ using synthetic or donor
spare parts, has become a practical art.
Several hundred thousand people are now walking around with arterial
grafts of one type of another neatly and firmly sewed into their bodies.
The grafts are replacing arteries which, because of injury,
infection or ordinary arteriosclerosis [hardening of the arteries], have become
clogged or stretched perilously thin.
The stretching type of damage, usually affecting the aorta, is known as
an aneurysm. Ballooning out like a weak
spot in the tire, and aneurysm may burst at any time and let the victim
hemorrhage to death.
The clogging of occlusive type of circulatory impairment
most often hits the legs. At first it
may cause only pain on walking, but it can go on to gangrene and eventually
amputation. In many male patients it
also produces sexual impotence.
Both ailments are especially common in men from the age of
50 on, although women are also affected.
Of the two, aneurysm is the more dangerous. For it may give no advance warning, and when
untreated it is rapidly fatal, with an average period of survival of only one
or two years after diagnosis.
Mr. Gay’s trouble was an aneurysm of the abdominal segment
of the aorta, a complication of arteriosclerosis. His physician discovered it when Gay went for
a routine checkup in July 1956.
“He found a mass in my abdomen that beat just like my
heart,” Gay said. “I realized it had
been there for some time, but I hadn’t thought much about it.”
Within a few days Gay was on an operating table having his
dangerously swollen aorta replaced with seven-inch length of sturdy nylon. The graft was branched at the lower end to
connect with the two main arteries supplying the legs. Six months after the operation Gay was
working full-time again. There were
certain restrictions on him—he was not supposed to lift anything heavier than
five pounds, for instance—but, as he said, at the time “I guess I’m lucky to be
alive.”
In contrast to the aneurysm, the obstructing type of
circulatory disturbance usually comes on slowly, over a period of months or
years. Typical is the experience of an
engineer whose trouble started when he was 51.
He first felt a cramping pain in the right calf after walking a few
minutes. As time went on, the pain
struck more quickly and intensely, forcing him to stop and rest every half
block. As the relentless narrowing of the
blood-supply lines continued, the pain spread to the thigh, the hip, and the
lower back.
In the engineer’s case, a nylon graft was inserted to
by-pass the obstructed segments of the blood vessels. Relief was immediate. The patient was able to play nine holes of
golf regularly, and as a safety engineer for a gas company he often miles along
the pipelines.
The generally discouraging results of medicine’s earlier
efforts, plus the widespread notion that hardening of the arteries is an
irreversible consequence of aging, created an almost fatalistic attitude toward
the problem of chronically impaired circulation. Today, however, there is scarcely a spot
along the main channels of the body’s blood stream, which the vascular surgeons
cannot reach for repairs. A patient’s
age is no deterrent. I saw an aneurysm
as big as a grapefruit successfully removed from the abdomen of a man of 84.
And many aneurysms have been fixed days of grace by sealing off the break with
clotted blood. A patient flown to
Houston, Texas, from Venezuela after his aneurysm had ruptured was saved with
an artificial artery.
As a matter of fact, Houston is the country’s busiest artery
mending center. The vascular surgery
group there, founded by Dr. Michael E Debakey, professor of surgery at Baylor
University College of Medicine, has in the past five years installed more than
25,000 arterial grafts. Most of these
have been homografts—donor vessels obtained at autopsy. But since last spring Dr. Dena key and his
fellow surgeons have used synthetic arteries almost exclusively, believing that
they are stronger and more immune to re-invasion by arteriosclerosis patches.
A German scientist, E Hopfner, in 1903, and the late Dr.
Alex Carrel, of Rockfelelr Institute for Medical Research, in 1905, made the
first successful transplantations of arteries—from one dog to another. But it was not until 1948 that artery
grafting reached a practical level, when Dr. Robert E. Gross, chief surgeon of
Boston Children’s Hospital, employed human grafts preserved in a special
solution and refrigerated.
Many communities found the demand for donor arteries far
exceeded the supply, however, so the search for a strong synthetic artery
continued. At Columbia-Presbyterian
Medical Center, in New York, Drs. Arthur H Blake more, Arthur B. Voorhees, Jr.,
and A. Jaretski, III, tried a fine-woven Vinyon cloth, seemed to form a
tube. Engrafted to a dog’s aorta, the
tailored artery was soon lined with a smooth, impermeable layer of the animal’s
own tissue cells. Encouraged, the
surgeons began, in 1953, to use the cloth artery in human patients.
When Dr. Blake more described his Vinyon arteries at a
Cleveland meeting in 1954, Dr. W. Sterling Edwards, an assistant professor of
surgery from Alabama Medical College, wondered if these flabby cloth vessels
could be given more body. Back in
Birmingham he talked the problem over with a patient, Pat Moore, an electrical
engineer employed by the Chemstrand Corp. in Decatur, Alabama. Intrigued, Moore sold his company on the idea
of developing a synthetic artery. Since
the commercial production of such a product was outside its field, Chemstrand
entered into the work on a non-profit, public service basis.
Dr. James S. Tapp, head of Chemstrand’s pioneering research
section, reasoned that braided tubing was a logical form for the artery. Nylon shoelaces are made of braided
tubing. He ordered 250 yards of it. To give the tubing the required firmness he
dipped it in a solution of formic acid, a semi solvent for nylon. This also reduced porosity. To make it water resistant, he treated the
fabric with silicone.
Now Dr. Tapp ordered the tubing in larger diameters—one
quarter to three quarters of an inch.
But when installed in dogs’ aortas and in the groin of a human patient,
the first nylon arteries kinked when bent and shut off the blood flow. This problem was solved by accident. One day Dr Tapp pushed a length of braided
tubing off a glass rod, the tubing crinkled up in accordion pleats, as a paper
wrapper does when removed from soda straw.
When he tried bending the crimped tubing, it central passage stayed
open. It was kink-proof. Subsequent heat treatment gave the crimp a
permanent set.
“We were afraid the rough lining of the crimped tube would
impede the blood flow and cause clots,” Dr. Edwards says. “But we hooked one up to the aorta of a dog,
and it worked. In short time the dog’s
tissues had given it a perfectly smooth inner lining. “The crimping of the synthetic artery also
gave it stretchebility, important when a graft lies across a knee of hip joint.
Surgeons and patients now have a choice of arteries between
braided nylon and knitted Dacron. Dr.
DeBakey has developed the latter type with experts of the Philadelphia Textile
Institute, who are turning out Dacron arteries of a modified 40-year-old
necktie-knitting machine.
My blood-vessel operations are still major surgery. The occlusive type of impairment, such as the
chronic clogging of a leg vessel, demands careful evolution to determine
whether or not an operation is advisable.
When the trouble is an aneurysm, however, there is usually no hesitancy
about surgery. In the Houston group’s
experience, for instance, operative mortality on thoracic (chest) aneurysms now
runs only 5 percent—although without surgery most of the patient’s die, and the
95 percent saved constitute a tremendous salvage. In abdominal aneurysm repair, the same
surgeons have brought the operative death rate down from 25 percent to less
than 2 percent in the most recent cases.
Surgery’s success in repairing worn-out or plugged-up
arteries has come only with a changing concept concerning arteriosclerosis, the
underlying cause of most circulatory derangements. Hardening of the arteries was formerly
considered a generalized and diffuse disease, not a condition which surgery
could do anything for. Now surgeons have
begun to realize that arteriosclerosis is in many cases a local condition,
segmental in nature—something they can do a great deal about. Tremendous numbers of patients can be helped.
