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One hundred consecutive aortograms were studied to establish the efficacy of conventional arteriography in demonstrating distal vessels and the pedal arch. The standard technique was modified by using a long injection time, a large volume of contrast material (iopamidol 370), prolonged filming and multiple exposures of the feet. On the basis of these examinations each limb was classified as having aorto-iliac disease (18 limbs), superficial femoral disease (103 limbs), combined segment disease (28 limbs) or generalised disease (51 limbs). Calf and ankle arteries were seen in 196 of the 200 limbs (98%). Patency of the pedal arch was established in 184 (92%). Fourteen percent of the group of patients with combined segment disease did not have their pedal arch visualised and this group contained most of the examination failures. This modified method of aortography can demonstrate the entire arterial tree from the aorta to the foot in 92% of limbs with symptomatic chronic atherosclerotic disease. This allows the majority of peripheral vascular reconstructions to be planned and performed without the need for intra-operative arteriography.

Cardiac arrest during the repair of a leaking aortic aneurysm is a well recognized complication of an unsuspected aorto-caval fistula. Previous reports have suggested that death results from embolisation of debris through the fistula. We report a patient who underwent successful resuscitation in whom the sudden alteration in haemodynamics produced by crossclamping the aorta appeared responsible for the development of ventricular fibrillation. Preliminary caval compression with gradual application of the aortic clamp may allow time for equilibration to occur and prevent cardiac arrest.

Aortic dissection is a common complication of Marfan's syndrome. We report such a patient who survived two separate dissections which both occurred shortly after uneventful pregnancies. The first dissection was a self-limiting DeBakey type III but the second commenced in the left common iliac artery and extended retrogradely into the lower abdominal aorta. This latter type of dissection does not appear to have been previously reported.