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A 2 cm long iliac av-fistula is established in 13 dogs. Flow and pressure measurements are performed in the distal fistula artery and the adjacent arteries before and immediately (stage I) as well as 3 months (stage II) and 6 to 12 months (stage III) post shunt. The development of extensive collaterals adjacent to the chronic iliac av-fistula is demonstrated angiographically and by post-mortem vascular casts. After occlusion of the proximal fistula artery a retrograde flow is directed towards the fistula even in the acute stage. This "free" retrograde flow increases from 70 ml/min to 1230 ml/min in stage II and 1755 ml/min in stage III. Collaterals of the tail artery contribute approximately 44%, of the contralateral iliac artery 20% and side branches of the abdominal aorta most of the remaining 36% of the retrograde arterial fistula flow. Successive occlusion of the tail artery and the contralateral iliac artery in stages II and III results in a nearly identical per cent decrease in "free" retrograde flow and in pressure. Even in the pre-fistula stage clamping of the iliac artery induces the same relative pressure-drop in the distal iliac artery. These findings indicate, that the three main collateral networks adjacent to the iliac artery all expand proportionally to their prefistula status in the 6 - 12 months following construction of the iliac av-fistula.

Over a ten year period of time from 1.3. 1962 to 31.12. 1972 at the Dept. of Surgery, University of Heidelberg 104927 patients were admitted to the hospital, 77950 operative procedures were carried out and 4217 patients died post operatively. The etiology of death as related to age distribution, disease and time of postop. death are discussed. The lethality causes are demonstrated by the classification of Petren. Autopsy examination reveals cardiac and/or circulatory failure to be the main cause of death (26,4%), followed by malignant tumors (12,7%), pneumonia (12,6%), cerebral causes (10,2%) and peritonitis (9,5%). Possible consequences of the distribution are being discussed.

Analysis of the clinical and autopsy reports of 200 deaths following surgery for colorectal cancer from 1956 to 1974, at the Dept. of Surgery, University of Heidelberg, revealed that pneumonia (24.5%) was the most common cause of death followed by peritonitis (22%), pulmonary embolism (15.5%), advanced tumor disease (14%), cardiac failure (9.5%), ileus (5.5%), and others (9%). The explanation for the postoperative mortality rate of 12% (cancer of colon) and 13.2% (cancer of rectum) lies in the fact that 82.5% of those who died postoperatively were beyond the age of 60, and 40.5% beyond 70 years at the time of surgery. Moreover, in 50.5% advanced tumors with regional and/or distant metastases were found. In 55.5% severe preoperative complications (ileus: 38%, peritonitis: 11%, abscess formation or hemorrhage: 6.5%) required an emergency operation. Only 38.5% of the procedures were considered for cure. Besides the need for early recognition of the cancer, intensification of pre- and postoper treatment appears to be the predominant task in the effort to decrease postoperative mortality.

On the basis of our experience with 1827 femoropopliteal arterial reconstructions performed from 1959 through 1974 we have worked up a system of strict guidelines for the choice of procedure. The vein bypass is the method of choice in all cases at stages III/IV (i.e. resting pain or gangrene), in lengthy occlusions of the femoral arteries continuing into the distal popliteal arteries or in stenotic lesions or occlusions of the tibial arteries, in all recurrent occlusions, and in cases with calcification or dilatation of the arterial wall. The indication for endarterectomy is restricted to stage II (i.e. intermittent claudication) and to segmental occlusions of the femoral or popliteal arteries as well as transitional or lengthy occlusions of the femoral artery continuing to the proximal popliteal artery. Under these guidelines a total group of 645 patients underwent 721 femoropopliteal reconstructions-307 endarterectomies and 414 vein grafts-from 1971 through 1974. The average age of the patients was 60 years. In 50% of all cases operations were carried out for advanced ischemia treatening the extremity. For all the series the patency rate of vein bypass was 79% and of endarterectomy 71%. Accumulative patency rates by the life table method according to the preoperative degree of arterial insufficiency and the postoperative follow up period of 4 years do not show statistically significant differences between both procedures under the given guidelines.

Internal carotid endarterectomy is an effective and longlasting means of preventing cerebrovascular accidents. After 1-16 years it was entirely successful in 97.8% of asymptomatic patients; 79.3% of patients with transient ischemic attacks experienced no further symptoms, 13% were improved. In patients with acute strokes 20% were cured, 70% improved, and 10% unchanged. The follow-up of patients with completed stroke yielded no further neurological deficit. The late results 1-14 years ater reconstruction of the other supraaortic vessels were good in 92,5% of cases.

Als Spatergebnisse 1–16 Jahre nach Desobliteration einer Carotisstenose im Stadium I bleiben 97,8 % der Patienten asymptomatisch, nach Korrektur eines Stadium II sind 79,3 % vollig beschwerdefrei und 13,0% deutlich gebessert. Nach operativer Behandlung des frischen Schlaganfalls finden sich als Spatergebnis 20 % geheilt und 70 % gebessert. Im Defektstadium nach durchgemachtem Schlaganfall werden keine weiteren neurologischen Ausfalle beobachtet. Nach Eingriffen an den anderen Aortenbogenasten zeigen sich in 92,5 % uberzeugende Langzeitergebnisse.