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The results of iliac vein reconstruction performed early after secondary iliofemoral venous thrombosis were retrospectively evaluated. The review comprised seven patients who underwent acute thrombectomy combined with cross-femoral (4 cases) or iliocaval (3 cases) bypass procedures using polytetrafluoroethylene (PTFE) grafts. The clinical course, graft patency and venous physiology were studied. Five patients had a satisfactory clinical course, but one patient died of postoperative complications and another underwent leg amputation after 20 months. Contrast and radionuclide phlebograms showed that only two grafts were still patent after two years, but only one of these was still patent five years postoperatively. Clinical symptoms and physiologic parameters correlated poorly with graft patency, demonstrating the necessity of phlebography in evaluating patency rates after venous surgery. Our study indicates that early venous reconstruction using PTFE grafts does not result in satisfactory long-term patency rates. Further development of graft materials suitable for the venous system is required.

Fifteen premenopausal women had by-pass reconstruction performed for aorto-iliac disease. A high prevalence of smoking, oral contraception and hyperlipemia was found. The outcome of reconstructive surgery was initially excellent. Serious complications and progress of the arteriosclerosis, however, made the late results more doubtful.

In this follow-up of 1,112 patients operated on for abdominal aortic aneurysm (AAA) it was noted that cerebrovascular accidents (CVAs) caused significant (8.2%) late mortality. Seventy-one patients developed non-fatal or fatal CVAs at 5.9 +/- 2.9 (mean +/- SD) years after the initial aneurysm repair. The incidence of CVA was 4.2% and 9.5% within five and ten years, respectively. In patients with preoperative evidence of both hypertension and heart disease, the incidence of CVA within five years was 9.1% compared to an incidence less than 4% in patients with either or neither of these risk factors (p less than 0.01). Multivariate analysis of individual risk factors revealed that only age (p less than 0.001), hypertension (p less than 0.001), angina pectoris (p less than 0.02) and other heart disease (p less than 0.001) were independently associated with a reduced survival free of CVA. Thus, cerebrovascular accidents are responsible for significant late morbidity after AAA repair. Patients at high age or with evidence of hypertension and heart disease carry a greater risk for this complication.

Twenty-eight consecutive cases of acute superficial thrombophlebitis of the long saphenous vein above the knee were reviewed concerning presence of asymptomatic deep venous thrombosis and pulmonary embolism and early clinical results after surgical treatment. Contrast phlebography of the ipsilateral leg revealed asymptomatic involvement of major deep veins of the thigh or calf in 4 of 21 examined patients. Perfusion lung scanning and chest radiography demonstrated typical segmental perfusion defects consistent with pulmonary embolism in two of ten examined patients. High ligation and stripping of the phlebitic veins gave prompt cure in 19 patients, though in two who were simultaneously treated with anticoagulants there was troublesome bleeding. Simple high ligation was performed in nine patients without complications, but four of them had protracted phlebitic pain. The results indicated that preoperative phlebography and lung scanning are helpful in detecting associated asymptomatic disorders and for planning therapy in patients with clinically isolated, superficial thrombophlebitis of the long saphenous vein. The treatment of choice is acute high ligation with removal of all phlebitic veins. If anticoagulation is indicated because of concomitant deep venous thrombosis or pulmonary embolism, the initial procedure should preferably be limited to high ligation.

Fifteen patients were operated on for compression of the celiac artery with division of the median arcuate ligament. Initially most patients were released from their preoperative abdominal pain. At follow-up after 1 1/2-9 1/2 years only two patients were asymptomatic. Our results corroborate the nonentity of the celiac compression syndrome. The existence and identification of a subgroup of patients with symptomatic compression of the celiac artery is discussed.

Some of the pitfalls in the management of inflammatory abdominal aortic aneurysm are stressed in the presentation of six illustrative cases. Background data on the presumed etiology and common symptoms are provided. The diagnostic value of computed tomography for preoperative detection of the fibrosis surrounding these aneurysms and the differentiation from other conditions are also discussed.