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Three approaches are considered: the left thoracoabdominal approach, the right-sided retro- or supracolic route and the transabdominal access. Aorto-common hepatic venous bypass grafting is the preferred procedure in singular occlusions of the celiac axis. Reimplantation and aorto-mesenteric venous bypass are the treatments of choice in singular occlusions of the mesenteric artery. Occlusions of both upper intestinal arteries can be treated with a venous bridge bypass graft or by transaortic end-arterectomy. Operative mortality is low (0.9%). Remaining occlusion and recurrent symptoms occurred in 12 of 92 patients.

Optimal protection of the brain during carotid endarterectomy is of great importance and is guaranteed by general anaesthesia with maintenance of normal blood-pressure and a normal CO2-level, routine use of internal shunts and heparinization. Operation of "asymptomatic" patients has to be seriously considered. Patients with acute occlusions of the carotid artery should not have surgery as emergency procedures, unless the operation can be done immediately after the onset of symptoms. In chronic occlusion of the internal carotid artery endarterectomy may be considered if the shiphon is patent and in good condition.

For this second panel by correspondence, we have asked 3 distinguished experts to answer 7 questions and to comment on 3 case histories concerning vascular surgery. Although a direct discussion between the participants was not possible an impressive degree of agreement is here being demonstrated.

Based on experience with about 1,000 patients with operable aortoiliofemoral occlusive disease, the factors influencing the operative procedure are discussed. These include the angiographic picture, the severity of ischemia, general risks, accessibility of the operating field, and availability of reconstructive material. It is concluded that, in discussing the operative procedure in aortoiliofemoral occlusive disease, the central question must be, which procedure is best for this patient, in view of his special circumstances, and not, which procedure is technically possible.

The costoclavicular compression syndrome and the cervical rib syndrome can cause arterial complications of the subclavian artery: mural thrombosis, occlusion and aneurysma. These complications can result in peripheral emboli or cerebrovascular insufficiency. Such sequelae can be avoided by timely surgical treatment of these compression syndromes. The therapy of choice is transaxillary rib resection. The same axillary approach can also be used for directly reconstructing the subclavian artery.

Based on the experience with 243 patients with chronic occlusive disease of the visceral arteries, the different symptoms of intestinal angina are described. Problems concerning diagnostic procedures, especially angiography, and indication for reconstructive arterial surgery are discussed.