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Acute early postoperative femoral-distal bypass graft failure associated with profound lower extremity ischemia is unusual because early graft failure commonly reverts leg circulation to the preoperative status. Two cases are reported where the etiology of profound early postoperative ischemia and graft failure were not due to technical aspects of graft reconstruction itself but rather to vascular clamp injury to a severely atherosclerotic common femoral artery with early postoperative common femoral artery, profunda femoris artery and graft thrombosis. This event requires immediate recognition and common femoral artery reconstruction for limb salvage.

Bands around extremities may be from congenital, infectious, accidental, or purposeful causes. The older child may reveal the cause of self-inflicted or caregiver-inflicted banding. Banding in a nonverbal child will challenge the diagnostic acumen of the physician. Bands of unknown cause, or bands that may have been placed purposefully by a caretaker, must be reported as possible child abuse. Failure of the caretaker to seek help for the consequences of a band may suggest that the bands were intentionally placed. This failure may also be construed as medical neglect. Four cases of banding, which were referred to a child abuse program for consultation, are described.

The development of vascular clamps requires a reliable method to quantitate clamp-related vascular injuries. The degree of vessel damage usually is estimated subjectively from photomicrographs made with scanning electron microscopy. In order to test whether the use of vascular rings to assess residual vascular function may be a better method, rabbit thoracic aortas were occluded by five types of clamps: a Fogarty softjaw bulldog, a Fogarty Hydragrip, a 6-inch Satinsky clamp, an Edslab bulldog, and a silicone vessel band. Each area of clamp injury was sectioned into a vascular ring and suspended in a tissue bath. Residual vascular function was determined by contraction in response to phenylephrine and by relaxation in response to methacholine chloride and sodium nitroprusside. Morphologic studies with use of Evans blue dye and scanning electron microscopy complemented the vascular-function studies. The Fogarty bulldog clamp was the best at preserving vascular contraction and relaxation; the more crushing Satinsky clamp was the worst. The testing of vascular rings for residual function appears to be a useful technique for objectively quantitating vascular clamp-related vascular damage.

No significant changes were found in heart rate, blood pressure, cardiac output, arterial blood gases or physiological deadspace: tidal volume ratio before and after clamping and unclamping the abdominal aorta below the renal vessels. Nevertheless, drugs should be available to reduct the afterload on the heart if any evidence of myocardial ischaemia appears during the period of aortic clamping. The importance of maintaining an adequate circulating blood volume at all times is stressed.

Incidental prophylactic inferior vena cava clipping (IVCC) has been used in 30 patients undergoing colonic operations. The results obtained compare quite favorably with other methods of preventing postoperative pulmonary embolism (PE). This procedure would be justified in patients with a postoperative PE risk greater than 5 to 10 per cent. Practical criteria to identify this group of patients are presented, and the value of utilizing a risk profile is emphasized. There is no mortality from the procedure itself, and the morbidity was limited to lower-extremity edema in three patients who otherwise could have been expected to develop PE. The edema lasted two months in one patient and cleared rapidly in the other two. Attesting to the procedure's effectiveness, there were no cases of recurrent PE. Caval partition is an appealing mode of prophylaxis in high-risk patients because of its safety, efficacy, and permanence.