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The compartment syndrome is an extremely rare complication after varicose vein surgery. If the early symptoms are not recognized and a treatment is not performed immediately most patients lose sensomotory function. Three cases with compartment syndrome after varicose vein stripping were the reason to point out the anatomy and pathophysiology of this complication and to explain the surgical technique.

Caval interruption is widely regarded as the treatment of choice for the prevention of recurrent pulmonary embolism (PE). The safety, ease of insertion and "convenience" of the devices are the main arguments for filter placement. Today many filters are placed for prophylactic reasons, sometimes without an established diagnosis of pulmonary embolism or underlying deep venous thrombosis. Early and late complications have been published but the rate is reported to be low, although only limited numbers of patients have been followed. In an 18-year period 11 patients with problems following caval interruption were treated, 10 with acute complications, one with chronic caval occlusion. Six were treated conservatively, five underwent venous thrombectomy and a.v.-fistula. The device was removed in four. During the same period only three permanent filters were placed in our hospital (two with complications). Caval interruption is useful in selected high-risk patients and is the least invasive but not necessarily the best treatment. Provided stringent criteria are applied, the early and late complications can be accepted in order to prevent sudden death in patients with threatening massive PE. Extended or more liberal indications for caval interruption are neither necessary nor justified.

Digital subtraction angiography (DSA) was performed in 53 of 417 patients with renal transplants. The incidence of clinical apparent vascular complications was 9.1% of all patients with renal transplants (38/417). The most frequent vascular disorders were formed by arterial stenoses at 5.0% of the cases followed by arterial obstructions in 1.7% of the patients. Rare vascular complications were arteriovenous fistulas (0.7%), aneurysms (0.5%) and venous thromboses (0.2%). Because of the high diagnostic value of intraarterial DSA, all patients with renal transplants with a complicated postoperative course should be eligible for angiographic control. In case of a suspected vascular disorder intraarterial DSA should be performed at an early stage.

Late complications following aortic graft replacement are rare. Within 5 years these severe complications have to be expected in about 1-3%. A staged but adequate treatment is necessary. If the renal arteries are included besides technical and anesthesiological experiences a refinement of vascular surgical technique is required. Nevertheless a high morbidity and mortality rate remains, depending on the expertise of the vascular surgeon, on an early and precise diagnosis as well as on the severity of additional organ diseases. Routine yearly ultrasound examinations following aortic graft replacement are recommended, to detect late complications before the events of rupture, graft enteric fistula or severe bleeding complications require extensive surgical procedures. Any vascular surgeon performing abdominal and thoracoabdominal aortic surgery has to be familiar with the basic diagnostic and therapeutic approaches managing late complications following aortic graft replacement.

From 1970 to 1987 among 964 patients with aortic aneurysms 52 (5.4%) underwent aortic graft replacement for inflammatory aortic aneurysm. 79.2% were symptomatic, 18.9% ruptured at the time of admission. CT-scan is of main diagnostic value. The perioperative mortality rate was 15.1%. At follow-up (28 months mean) 35 of 38 living patients (92.7%) were examined clinically, by sonography and in most cases by CT-scan. The late complication rate was 20% (n = 7, atrophic kidney 3, anastomotic aneurysms 4). In contrast to abdominal aortic aneurysms inflammatory aneurysms present an elevated morbidity and mortality rate which has to be reduced by exact preoperative diagnosis and modified surgical technique.

Fifty-three patients were examined by angio-dynography and angiography in a prospective study following vascular surgery of the lower extremities. The question of patency was correctly solved in all cases. A-V communications could be localised in eight out of nine cases. Evaluation of anastomoses is equally accurate by both methods; all angiographically demonstrated stenoses were also visible on sonography. Aneurysms at the anastomoses and peri-vascular fluid collections were better shown by angio-dynography, as might have been expected. The demonstration of the distal run-off, following femoro-crural bypass, presented a problem; in eight cases this could not be achieved because of technical difficulties. Surprisingly, angio-dynography proved superior in demonstrating large distal A-V shunts. Our experience so far indicates that angio-dynography may be used as an alternative to angiography for certain specific indications (bypass patency, large A-V shunts and complications around the anastomosis). Demonstration of vessels, and particularly of distal femoral bypasses can be improved by using the "slow-flow technique".