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There are few reports of vascular (blood vessels) reconstructive surgery performed to relieve arterial insufficiency in patients who have end-stage (terminal) kidney disease. These patients are believed to be poor risks for vascular surgery; many are diabetic and often have diffuse, severe arterial disease with calcification of the arteries. A study was undertaken of 39 patients with end-stage renal disease who underwent limb revascularization surgery to determine if the standard criteria for revascularization could be applied to this group of patients. Fifty-six legs underwent infrainguinal revascularization (bypass graft) surgery; nine legs had additional surgery for the removal of blood clots. Thirty-seven of the 39 patients were on dialysis, and 3 patients had functioning transplanted kidneys. Vascular surgery was performed because of ischemia (inadequate blood supply) resulting in gangrene (tissue death), leg pain at rest, leg ulcers, or severe claudication (leg cramping when walking). The rate of patency of the grafts at one year was 77 percent, and 68 percent at two years. During the follow-up period, which averaged 23 months (range 0 to 115 months), there were 24 deaths. Five deaths occurred in the perioperative period (shortly before to shortly after surgery), three of which were due to heart attack. At three years, 39 percent of the patients were alive with 84 percent of legs saved. These findings suggest that limb revascularization can be successfully performed on patients with end-stage renal disease, and that the standard criteria for revascularization surgery can be applied. (Consumer Summary produced by Reliance Medical Information, Inc.)

BACKGROUND: Lymphatic leakage is a relatively uncommon but serious complication following vascular procedures. A conservative approach consisting of bed rest, leg elevation, prophylactic antibiotics, compressive dressings, and intermittent aspiration is the most commonly used treatment. Because of the long time it takes to cure this condition and the potential for infections, a more aggressive approach consisting of wound exploration and ligation of the leaking lymphatic has been proposed. We review our experience of the past 3 years treating 17 of these complications by using 1 of these 2 approaches. PATIENTS AND METHODS: Seventeen groin complications were seen over a period of 3 years. Ten (59%) patients were treated by selective ligation assisted with isosulfan blue dye injection, and the remaining 7 (41%) were treated conservatively. RESULTS: Mean hospital stay was 2.4 days (range 1 to 4) for the operative group versus 19 days (range 14 to 42) for the conservative group. One complication was seen in the operative group, whereas 4 (57%) patients developed groin infections following conservative therapy. One (10%) patient developed a recurrence following ligation that was treated successfully by reoperation. CONCLUSION: Our experience with the use of surgical ligation of leaking lymphatic assisted by isosulfan blue, when compared with conservative treatment, has led to a decrease in hospital stay, lower complication rates, and fewer recurrences. in our view, this approach represents the best form of treatment for postoperative groin lymphatic complications. Am J Surg. 1995;170: 206-208.

We report on a 9-year-old boy with severe hypertension due to a variant of fibromuscular dysplasia of the renal artery supplying a functioning pelvic kidney. The other kidney proved to be a nonfunctioning multicystic remnant and several other congenital abnormalities of the genitourinary tract were present. Corrective vascular surgery was followed by normalization of arterial pressure and significant reduction of plasma renin activity. This is the first case report of renovascular hypertension due to renal artery stenosis in a single functioning pelvic kidney.

• Five patients had anuric renal failure caused by occlusion of the main renal arteries. All had a background of controlled hypertension, but in three patients, hypertension accelerated in the months before anuria. Extensive atherosclerotic disease was clinically evident in the peripheral (3/5), coronary (4/5), and cerebral (1/5) vessels. Identifiable precipitating events preceded the development of anuria in four patients. Although the use of renal ultrasonogram and scintiscan was suggestive, angiography was essential to establish the diagnosis after a brief period of maintenance hemodialysis. Renal artery revascularization performed as long as 38 days after the onset of anuria resulted in restoration of kidney function.(Arch Intern Med 1981;141:1647-1651)

Thirty vascular complications were seen in a group of 444 patients who had 516 arteriovenous fistulas for hemodialysis: 413 standard peripheral arteriovenous fistulas and 103 modifications, which included the use of 35 autogenous vein grafts and 62 bovine heterografts. Four hundred sixty-two of the fistulas were done with the radial or ulnar arteries, 53 with the brachial artery, and one with the superficial femoral artery. Symptomatic ischemia due to "steal" developed in eight patients (1.6%). Four of these patients developed gangrene, with one requiring finger amputation and three of them hand amputation. False aneurysms developed in 14 patients, ten infectious and four traumatic. Venous aneurysm requiring surgery developed in four patients and hand venous hypertension syndrome with chronic venous stasis in the hand was seen in four patients.