Aortic corset syndrome

The majority of proximal anastomotic complications of aortofemoral bypass grafts are related to the formation of pseudoaneurysms or true proximal aneurysmal dilation of the residual infrarenal aorta. The late development of occlusive disease at the proximal anastomosis is an extremely rare event. We report two patients in whom symptomatic stenoses developed involving the proximal anastomoses of aortofemoral bypass grafts originally placed for aortoiliac occlusive disease. Surgical exploration demonstrated the presence of a constricting prosthetic corset wrapped around the proximal suture line of each graft. Exuberant neointimal hyperplasia was responsible for both stenoses.     

Acute hemodynamic effects of lumbar sympathectomy

Lumbar sympathectomy increases total limb blood flow after aortofemoral bypass in a high percentage of cases. This was true in eleven of fourteen extremities (78.6 per cent) in our series even though no specific selection criteria for entry into the study, other than the need for aortofemoral bypass, were used: that is, patients were entered into the study irrespective of preoperative ankle/arm pressure indexes or results of hyperemia testing. Overall, flow rates after sympathectomy was added to aortofemoral bypass were 1.55 times greater than after aortofemoral bypass alone. This degree of augmentation of flow may be important, particularly in cases of limited outflow.     

The force/time relationship of clinically used sensory testing instruments

Aortoiliac occlusive disease is a significant cause of lower extremity ischemic symptoms. Over the past two decades, most patients have been treated with a variety of surgical procedures, including aortofemoral and extra-anatomic bypasses. Most recently, percutaneous balloon angioplasty and stents have been successfully used for the treatment of limited iliac lesions. New endovascular grafts that combine vascular grafts with stents in a device with new characteristics may allow the successful treatment of patients with extensive aortoiliac occlusive disease in a less invasive fashion. In our early experience, the endovascular grafts were constructed with Palmaz balloon-expandable stents and standard polytetrafluoroethylene (PTFE) grafts. The 18-month primary and secondary patency rates were 89% and 100%, respectively, with a limb salvage rate of 94%. Endovascular grafts can be successfully used to treat patients with extensive aortoiliac occlusive disease, with excellent early results. Long-term results and further graft improvements will define their role in the treatment of patients with aortoiliac occlusive disease.     

Vein harvest ischemia: a peripheral vascular complication of coronary artery bypass grafting

Lower-extremity ischemia can lead to impaired healing of saphenous vein excision sites in patients with significant peripheral vascular disease (PVD). Five patients who required infrainguinal revascularization for wound necrosis of the harvest site after coronary artery bypass grafting are described. The male/female ratio was 2:3 with a mean age of 67 (range 45-87) years. The most commonly associated problems were insulin-dependent diabetes mellitus (80%) and congestive heart failure (60%). The saphenous vein was harvested from the thigh and leg in three patients and exclusively from the leg in the others. Manifestations of ischemia ranged from persistent ulceration to complete wound disruption threatening limb loss. Impaired healing was isolated to infragenicular wounds in all patients. Pedal pulses were not detected in any of the affected extremities. Determination of the ankle/brachial pressure indices (ABI) revealed values of < 0.5 in three affected limbs. Non-compressible vessels resulted in falsely raised ABI of > 1.0 in the remaining two limbs; however, Doppler waveform analysis in these patients demonstrated significant PVD. Aggressive wound care and antibiotic therapy were continued for mean of 9 weeks before operative intervention. Infrainguinal reconstruction included femoropopliteal (two), femorotibial (two) and popliteal-tibial bypass (one). Autologous arm and saphenous veins in addition to expanded polytetrafluoroethylene grafts were used effectively. Limb salvage and wound healing were achieved in 100% of the patients without untoward sequelae. It is concluded that unrecognized PVD in patients undergoing coronary artery bypass grafting can lead to significant morbidity. Patients at risk may be identified with a combination of history, physical examination and non-invasive testing.(ABSTRACT TRUNCATED AT 250 WORDS)     

Selection of surgical approaches in the treatment of aortoiliac arterial occlusive disease

31 patients with aortoiliac occlusive disease with or without infrainguinal occlusion was treated with thromboendarterectomies, aortoiliac or aortofemoral arterial bypasses, extra-anatomic bypasses and sequential arterial bypasses in the past 5 years. The results were satisfactory. The surgical mortality was 3.2%, the primary 5-year patent rate was 84.2%, and the secondary 5-year patent rate was 96.5%. We emphasize the value of ABI to indicate arterial reconstruction.     

Patient tolerance of craniotomy performed with the patient under local anesthesia and monitored conscious sedation

PURPOSE: To determine whether preoperative aortoiliac arteriography can be replaced with noninvasive evaluation in the management of some patients with chronic lower extremity ischemia. METHODS: Preoperative evaluation was performed on 184 ischemic limbs (119 patients) over 19 months by means of aortoiliac arteriography with runoff and noninvasive studies, which included common femoral artery duplex scanning, waveform and acceleration time (normal <140 msec), and aortoiliac duplex scanning. An algorithm was proposed for combining indirect (common femoral artery evaluation) and direct (aortoiliac evaluation) noninvasive studies to decrease the need for aortoiliac arteriography when possible. RESULTS: Aortoiliac occlusive disease (> or =50% stenosis to occlusion) was present at arteriography in 48 limbs (30%), and there was no inflow disease in 114 (70%). Aortoiliac lesions were identified by means of noninvasive studies. The accuracies of femoral waveform, acceleration time, and aortoiliac duplex studies were 85%, 89% and 87%. The negative predictive values were 92%, 94% and 100%. The acceleration time results were not affected by runoff status but were significantly different for various categories of stenosis (p < 0.05). The algorithm was applied to the data obtained. When acceleration time and waveform were normal, 84 of 86 patients (98%) had no stenosis at arteriography. When aortoiliac duplex findings were normal, the arteriographic findings were normal in all examinations. CONCLUSION: A combination of indirect and direct noninvasive studies can be used reliably to rule out clinically significant inflow occlusive disease and allows selective use of aortoiliac arteriography in patients with lower extremity ischemia.     

The role of profundaplasty in revascularization of the lower extremity

Profundaplasty has been performed on 112 limbs (88 primary and 24 secondary) in eighty-five men. Seventy-six limbs had incapacitating claudication, twenty-three rest pain, and thirteen either gangrene or ischemic ulceration. In thirty-six limbs treated by profundaplasty alone there were no deaths but five subsequently had amputation for ischemic pain. In the seventy-six limbs treated by profundaplasty plus other operative augmentation there were three operative deaths and one late death; three required further operative surgery and in four amputation was necessary. Oblique arteriographic films of the femoral area are essential for evaluation of the profunda femoris artery. Both radionuclide and Doppler pressure studies confirmed physical and arteriographic findings. The latter would appear superior because of ease of availability and cost. After profundaplasty alone and aortofemoral bypass there was a moderate increase in calf blood flow, but in only those with a patent superficial femoral artery did blood flow and pressure studies return to within normal limits. Profundaplasty is an important addition to the armamentarium of the vascular surgeon in dealing with arteriosclerotic insufficiency of the lower extremities.     

Dynamics of the martial arts high front kick

Fast unloaded movements (i.e. striking, throwing and kicking) are typically performed in a proximo-distal sequence, where initially high proximal segments accelerate while distal segments lag behind, after which proximal segments decelerate while distal segments accelerate. The aims of this study were to examine whether proximal segment deceleration is performed actively by antagonist muscles or is a passive consequence of distal segment movement, and whether distal segment acceleration is enhanced by proximal segment deceleration. Seventeen skilled taekwon-do practitioners were filmed using a high-speed camera while performing a high front kick. During kicking, EMG recordings were obtained from five major lower extremity muscles. Based on the kinematic data, inverse dynamics computations were performed yielding muscle moments and motion-dependent moments. The results indicated that thigh deceleration was caused by motion-dependent moments arising from lower leg motion and not by active deceleration. This was supported by the EMG recordings. Lower leg acceleration was caused partly by a knee extensor muscle moment and partly by a motion-dependent moment arising from thigh angular velocity. Thus, lower leg acceleration was not enhanced by thigh deceleration. On the contrary, thigh deceleration, although not desirable, is unavoidable because of lower leg acceleration.     

Introduction of video endoscopic vascular surgery of the pelvic area

The fact that operative lethality and other typical postoperative complications following surgical treatment of aortoiliac atherosclerotic disease are mainly related to the surgical trauma (derived from the extensive abdominal incision and dissection), but not to the classical arterial reconstruction itself, has led us to develop a videoendoscopic aortoiliacal surgical method which is supposed to diminish the potential postoperative complications. Thus, a new endoscopic instrument set for vascular surgery has been developed in close cooperation with Aesculap AG Tuttlingen, Germany. After evaluating the basic techniques of videoendoscopic patching and end-to-side anastomosis with the newly designed instruments on a training model (n = 50), the feasibility of videoendoscopic vascular surgery on aortoiliacal vessels was tried out on human corpses (n = 8). The positive results of the initial survey have finally encouraged us to conduct our first series of animal studies on piglets (n = 25). The investigation regarding ultrasonically monitored blood flow in the femoral arteries after videoendoscopic aortofemoral bypass grafting and other systemic, hemodynamic parameters showed positive results. No complications were encountered in any of the standardized animal studies. Favorable activity levels were recorded. Meanwhile we have performed 5 extraperitoneal videoendoscopic aortofemoral artery bypasses in patients with aortoiliac occlusive diseases. One patient in whom we had occluded the inferior mesenteric artery died due to an ischaemic colitis. The other patients had an uneventful postoperative course. The videoendoscopic vascular procedures were carried out according to the rules of conventional vascular surgery. Nevertheless, further experimental research and development of endoscopic instruments have yet to be done, to optimize the new surgical method and to clarify the advantages of videoendoscopic vascular surgery.     

Tibial and peroneal bypass in severe occlusive disease of the lower extremities

Symptomatic arteriosclerotic occlusive disease involving the femoral and proximal popliteal arteries is currently best treated by reversed autogenous saphenous vein bypass graft. Severe occlusive disease frequently includes the popliteal and/or origin of the trifurcation vessels with reconstitution of one or more of the vessels in the lower leg. We have used distal bypass 97 times in 90 patients during the past decade. There was only one postoperative death in the series in spite of the advanced age and concurrent disease in the majority of the patients. Our indications for operation continue to be relief of pain or salvage of an extremity. We rely on high quality preoperative angiograms for selection of vessels to receive the bypass. The posterior tibial artery was used in 63 of the cases, while the anterior tibial and peroneal were used in 24 and 10 cases, respectively. There were 11 immediate inhospital failures in this series of 97 cases requiring amputation in five. Three additional patients had amputations during the ensuing several months. Of the 85 grafts functioning at the time of discharge from the hospital, 16 or (18.8%) failed during the first years. Grafts that remained patent for one year have a high incidence of long term patency which is in keeping with other reported series.     

A family of autosomal dominant facio-limb-girdle muscular dystrophy

A family of autosomal dominant facio-limb-girdle muscular dystrophy was reported. The proband was a 28-year-old male. His father and sister suffered from a similar disease. All patients developed weakness of lower limbs and atrophy of thigh at second to fourth decades. All showed mild facial and neck flexor weakness as well as proximal dominant weakness and atrophy of four limbs. Limb muscle involvement was more severe in lower limbs than in upper limbs in all cases. Interestingly, all showed limitation of ankle dorsiflexion (tight heel cord), although distal muscles of lower limbs were not involved or only mildly involved clinically. On laboratory examination, serum CK increased slightly. Needle EMG revealed low amplitude, polyphasic MUP in limb muscles in all cases. Biopsied muscles taken from the proband showed non-specific myogenic changes. Rimmed vacuoles were not observed. Our cases were different from Bethlem myopathy, because the age of onset was late and joint contractures were mild in our cases, as compared with Bethlem myopathy. Clinical manifestations of our family showed a strong resemblance to the family reported by Girchlist et al, but similar cases were not reported in Japan.     

Aortoiliac stent deployment versus surgical reconstruction: analysis of outcome and cost

PURPOSE: The purpose of this study is to compare complication rate, primary patency, and cost of stent deployment with direct surgical reconstruction for the treatment of severe aortoiliac occlusive disease. METHODS: From March 1, 1992, to May 31, 1996, 119 patients receiving treatment for aortoiliac occlusive disease were analyzed after exclusions. Sixty-five patients had stent deployment and 54 patients had surgical reconstruction. Data were evaluated within and between the groups by univariate and multivariate logistic regression, life-table, t-test, and cross tabulation with chi2 analysis. RESULTS: There was no significant difference between the groups with regard to demographic features or presenting symptoms (all p values > 0.07). Incidence of procedure-related complications was similar (p = 0.30). However, there were more systemic complications in the surgery group (15 versus 2; RR = 5.5, p < 0.01) and more vascular complications in the stent group (16 versus 3; RR = 12, p < 0.002). Incidence and type of late complications were not appreciably different (all p values > 0.05). Cumulative primary patency rate of bypass grafts was significantly better than stented iliac arteries at 18 months (93% versus 77%), 30 months (93% versus 68%) and 42 months (93% versus 68%); p = 0.002, log rank. Multivariate analysis identified female gender (RR = 4.6, p = 0.03), ipsilateral SFA occlusion (RR = 5.6, p = 0.01), procedure-related vascular complication (RR = 9.7, p = 0.002), and hypercholesterolemia (RR = 5.0, p = 0.02) as independent predictors of bypass graft or stent thrombosis. Mean total hospital cost per limb treated did not differ significantly between surgery and stent deployment groups ($9383 versus $8626, respectively; p = 0.66, t-test). CONCLUSIONS: Treatment of severe aortoiliac occlusive disease by surgical reconstruction or stent deployment has a similar complication rate. Mean hospital cost per limb treated is essentially equal. However, cumulative primary patency rate of bypass grafts is superior to stents. Therefore, considering the elements of cost and patency, surgical revascularization has greater value. The benchmark for cost-effective treatment of severe aortoiliac occlusive disease is direct surgical reconstruction.     

When to ambulate the patient with a vascular graft in the groin

Ankle blood pressure studied pre- and postoperatively in 60 patients after aortofemoral and femoral distal bypass surgery showed no adverse effect after major positional changes (supine, sitting, and standing). Early ambulation was not harmful to graft dynamics in this group of patients.     

Doppler sonography diagnosis of restenosis after percutaneous transluminal angioplasty: sensitivity and specificity of the pedal-brachial index in relation to changes in absolute arterial blood pressure

INTRODUCTION: Percutaneous transluminal angioplasty (PTA) is accepted for the treatment of patients with severe, disabling claudication who fail conservative management and also for patients with limb threatening ischaemia [1-5, 18, 20]. The development of neointimal hyperplasia (predominantly during the first 6-12 months after PTA), and the progression of the underlying atherosclerotic disease (thereafter), are the reasons of restenosis and reocclusion [1-4, 6]. More than 50% of occurring restenoses are primarily oligo/asymptomatic [1-4, 6-10, 25, 26]. Follow-up visits are aimed at detecting significant restenoses, before reocclusion occurs, so that timely reintervention is possible. In asymptomatic patients in whom reintervention is not necessary, repeated angiography is not justifiable. Non-invasive alternatives include Duplex scanning or the assessment of simple peripheral haemodynamic variables such as ankle systolic pressures and the ankle/brachial pressure index (ABI). The aim of this study was: (1) To determine the sensitivity and specificity of post PTA changes in the ABI, and changes in the absolute ankle pressure to detect restenoses after femoropopliteal PTA (as a gold standard, Duplex scanning, with its reported high sensitivity, specificity and accuracy for detecting restenosis was chosen [9, 25]. (2) For both methods, to evaluate the criteria (minimal magnitude of change-cut off points) necessary to detect restenosis with reasonable reliability. (3) To compare the diagnostic value of changes in ABI to changes in absolute ankle pressure, and to determine the method of preference for detection of post-PTA restenosis. MATERIAL AND METHODS: The study included 171 consecutive patients with peripheral arterial occlusive disease, Fontaine stage II or stage III, selected for femoro-popliteal PTA. All pts presented with single or multiple arterial stenoses or occlusions not exceeding 10 cm of length within the femoro-popliteal segment. At least one lower leg artery had to be patent. Only pts in whom PTA was successful (maximum residual lesion within the dilated segment showed < or = 30% diameter reduction (DR)) were accepted for a 12-month follow-up. After PTA all patients were prescribed a platelet aggregation inhibitor. The investigational scheme included the following procedures: 1. Duplex scanning of the entire lower leg vascular tree before PTA, within 7 days after PTA as well as at 4 weeks and at 12 months. 2. Scoring of Duplex results using the Bollinger angiography score system [11] which distinguishes the pelvic segment, a proximal and a distal superficial femoral segment, the popliteal artery including the popliteal trifurcation and the proximal 1/3 of the lower leg arteries. The score system allows the differentiation of single and multiple plaque (< or = 25% DR), single or multiple stenoses (< or = 50% and < or = 50% DR) involving less or more than 50% of the segment under investigation as well as short (< 50% of segment length) and long (> or = 50% of segment length) vascular occlusions. 3. The assessment of the resting ankle systolic pressures (dorsalis pedis artery, posterior tibial artery) of the reference leg, pre PTA, at 4 weeks, and 3, 6, 9 and 12 months using a 8 Mhz CW Doppler device (Parks 908) with the patient in the supine position and after a resting period of > or = 30 minutes. 4. The calculation of the ankle/brachial pressure index (ABI) as the ratio of the higher systolic pressure value from either the posterior tibial or the dorsalis pedis artery divided by the higher value of the two (bilateral) systolic brachial pressures. 5. A full physical examination including a pulse status, vascular auscultation as well as the assessment of the clinical symptomatology pre PTA, at 4 weeks as well as at 6 and 12 months. The following findings were suggestive of restenosis/reocclusion of the dilated segment. 1. Reoccurrence of a stenosis < or = 50% DR within the dilated segment and/or its inflow or outflo     

Giant ossified cavernous hemangioma of an extremity associated with an equinovarus deformity

A 39-year-old woman suffered from swelling and tenderness of the right leg for 31 years. Imaging studies showed a large soft tissue lesion on the right side extending from the proximal portion of the thigh to the ankle. She underwent several operations due to the leg mass and associated equinovarus deformity of the right ankle. The pathologic findings were those of an ossified cavernous hemangioma. This appears to be one of the largest hemangiomas to be reported. It revealed the three types of calcification characteristic of hemangiomas. Equinovarus deformity of the ankle caused by contracture of the calf in this case was probably related to repeated bleeding.     

Changes in lower limb volume in humans during parabolic flight

Variations in gravity [head-to-foot acceleration (Gz)] induce hemodynamic alterations as a consequence of changes in hydrostatic pressure gradients. To estimate the contribution of the lower limbs to blood pooling or shifting during the different gravity phases of a parabolic flight, we measured instantaneous thigh and calf girths by using strain-gauge plethysmography in five healthy volunteers. From these circumferential measurements, segmental leg volumes were calculated at 1, 1.7, and 0 Gz. During hypergravity, leg segment volumes increased by 0.9% for the thigh (P < 0.001) and 0.5% for the calf (P < 0.001) relative to 1-Gz conditions. After sudden exposure to microgravity following hypergravity, leg segment volumes were reduced by 3.5% for the thigh (P < 0.001) and 2.5% for the calf (P < 0.001) relative to 1.7-Gz conditions. Changes were more pronounced at the upper part of the leg. Extrapolation to the whole lower limb yielded an estimated 60-ml increase in leg volume at the end of the hypergravity phase and a subsequent 225-ml decrease during microgravity. Although quantitatively less than previous estimations, these blood shifts may participate in the hemodynamic alterations observed during hypergravity and weightlessness.     

Experience of reoperations followed by repairs of abdominal aortic aneurysms

We experienced 8 cases who required reoperations, including 2 re-redo operations, after repairs of infrarenal abdominal aortic aneurysms. Of 8 patients, one patient developed a new aneurysm due to atherosclerosis in thoraco-abdominal aorta involving all visceral arteries and other 7 patients had aneurysmal formations at proximal anastomotic sites, including 3 suprarenal, 2 juxtarenal and 2 infrarenal aortic lesions. Etiology at initial operation in patients who subsequently developed anastomotic aneurysms included vasculo-Beh?et disease in 4, atherosclerosis in 2 and dissecting aortic aneurysms type III due to Marfan syndrome in 1. At reoperation, all who had vasculo-Beh?et disease had ruptures of anastomotic sites and 2 patients underwent repairs of dehiscent patch, 1 extra-anatomic bypass between ascending and abdominal aorta and 1 interposition of graft. One patient who had graft infection after repair of abdominal aortic aneurysm required axillo-femoral bypass with removal of infected graft. A patient who had dehiscence of proximal anastomosis after repair of aortoiliac occlusive disease required interposition of graft. Two patients, Marfan syndrome and aneurysm in thoraco-abdominal aorta, underwent graft replacement of thoraco-abdominal aorta concomitant with reconstruction of all visceral arteries. There were 8 patients who required reoperations for aneurysms at distal anastomotic sites after repairs of abdominal aortic aneurysms. Five patients underwent repairs of new aneurysms, including replacement of total arch in 3, descending aorta in 1 and iliac artery in 1. In all cases, no hospital death was noted, however, late deaths were occurred in vasculo-Beh?et disease, Marfan syndrome and graft infection. Thus, late result depends on etiology of disease. Although patients who requires reoperation after repair of abdominal aortic aneurysms have higher operative risk factors, early and late results are satisfactory compared to initial operations.     

Distribution and latency of muscle responses to transcranial magnetic stimulation of motor cortex after spinal cord injury in humans

Noninvasive transcranial magnetic stimulation (TMS) of the motor cortex was used to evoke electromyographic (EMG) responses in persons with spinal cord injury (n = 97) and able-bodied subjects (n = 20, for comparative data). Our goal was to evaluate, for different levels and severity of spinal cord injury, potential differences in the distribution and latency of motor responses in a large sample of muscles affected by the injury. The spinal cord injury (SCI) population was divided into subgroups based upon injury location (cervical, thoracic, and thoracolumbar) and clinical status (motor-complete versus motor-incomplete). Cortical stimuli were delivered while subjects attempted to contract individual muscles, in order to both maximize the probability of a response to TMS and minimize the response latency. Subjects with motor-incomplete injuries to the cervical or thoracic spinal cord were more likely to demonstrate volitional and TMS-evoked contractions in muscles controlling their foot and ankle (i.e., distal lower limb muscles) compared to muscles of the thigh (i.e., proximal lower limb muscles). When TMS did evoke responses in muscles innervated at levels caudal to the spinal cord lesion, response latencies of muscles in the lower limbs were delayed equally for persons with injury to the cervical or thoracic spinal cord, suggesting normal central motor conduction velocity in motor axons caudal to the lesion. In fact, motor response distribution and latencies were essentially indistinguishable for injuries to the cervical or thoracic (at or rostral to T10) levels of the spine. In contrast, motor-incomplete SCI subjects with injuries at the thoracolumbar level showed a higher probability of preserved volitional movements and TMS-evoked contractions in proximal muscles of the lower limb, and absent responses in distal muscles. When responses to TMS were seen in this group, the latencies were not significantly longer than those of able-bodied (AB) subjects, strongly suggestive of "root sparing" as a basis for motor function in subjects with injury at or caudal to the T11 vertebral body. Both the distribution and latency of TMS-evoked responses are consistent with highly focal lesions to the spinal cord in the subjects examined. The pattern of preserved responsiveness predominating in the distal leg muscles is consistent with a greater role of corticospinal tract innervation of these muscles compared to more proximal muscles of the thigh and hip.     

Long-term results after open and semiclosed thrombendarterectomy for aortoiliac occlusive disease

OBJECTIVES: This study reviews the long-term results of 514 aortoiliac thrombendarterectomies (TEA's). DESIGN: A prospective study in a major university hospital in Switzerland. SUBJECTS: 353 male and 62 female patients with aortoiliac occlusive disease. Operative indications: disabling claudication (n=334), rest pain (n=44), and gangrene (n=37). METHODS: Open and semiclosed TEA's were performed on 167 and 347 limbs, respectively. Follow-up was continuous and complete in 97.1 % of patients over a period of more than 15 years. RESULTS: The overall life-table patency rate at 5, 10, and 15 years postoperatively were 93.4 %, 90.4 %, and 84.2 %, respectively. Fifteen years postoperatively, the patency rate of 92.3 % after open TEA was significantly higher (p<0.04) than after semiclosed TEA (79.5 %). However, similar patency rates of 69.5 % and 69.8 % were observed 20 years postoperatively. Further significant prognostic factors on patency were: anatomic localization (p<0.004), preoperative stage of arterial occlusive disease (p<0.008), and gender (p<0.007). Patient's age did not influence the outcome in terms of patency. Hospital mortality rate was 1.2 %. Early obstruction occurred in 2.2 %, leading to subsequent early amputation of 1.4 % and reoperations in 1.2 %. The long-term actuarial survival rates of the patients were 55 %, 36 %, and 18 % after 10, 15, and 20 years postoperatively. CONCLUSION: Both open and semiclosed TEA give highly satisfactory long term results in aortoiliac occlusive disease with a low morbidity and low mortality.     

Multiple level arterial occlusions of the leg. Reliability of indirect thigh pressures in the assessment of proximal arterial obstruction

19 patients with obstructive arterial disease both proximal and distal to the inguinal ligament were studied with segmental blood pressure recordings because reconstruction of the proximal lesion was considered. The common femoral pressure was measured intraarterially as well as with a 12 cm cuff placed as proximally as possible on the thigh. The proximal pressures measured by the two techniques were found to correlate well. Thus, the atraumatic cuff pressure technique is validated which can be of use in evaluating multilevel occlusions and the associated run off problem involved in partial proximal reconstruction.