Populations with the Leriche syndrome.

Complete infrarenal aortic occlusion was found in 20 of 325 patients who underwent bypass for atherosclerosis of the distal aorta. Eleven had normal distal arteries as demonstrated by arteriography; the remaining patients had multilevel areas of stenosis and occlusion below the inguinal ligament. The two groups were significantly different in age, blood pressure levels, and duration of symptoms. The bypass relieved symptoms and restored flow in all the patients with normal distal vessels. There were four acute graft failures, two of which resulted in death, in the group with distally diseased vessels, and only two of these nine patients were symptomatically improved by the bypass. These data indicate that there are at least two distinct patient populations with the Leriche syndrome. Anatomic changes at the aortic bifurcation may be responsible for the clinical differences.

Percutaneous subclavian vein catheter hemodialysis--impact on vascular access surgery.

The problem of the immediate need for access to the circulation for hemodialysis arises because of an acute renal failure (ARF), the failure of an established access route, or the acute presentation of end-stage renal disease. Prior to 1976 emergent hemodialysis at our center necessitated either surgical placement of an external shunt or intermittent femoral vein cannulization, Since 1976 indwelling percutaneous subclavian vein catheterization (SVC) has been used on a routine basis for emergency hemodialysis. We have evaluated retrospectively the clinical courses of 50 patients with ARF and 48 patients with chronic renal failure (CRF) who underwent SVC dialysis in comparison with the clinical courses of 50 patients with ARF and 35 patients with CRF who had external shunt dialysis. In the ARF group, SVC dialysis resulted in lower incidences of serious infection, hemorrhage, and access thrombosis and reduced the number of replacement access procedures needed. In the CRF group, SVC permitted creation of more autogenous fistulas, rarely failed because of infection or thrombosis, and could therefore be used for extended periods, allowing primary autogenous fistula placement and maturation. Future access sites were also saved. SVC dialysis has become our primary interval angioaccess procedure for acute hemodialysis.

Erythromelalgia--a case study.

Erythromelalgia is a rare syndrome characterized by pain, redness, and heat involving the lower and, less frequently, the upper extremities. Symptoms occur with local or environmental stimulation and may be mild for years or become disablingly severe. A finding of relief with ice-water immersion helps distinguish erythromelalgia from disorders such as causalgia and reflex sympathetic dystrophy. Erythromelalgia may be classified in three ways: (1) early-onset, (2) adult-onset aspirin-sensitive, and (3) adult-onset non-aspirin-sensitive. Treatment options, which include medication, sympathetic blocks, and surgery, are determined by classification.

Duodenal obstruction by abdominal aortic aneurysms.

We report a case of duodenal obstruction caused by an abdominal aortic aneurysm. The duodenum was firmly attached to the lateral wall of the aneurysm by a tough, fibrous band. Duodenal obstruction is a rare presenting complaint in a patient with an abdominal aortic aneurysm. Anatomic features have not been routinely described in previous patients. We propose a mechanism for the cause of this entity and a review of the literature. The treatment of choice is resection of the aneurysm with graft replacement of the aorta.