[Dyspnea on exertion, angina pectoris and loud buzzing in the right groin in an 82-year-old man]. / Belastungsdyspnoe, Angina pectoris und lautes Schwirren über der rechten Leiste bei einem 82-Jährigen.

We report on the case of an 82-year-old man who was suffering from chest pain and dyspnea. Acute cardiac ischemia could be excluded. Cardiac catheterization also revealed an aneurysm of the right common iliac artery. In addition, an arteriovenous fistula between the iliac artery and vein was detected by computer tomography angiography. Apparently, these symptoms were caused by a high output heart failure with known coronary heart disease. The patient was treated by implantation of prosthesis and oversewing the fistula which led to full recovery.

Results of open vascular surgical therapy in chronic peripheral arterial disease.

Surgery in chronic peripheral arterial disease (PAD) can alleviate symptoms in claudicants and may impede amputation in critical limb ischemia. The current data on different surgical strategies and techniques from the aortoiliac region to the pedal arteries as well as amputation as last resort are described and discussed. Treatment of PAD depends on the condition of the patient and his comorbidities. The question of optimal therapy for each patient cannot always be answered in the operating theatre or the angio-suite.

Successful surgical management of a recurrent leiomyosarcoma of the inferior vena cava.

The leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumour of the venous system. The recurrence of the tumour after previous initial surgical resection is common and occurs in more than half of the patients. Surgical resection of a local recurrence is poorly described in the literature and the available data are restricted to a small number of cases. We report the case of a 62 year old woman, who was referred to our vascular surgical unit for recurrence of a leiomyosarcoma of the inferior vena cava, 35 months after diagnosis and initial surgical treatment. We performed an extensive local resection and circumferencial replacement of the IVC. 18 months after the second operation and adjuvant radiotherapy, the patient is in a very good physical condition and CT-scans show no evidence of tumour recurrence.

[Esophageal necrosis following endovascular treatment of a ruptured thoracal aortic aneurism: caused by mediastinal compartment syndrome]. / Osophagusnekrose nach endovaskulärer Versorgung eines rupturierten thorakalen Aortenaneurysmas : Folge eines mediastinalen Kompartments.

We report a case of acute esophageal necrosis after endovascular stenting for acute rupture of a thoracic aortic aneurysm into the mediastinum caused by mediastinal compartment syndrome and overstenting of intercostal arteries.

[Ruptured abdominal aortic aneurysm : perioperative indicators for the clinical course following conventional open surgery]. / Rupturiertes Bauchaortenaneurysma : Perioperative Prädiktoren für den klinischen Verlauf nach konventioneller offener Behandlung.

OBJECTIVES: Ruptured abdominal aortic aneurysms (rAAA) still represent a life-threatening vascular disease, with high mortality despite improved diagnostic tools and perioperative patient management. The aim of this study was to reveal predictors of perioperative mortality and survival after open (conventional) rAAA repair. PATIENTS AND METHODS: We analyzed data from our department containing 67 patient histories and clinical notes which were collected between January 1984 and December 2004. The study patients underwent emergent surgery for rAAA. In these cases we defined 72 preoperative, 47 intraoperative, and 39 postoperative variables for further analysis. RESULTS: Our results indicate that the worst survival prognosis could be defined in patients with rAAA and aneurysmatic inclusion of the iliac arteries with concomitant prolonged shock who received an aorto-iliac bypass. For these patients we calculated a cumulative 30-day survival rate of 59.7% and 1-year survival of 43.3%. An influence of age and comorbidity on the mortality rate could not be proven. Furthermore the conclusion cannot be drawn that postoperative course was influenced by intra- vs retroperitoneal rupture localization. CONCLUSION: This study provides evidence that neither old patient age nor comorbidities influence the mortality of patients suffering from rAAA, for whom time-consuming case selection according to previous morbidities should therefore be omitted. Instead we recommend conventional surgical repair as soon as possible to maximize the chances of survival.

[Indication for emergent revascularisation of acute carotid occlusion]. / Stellenwert der Revaskularisation eines akuten Karotisverschlusses.

BACKGROUND AND PURPOSE: We examined indications for emergent revascularisation of acutely occluded internal carotid artery (ICA) using current diagnostic methods. MATERIAL AND METHODS: From 1997 to 2006 we prospectively followed 34 consecutive patients undergoing emergency revascularisation due to acute extracranial ICA occlusion and acute ischaemic stroke within 72 h after symptom onset (mean 25) and within 36 h after admission (mean 16). Exclusion criteria were occlusion of the intracranial ICA or ipsilateral middle cerebral artery (MCA), ischaemic infarction of more than one third of the MCA perfusion area, or reduced level of consciousness. All patients underwent duplex sonography, cerebral CT, and/or MRI and angiography (MRA and/or DSA). We performed endarterectomy and thrombectomy of the ICA. RESULTS: Confirmed by postoperative duplex sonography at discharge, ICA revascularisation was successful in 30 (88%) of 34 cases. Postoperative intracranial haemorrhage was detected in two patients (6%) and perioperative reinfarction in one (3%). Compared to the preoperative status, 20 patients (59%) showed signs of clinical improvement by at least one point on the Rankin scale, ten patients (29%) remained stable, and two patients (6%) had deteriorated. The 30-day mortality was 6% (two patients). CONCLUSION: After careful diagnostic workup, revascularisation of acute extracranial ICA occlusion is feasible with low morbidity and mortality.