Homocysteine as a risk factor of restenosis after carotid endarterectomy.

AIM: Homocysteine (Hcy) has been identified as a potential risk factor for vascular disease. This study investigates the role of serum Hcy as clinical risk factor for restenosis after carotid endarterectomy (CEA). METHODS: In a prospective design, we studied patients who underwent carotid endarterectomy with venous patch closure technique with respect to alterations of Hcy levels pre and postoperatively. The patients studied were subjected to reevaluation for possible restenosis at time-points 3, 6, 9, 12, 18 and 24 months postoperatively. RESULTS: Fifty-three symptomatic and 37 asymptomatic patients with stenosis of internal carotid artery >70% were studied. Restenosis appeared in 7.25% of the patients within 24 months postoperatively. Hcy was the only parameter that correlated significantly with the presence of restenosis (P=0.010) and the presence of type VI (complicated) atheromatous plaque (P=0.005) within 24 months postoperatively. CONCLUSION: Hcy levels were found to be statistically significantly correlated with both the presence of complicated atheromatous plaque and the degree of internal carotid artery restenosis after CEA.

Elective bypass surgery for chronic mesenteric ischemic disease: report of 3 cases and review of the literature.

Chronic mesenteric ischemic disease is an unusual cause of chronic abdominal pain. We present our experience from open surgical treatment of patients with this rare disease followed by a short review of the literature. During the period 2006-2008, three patients were referred to our department with clinical and radiological findings of chronic mesenteric ischemic disease. In all patients, at least 2 out of 3 splachnic vessels (celiac artery, superior and inferior mesenteric artery) were occluded, with severe stenosis of the third. Open surgical revasculation was performed in all patients, using autologous or synthetic (Dacron) bypass grafts. Graft patency was examined with triplex ultrasound studies at 3, 6 and 12 months postoperatively and/or follow up CT angiography. All patients had patent grafts during the follow up period and have regained their normal body weight. Immediate and late results, technical details and controversies in open surgical revasculation for chronic mesenteric ischemic disease are reviewed. In conclusion open surgical revasculation for chronic mesenteric ischemic disease is a technically challenging procedure with good results in patients younger than 70 years old , with long occlusions of the splachnic vessels and severe calcification of the vessel wall.

Oxidative stress during abdominal aortic aneurysm repair--biomarkers and antioxidant's protective effect: a review.

BACKGROUND AND OBJECTIVES: Oxidative stress during abdominal aortic aneurysm (AAA) repair is likely to result as a response to an ischemia-reperfusion injury (IRI) to the lower limbs and gastrointestinal tract. This paper reviews the oxidative stress during AAA repair, with specific reference to biological markers and the potential antioxidant's protective effect. EVIDENCE AND INFORMATION SOURCES: The current literature (1966 to July 2010) was reviewed specifically for all articles describing human studies relevant with the particular subject: oxidative stress in patients with AAA repair. Key-words used as single or combined searches included "abdominal aortic aneurysm", "open repair", "EVAR", "oxidative stress", "oxidation" and "antioxidant". RESULTS: A total of 14 relevant human studies were identified. In the majority of studies all samples (blood samples or/and muscle biopsies) were obtained from the patients using regional sampling techniques before or after anaesthesia, during aortic clamping or balloon occlusion (ischemic time) and after aortic clamp removal (reperfusion time) in different time intervals up to 24 or 48 hours. The oxidative status during AAA repair operation was evaluated by measuring quantitative changes of different substances including mainly vascular endothelial adhesion molecules, lipid peroxidation by-products or reactive oxygen species (ROS) and their metabolites. Two studies compared two groups of patients with AAA treated either by open or endovascular repair (EVAR), while four studies used different types of antioxidant supplementation in order to correlate it with a reduction in oxidative stress and damage in the antioxidant group of patients. PERSPECTIVES AND CONCLUSIONS: Current evidence suggests that there is a high-grade oxidative stress during AAA repair operation. This was higher in cases of open repair beside EVAR and in cases with ruptured AAAs beside elective cases. The beneficial effect of an antioxidant supplementation in reducing the oxidative stress during AAA repair was also demonstrated. The use of a biological marker as a predictor of the development of systemic complications could also give a therapeutic advantage.

ICU transfer after elective abdominal aortic aneurysm repair can be succesfully reduced with a modified protocol. A fourteen year experience from a University Hospital.

AIM: To compare different selective criteria for Internal Care Unit (ICU) admission in two different timeframes, after abdominal aortic aneurysm (AAA) repair. A retrospective audit of acquired data was performed. METHODS: During a period of fourteen years (1994-2008), 1152 patients underwent an elective open operation for infrarenal abdominal aortic aneurysm, in our department. Six hundred and two patients (Group A) were treated in the period January 1994-January 2003, and 550 patients (Group B) between January 2003 and August 2008. Postoperatively, all patients were transferred to postanesthesia unit (PAU). After a 2 hours period of close observation, they were transferred either to the ICU or to the surgical ward, according to certain selective criteria (SC). In group A we used SC-A, for admission to an ICU, and in group B we used new, stricter, criteria (SC-B). Thirty-day mortality and morbidity, elective admissions to ICU, rate of subsequent ICU admission, from ward to ICU, and the mean hospital and ICU length of stay, were compared between the two groups. RESULTS: The use of SC-B resulted in a significant reduction of elective admissions to ICU (3.1% vs 8.5%, P<0.001). Nevertheless, the portion of patients, which were transferred with a severe postoperative complication from the ward to ICU, remained similar between the two groups (1.1% vs 0,9%, in group A and B, respectively). All other endpoints were similar in both groups. CONCLUSION: Modifying the protocol of ICU transfer, after elective abdominal aortic aneurysm repair, we can reduce the number of patients requiring ICU, without compromising patients' safety.

Carotid endarterectomy versus carotid angioplasty with or without stenting for treatment of carotid artery stenosis: an updated meta-analysis of randomized controlled trials.

Carotid angioplasty with or without stent placement (CAS) has been proposed as an alternative to carotid endarterectomy (CEA) for the treatment of carotid artery stenosis. We performed a systematic review and meta-analysis of randomized controlled trials to compare the safety and efficacy of endovascular techniques with surgery for carotid stenosis. We searched MEDLINE, PubMed and Cochrane databases to identify randomized controlled trials comparing CAS with CEA. Both random and fixed effects models were used to calculate the pooled odds ratios (OR) and their confidence intervals, with values lower than one indicating a benefit from the endovascular approach. Continuity correction was used for studies with zero events in one arm. We identified 11 trials randomizing a total of 3 258 patients; 1 623 to CEA and 1 635 to CAS. By random effects model, there was no significant difference between the treatments for any stroke (OR, 1.28; 95% CI, 0.82-2.02), or death or any stroke at 30-day (OR, 1.30; 95% CI, 0.92-1.84) and death or any stroke at 6 months (OR, 1.34; 95% CI, 0.86-2.09) or 1 year (OR, 1.41; 95% CI, 0.24-8.27). However there was a significantly higher risk of 30-day death or any stroke (OR, 1.33; 95% CI, 1.01-1.75) after CAS by fixed effects model. Endovascular treatment significantly reduced the risk of 30-day cranial nerve injury (OR, 0.13; 95% CI, 0.04-0.44). In conclusion treating carotid artery stenosis with CAS offers lower rates of cranial nerve injury compared with CEA. CAS could not be proved to be as safe as CEA in treating carotid artery stenosis. The results of ongoing randomized trials comparing CAS with CEA are easily awaited because they may provide sufficient evidence for a change in clinical practice.

Transradial access for carotid artery stenting: a single-center experience.

AIM: The aim of this study was to report our initial experience using the radial artery as access for carotid artery stenting (CAS) and review the existing literature. METHODS: From January to June 2008, nine high-risk consecutive patients were treated with carotid stents by using the radial artery as an access point. Major complications (perioperative myocardial infarction, stroke, transient ischemic attack [TIAs] and death) and minor complications (radial artery occlusion or hematomas) were evaluated during this procedure. RESULTS: Seven of these patients had a right (77.8%) and two had a left (22.2%) sided carotid artery stenosis. Patients were symptomatic (TIAs or strokes or both) and had a >60% stenosis of the internal carotid artery. The technical success rate was 100% and all patients mobilized two hours after the procedure and were discharged home on the first postoperative day. No major or minor complications were reported. CONCLUSION: Patients with vessel pathology or unfavorable anatomy in the iliofemoral arteries or/and the aorta, can be candidates for CAS through the radial artery. Refinement of the technique and improvement in endovascular devices may lead to the replacement of the conventional femoral access by the transradial route in the near future.

Distribution of traction forces associated with shape changes during amoeboid cell migration.

Amoeboid motility results from the cyclic repetition of shape changes leading to periodic oscillations of the cell length (motility cycle). We analyze the dominant modes of shape change and their association to the traction forces exerted on the substrate using Principal Component Analysis (PCA) of time-lapse measurements of cell shape and traction forces in migrating Dictyostelium cells. Using wild-type cells (wt) as reference, we investigated Myosin II activity by studying Myosin II heavy chain null cells (mhcA-) and Myosin II essential light chain null cells (mlcE-). We found that wt, mlcE-and mhcA- cells utilize similar modes of shape changes during their motility cycle, although these shape changes are implemented at a slower pace in Myosin II null mutants. The number of dominant modes of shape changes is surprisingly few with only four modes accounting for 75% of the variance in all cases. The three principal shape modes are dilation/elongation, bending, and bulging of the front/back. The second mode, resulting from sideways protrusion/retraction, is associated to lateral asymmetries in the cell traction forces, and is significantly less important in mhcA- cells. These results indicate that the mechanical cycle of traction stresses and cell shape changes remains remarkably similar for all cell lines but is slowed down when myosin function is lost, probably due to a reduced control on the spatial organization of the traction stresses.

Guided remote endarterectomy for superficial femoral artery occlusions: a technical note.

The aim of this paper was to describe a new modification of the remote endarterectomy for the treatment of long superficial femoral artery (SFA) occlusions and to present our preliminary results. Through a subinguinal incision and arteriotomy over the SFA origin, a hydrophilic guidewire was introduced into the subintimal plane of the SFA and advanced distally until reentry into the distal patent popliteal artery. The hydrophilic guidewire is exchanged for an Ablatz wire to provide support for the advancement of the single endarterectomy ring. The MollRing Cutter was introduced in the SFA after the removal of the single endarterectomy ring and it was advanced until the re-entry point. The atherosclerotic core was removed and a nitinol self-expanding stent was placed at the peripheral end of the endarterectomy. Arteriotomy was closed with a patch. Guided subintimally-assisted remote endarterectomy seems to be a successful and safe modification of the traditional technique in the treatment of SFA occlusion, in patients with critical limb ischemia.

Cellular proliferation in complicated versus uncomplicated atherosclerotic lesions: total cell population, foam cells and newly formed microvessels.

Although cellular proliferation is a key component in the progression of atherosclerosis, research so far has been focused primarily on VSMCs. In this study we attempted to evaluate overall proliferation rates in general, as well as foam cells and the endothelial cells lining newly formed plaque microvessels in particular. For this purpose, cellular proliferation was assessed through immunohistochemical staining for PCNA in 10 fresh human carotid artery samples received from patients undergoing carotid endarterectomy. Overall proliferative activity was found significantly higher (P

The relationship of endothelin-1 and inducible nitric oxide synthase at several stages of the anastomotic healing process.

AIM: The aim of this study was to investigate the interaction between the endothelin-1 (ET-1) and inducible NO synthase (iNOS) in anastomotic healing. METHODS: The expression of ET-1 and iNOS were investigated by immunohistochemistry in a rat end-to-end arterial anastomotic model. The aorta of 50 male Wistar rats was exposed, then transversely divided and re-anastomosed. The animals were sacrificed immediately after the operation (group A, control group), after 24 h (group B), on 7th postoperative day (group C), on 30th day (group D) and at 6 months (group E). Intima and media thickness and their ratio of the anastomotic segments in each group were calculated from computer digitized images of the individual sections. ET-1 and iNOS expression were measured on a semiquantitative scale ranging from 0 to 3. RESULTS: ET-1 was expressed from endothelial and smooth muscle cells (SMCs), while iNOs was expressed from SMCs and inflammatory cells. An intense expression of ET-1 was demonstrated mainly at 1 week and to a lesser degree at 1 month. Yet, at 6 months this expression was significantly weakened (P<0.001). In contrast, an intense iNOS expression was identified at 24 h, substantially regressing at statistical significant lower levels after 1 week (P<0.001). Bivariate correlation test showed a positive correlation between ET-1 and iNOS expression. CONCLUSION: ET-1 appears to play an important role in intimal thickening during anastomotic healing, especially in the late period of the process. Although there is a positive correlation between ET-1 and iNOS production, the activity of the latter is relatively limited after the first postanastomosis week.

Can the diameter of endoluminal shunt influence the risk of hyperperfusion syndrome after carotid endarterectomy?

AIM: The aim of this study was to evaluate if there is a possible relation between the size of endoluminal shunt, in carotid endarterectomy (CEA), and the risk of postoperative hyperperfusion syndrome. METHODS: We retrospectively studied prospectively collected data from 156 patients, who were subjected to CEA using shunting and vein patch angioplasty. One hundred and thirty-eight of the patients had bilateral, high grade (> or = 90%) internal carotid lesions and the remaining 18 had a high-grade stenosis (> or = 90%) and a contralateral internal carotid artery (ICA) occlusion. In 81 patients varying diameters of shunts were used (8-14 Fr) according to the diameter of ICA (group A) and in the other 75 patients (group B) only the smallest shunt was used (8 Fr). Development of hyperperfusion syndrome was evaluated both clinically and radiologically with magnetic resonance imaging. RESULTS: Fifteen patients developed hyperperfusion syndrome (9.6%), between 0 to 6 days postoperatively. Thirteen belonged to group A (86.6%), and 2 (13.3%) belonged to group B (P<0.05). One had an intracerebral hemorrhage (0.6% of the study group) the 3rd postsurgical day. CONCLUSIONS: During CEA in patients with high-grade bilateral lesions, we recommend the use of a shunt with small diameter: this aims at reducing the risk of hyperperfusion syndrome.

Pressure dressing in breast surgery: is this the solution for seroma formation?

PURPOSE: Pressure dressing (PD) after modified radical mastectomy (MRM) for breast cancer is investigated here as an easy-to-apply method to reduce seroma formation and subsequent need for clinical care. PATIENTS AND METHODS: Two hundred mastectomized patients who were treated with PD on the skin flaps and the axilla immediately postoperatively (group A) were compared with a similar non-PD group (B). Surgical technique and perioperative care were the same. Drains were removed when drain output was reduced to 30 ml per day, or on postoperative day 8 regardless of output. RESULTS: Mean time with drains kept in situ was 4.9 and 5.5 days in group A and B, respectively. Five (2.5%) patients in group A and 16 (8%) in group B developed seromas after the removal of the drains. In total, 9 seroma needle aspirations were performed in group A and 26 in group B. Differences were statistically significant. CONCLUSION: Our findings are supportive of PD as an effective, cheap and easy-to-apply method for the reduction (a) of the time with drains in situ after MRM, (b) of the number of patients developing seromas and (c) of the seroma aspirations. This can potentially reduce further complications, needed medical care and cut expenditure.

The differential effect of estrogen, estrogen-progestin and tibolone on coagulation inhibitors in postmenopausal women.

OBJECTIVES: Hormone therapy increases the risk of venous thromboembolism, possibly through a negative effect on coagulation inhibitors. The aim of the study was to assess the effect of conjugated equine estrogens alone or in combination with medroxyprogesterone acetate, low-dose 17beta-estradiol combined with norethisterone acetate and tibolone on inhibitors of coagulation. METHODS: Two hundred and sixteen postmenopausal women received orally either conjugated equine estrogens 0.625 mg (CEE, n=24) or tibolone 2.5 mg (n=24) or CEE+medroxyprogesterone acetate 5 mg (CEE/MPA, n=34) or 17beta-estradiol 1 mg+norethisterone acetate 0.5 mg (E2/NETA, n=66) or no therapy (control, n=68) for 12 months. Plasma antithrombin, protein C and total protein S were measured at baseline and at 12 months. RESULTS: CEE, CEE/MPA and E2/NETA treatment were associated with a significant decrease in antithrombin levels (CEE: baseline 235.6+/-47.6 mg/l, follow-up 221.3+/-48.3 mg/l, p=0.0001; CEE/MPA: baseline 251.1+/-38.6 mg/l, follow-up 225.0+/-42.6 mg/l, p=0.009; E2/NETA: baseline 257.1+/-59.4 mg/l, follow-up 227.1+/-50.4 mg/l, p=0.007; tibolone: baseline 252.6+/-62.4 mg/l, follow-up 261.9+/-59.1 mg/l, p=0.39). Protein C decreased significantly in the CEE and CEE/MPA groups (CEE: baseline 3.64+/-1.17 mg/l, follow-up 2.48+/-1.47 mg/l, p=0.004; CEE/MPA: baseline 3.24+/-1.23 mg/l, follow-up 2.61+/-1.38 mg/l, p=0.001; E2/NETA: baseline 3.24+/-1.10 mg/l, follow-up, 3.15+/-1.11 mg/l, p=0.08; tibolone: baseline 3.26+/-1.25 mg/l, follow-up 3.09+/-1.32 mg/l, p=0.37). Protein S decreased significantly only in the CEE/MPA group (CEE: baseline 19.4+/-2.76 mg/l, follow-up 18.0+/-2.45 mg/l, p=0.56; CEE/MPA: baseline 18.4+/-3.42 mg/l, follow-up 14.5+/-3.43 mg/l, p=0.005; E2/NETA: baseline 19.0+/-3.11 mg/l, follow-up 19.5+/-3.43 mg/l, p=0.18; tibolone: baseline 18.5+/-3.09 mg/l, follow-up 18.0+/-4.09 mg/l, p=0.32). CONCLUSIONS: Estrogen and estrogen-progestin therapy are associated with a reduction in coagulation inhibitors, the extent of which depends on the regimen administered. Tibolone appears to have no effect on inhibitors of coagulation.

Alterations of hemostasis after laparoscopic and open surgery.

BACKGROUND: After tissue injury caused by trauma or surgery, alterations of hemostasis are observed and there is a risk for postoperative thromboembolic complications. Laparoscopic surgery, by causing limited tissue injury, appears to be associated with a lower risk for thromboembolism than open surgery. We conducted a prospective randomized study in order to detect potentially existing differences in activation of coagulation and fibrinolytic pathways between open and laparoscopic surgery. METHODS: Forty patients suffering from chronic cholelithiasis were randomly assigned to undergo open (group A n = 20) or laparoscopic cholecystectomy (group B n = 20) by the same surgical and anesthesiology team. Demographic data were comparable. Blood samples were taken (a) preoperatively, (b) at the end of the procedure, (c) 24 h postoperatively and (d) 72 h postoperatively. The following parameters were measured and compared within each group and between groups: platelets (PLT), soluble fibrin monomer complexes (SFMC), fibrin degradation products (FDP), D-dimers (D-D), fibrinogen (FIB), activated partial thromboplastin time (APTT), prothrombin time (PT). Thrombin-antithrombin III complexes (TAT) were measured at 24 and 72 h postoperatively. Prothrombin fragment 1 + 2 (F1 + 2) was measured at 24 and 72 h postoperatively in 11 patients of group A and 13 patients of group B, respectively. RESULTS: Demographics were comparable between groups. Immediately postoperatively, TAT and F1 + 2 were significantly higher in group A as compared to group B (p < 0.05). They also increased significantly postoperatively as compared to preoperative levels within each group (p < 0.05). D-dimers were significantly higher in group A as compared to group B (p < 0.01) immediately postoperatively. D-dimers also increased significantly postoperatively in group B as compared to preoperative levels (p < 0.001). FIB decreased slightly in both groups at 24 h postoperatively but there was a significant increase in group A as compared to group B (p < 0.01). SFMC were detected twice in group A and only once group B. FDP levels over 5 mug/ml were detected more often in group A than in group B (p < 0.05). No patient from either group suffered thromboembolism or abnormal bleeding as a postoperative complication. CONCLUSIONS: Open surgery as compared to laparoscopic procedures leads to activation of the clotting system of a higher degree. Although of a lower degree, hypercoagulability is still observed in patients undergoing laparoscopic surgery and, therefore, routine thromboembolic prophylaxis should be considered.

[Restoration of the continuity of the colon with preservation of an existing colostomy]. / Erhaltung einer vorbestehenden Kolostomie bei Re-Operation des Dickdarms - Ein technischer Hinweis.

A new technique for the restoration of the continuity of the colon with preservation of an existing colostomy is described here. A 75-year-old male with a three-year history of abdominal-perineal resection and a well functioning end colostomy was admitted to our department for a second primary cancer of the descending colon. At operation the colon was divided close to the abdominal wall; the colostomy was left in situ while the descending colon and mesocolon were radically resected. The viability of the colostomy was being continuously inspected. An EEA stapler was then inserted through the colostomy and an anastomosis was created. Shortening the length of the operation and avoiding the possible complications that follow the creation of a new stoma are the major benefits of the technique. Still, the viability of the colostomy after its separation of the rest of the colon and mesocolon has to be ensured before proceeding.

Renal artery aneurysm endovascular repair.

A 68-year-old woman with a left renal artery aneurysm underwent successful endovascular repair with the use of a commercial type self-expanding stent-graft. Complete aneurysm exclusion was achieved after stent-graft expansion. A side branch vessel was occluded after stent-placement, resulting in a small upper lobe renal perfusion defect. There were no other complications. The aneurysm remained excluded and its greatest diameter has been reduced from 2.6 cm to 1.95 cm, 10 months after treatment. Renal function remained normal.

A short incision for carotid endarterectomy results in decreased morbidity.

OBJECTIVES: To investigate the effect of a short incision (<5 cm) on the complication rate of the carotid endarterectomy (CEA). DESIGN: A retrospective cohort study. PATIENTS AND METHODS: From January 1994 to December 2005, 874 patients underwent 1048 primary carotid endarterectomy (CEA) procedures. Seven hundred and sixty nine operations were performed through a long neck incision (group A), while 279 were performed through a smaller incision (<5 cm) according to a standard protocol (group B). Preoperative and postoperative cranial nerve assessment was completed on all patients. The main outcome measures were stroke, death, cranial and cervical nerve injuries rates. RESULTS: The 30-day mortality rate was 0.26% in group A and 0.35% in group B (p=.792). The stroke rate was 0.13% and 0% in group A and B respectively (p=.839). The mean length of stay was 2.59 days in group A and 1.67 days in group B (p<.0001). In group A the overall incidence of motor and sensory nerve deficits was 13.5% (104 CEA, 92 patients) but in group B 2.9% (8 CEA, 7 patients, p<.0001, odds ratio [OR] 0.189, 95% confidence interval [CI] 0.091-0.393). CONCLUSIONS: Carotid endarterectomy through a small incision is a feasible and safe approach that provides cosmetic results and fewer nerve complications without compromising the safety of the procedure.

Changing patterns in the etiology of acute lower limb ischemia.

AIM: The aim of this study was to examine the causes of acute lower limb ischemia (ALLI) in a major referral center in Greece. METHODS: Hospital records of patients that were admitted with ALLI between January 1, 2000 and December 31, 2004, were retrospectively reviewed for this purpose. A total of 440 cases of ALLI in 351 patients were identified. RESULTS: In 174 (39.54%) cases, the ischemia was attributed to embolism; in 221 (50.23%) to thrombosis and in the remaining 45 (10.23%) to less common causes of ALLI (trauma [iatrogenic and non], vasculitis, dissection). Of 174 cases of embolism, 136 (78.16%) were of cardiac origin, 22 (12.64%) were due to non-cardiac emboli, while in the remaining 16 cases (9.2%) no specific origin of embolism was found. Of 221 cases of thrombosis 66 (29.86%) concerned native arterial thrombosis, while 155 (70.14%) concerned postinterventional thrombosis, including 144 (65.16%) cases of bypass graft thrombosis and 11 (4.98%) cases of iliac or femoral stent thrombosis. Sixty patients were admitted more than once with ALLI, most commonly due to repeated bypass graft thrombosis (85%). The latter was diagnosed in 32.73% of all ALLI cases and presented more often than native arterial thrombosis by a ratio of approximately 2.2:1. CONCLUSION: This study indicates that currently the leading cause for hospital admissions in patients with ALLI is thrombosis which most commonly occurs in bypass grafts rather than in native arteries.

Abdominal aortic aneurysm repair in patients with end stage renal disease.

OBJECTIVE: Abdominal aortic aneurysm (AAA) in patients with end stage renal disease (ESRD) represents a challenging therapeutic problem. This study was undertaken to analyze the surgical outcome of AAA repair in patients with ESRD and discuss the optimal peri-operative management of problems that resulted. METHODS: Between January 1995 and January 2005, 11 patients with ESRD underwent abdominal aortic aneurysm repair. All patients were under chronic haemodialysis. Risk factors related to surgical morbidity were evaluated. RESULTS: The average age was 68 years (57-84 years). Nine patients were men: 8 were hypertensive, 6 had diabetes, 4 had coronary artery disease, 3 had suffered a previous stroke, 3 had prior myocardial infarct and 8 were smokers. The duration of haemodialysis was 19 months (range 2 to 46 months). Five of the 11 patients had bilateral common iliac aneurysms in addition to the abdominal aortic aneurysm. The average diameter of infrarenal AAA was 6 cm (4.8-7.5). The mean duration of operation was 191 min. All patients underwent haemodialysis on the day before operation with an average period of 8.5 hours (6-12) and 2 to 20 hours postoperatively. The mean follow-up was 11.5 months (range 1 to 93 months). None of the patients died during the 30-day postoperative period. Two patients died from heart failure 3 and 7 months later. CONCLUSION: Abdominal aortic aneurysm can be repaired in patients with end stage renal disease with good results, despite the increased morbidity and mortality of this population.