Stent placement in hemodialysis fistulas helps treat lesions that cannot be adequately treated with percutaneous transluminal angioplasty (PTA) alone but has a follow-up patency rate similar to that of PTA. Standard central venous stents have a better patency rate than after PTA.

A flexible, self-expanding metallic endoprosthesis was employed for the treatment of venous outflow stenoses in four patients with a polytetrafluoroethylene shunt and two patients with a Brescia-Cimino shunt. The stenoses had led to shunt occlusion in five patients and to flow impairment in one. In the occluded shunts, thrombectomy and subsequent balloon angioplasty were performed in four patients, and percutaneous recanalization with angioplasty was performed in one. One shunt with decreasing flow was percutaneously dilated. Since the underlying stenoses recurred in four patients after 24 hours and did not respond sufficiently to angioplasty in two patients, up to four stents were placed in the venous segments. Thrombosis of the stents occurred in two patients after 24 hours and in one after 6 weeks and was successfully recanalized with thrombectomy in two. At 2-6 months follow-up, the stents and the shunts were patent in five patients. In three of these patients, intima hyperplasia, associated with narrowing of the stent lumen in two, was noted within 4 months after stent placement.

Microvascular transfer of the rib as an osteocutaneous or osseous free flap based on the thoracic branch of the thoracodorsal artery is described. A review of the literature revealed various patterns of rib vascularization in different areas of the body from the periosteum and the endosteal vessels. Reversing the blood flow in the transcortical vessels of the rib is reported to be possible. Injection studies showed a reliable connection between the thoracic branch of the thoracodorsal artery and the endosteal vessels of the sixth and seventh ribs at the origin of the anterior serratus muscle. This approach to free rib transfer has proved to be quick, easy, and reliable in various clinical applications.

Our experience with percutaneous transluminal angioplasty for treatment of stenoses and occlusions in surgically created arteriovenous fistulas (Brescia-Cimino) is reported. Methodological aspects are emphasized. Forty-nine PTAs were performed in 36 patients, in 3 combined with the use of a vascular metallic endoprosthesis (Wallstent). The initial success rates for stenoses and occlusions were 91% and 77%, respectively. Long stenoses and occlusions (greater than 4 cm) showed significantly worse initial results (55%) as compared to short ones (95%). Of the primarily successfully treated shunts, 90% are still functioning after a mean follow-up time of 8 months. The results indicate that PTA may replace surgical intervention as the primary method for treatment of insufficient flow for internal arteriovenous shunts, provided fresh thrombi are not the cause of the occlusion. Metallic endoprostheses and the use of atherectomy catheters were shown to be a valuable adjunct to classical PTA in selected cases.

In experiments on mice we were able to show that the negative effects attributed to burn toxins could almost completely be prevented by one single early treatment of the burned skin with a 0.04 M solution of cerium nitrate [Ce(NO₃)₃]. The survival rate was 10% for animals which were grafted with burned skin. Treatment with Ce(NO₃)₃ increased the survival rate to 74%. A reflection of this protective effect was the prevention of the burn-induced disturbance of the acceptor control ratio in isolated liver cell mitochondria. Repeated use of Ce(NO₃)₃ showed adverse effects due to an increased absorption. An effective treatment of burns with Ce(NO₃)₃ is without problems and can be done in any hospital.