Vascular surgeons are often asked to evaluate patients with recurrent thromboses or thromboses in unusual locations either arterial or venous. There may be obvious inciting factors, but in many of these patients the possibility of a previously undiagnosed hypercoagulable state must be considered. Hypercoagulable states can be acquired (smoking, medication, change in physiologic status as occurs with pregnancy) or congenital. Congenital hypercoagulable disorders are more prevalent in families or patients with a history of thromboembolic events early in life or multiple miscarriages and include conditions such as protein C or S deficiencies, factor V Leiden mutation, and prothrombin gene variant. This article reviews the hypercoagulable states that are encountered in clinical practice as well as guidelines for testing and goals of therapy.

Superficial temporal artery (STA) aneurysms as a result of trauma represent less than 1% of reported aneurysms. During the past 200 years only the type of trauma and the preferred treatment have significantly changed. Patients are generally young men with a recent history of blunt head trauma. They may complain of a mass, headache, or other vague symptoms. Neurologic defects are rare; however, if a neurologic deficit exists, the physician should consider either arteriography or a head CT scan to search for intracranial pathologic conditions. In most cases the diagnosis may be made by obtaining a complete history and physical examination. The treatment of choice is ligation and resection, which may be accomplished with the patient under local or general anesthesia. In rare instances, arteriography with selective embolization may be useful when the traumatic aneurysm is complicated by severe facial trauma. Three cases of STA aneurysms are presented. The history, pathophysiology, origin, presentation, diagnosis, differential diagnosis, and treatment of STA aneurysms are reviewed.

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The Ehlers-Danlos syndrome (EDs) is one of the most frequently inherited disorders of connective tissue. Type IV EDs, the arterial-ecchymotic type, is of concern to vascular surgeons because it is frequently associated with spontaneous catastrophic bleeding. This article summarizes our experience with five members of a family and reviews the 31 patients with type IV EDs described in the literature. The 22 male and 14 female patients had a mean age of 26 years. The 36 patients included 23 with easy "bruisability," 22 with hypermobility of their joints (especially the fingers), 13 with transparent skin, and 11 with excessive elasticity of the skin. The patients had 41 episodes of hemorrhage and 29 vascular surgical procedures. Twenty-nine of the patients had an aneurysm or a dissection, whereas eight patients had arteriovenous fistulas. Arteriography was associated with a complication rate of 67%. The prognosis for a patient with type IV EDs is poor; 44% die before surgery and 19% die during the operative period. Bleeding should be managed nonoperatively when possible. Fifty-one percent die before reaching 40 years of age. Arteriography should be avoided. The standard repair of aneurysms and perforations is unlikely to be successful because of marked vessel friability. Bleeding vessels should be repaired with buttressed sutures and no tension or should be ligated. Genetic counseling with assay of collagen production is recommended for family members.