In this retrospective study we have used life table analysis to compare the results of 37 transluminal angioplasties with those of 37 conventional operations (thrombectomy, thrombendarterectomy with/without grafting, bypass) in the treatment of stenoses and occlusions of haemodialysis fistulae. There was no difference between the groups in terms of lesion morphology or the patients' age and sex. Cumulative patency rates for angioplasty and surgery, respectively, were 94.5 and 78.1 per cent after 1 week, 72.3 and 64.1 per cent after 1 month, 41.2 and 28.9 per cent after 5 months and 31.3 and 19.3 per cent after 1 year (X2 test, P less than 0.001). The difference is due mainly to a high percentage of early occlusions in the haemodialysis fistula stenoses is possible it achieves results which are at least as good as those of operation.

64 ischemic stroke patients with angiographically verified occlusion of the internal carotid artery were studied. 32 patients underwent surgical revascularization in the acute stage within a few hours of acute onset of stroke. 32 patients had conservative management of treatment. Both groups were compared in regard to mortality rate, functional recovery and clinical findings or neurological deficits and psychiatric disturbances on admission and 4 weeks later. Correlations of functional recovery between the two groups showed no significant differences. Mortality rate in the conservatively managed group however was significantly lower than in the operative group.

No abstract

The autologous femoro-popliteal vein bypass is a proven treatment concept for the correction of the chronical, and more seldom, of the acute arterial occlusion with good long-term results. 1,2 Recurrent operations show a clearly worse prognosis than the first opera tion. The reasons are the technical difficulties of the revision, the absence of an autologous vessel graft and the less favourable prognosis of the lengthy desob literation, which is recommanded by certain authors as second operation.3,4 The pseudo-recurrent occlusion represents a rather rare indication for a new opertion. Because of an obliteration of the outflow artery, it is considered clinically and oscillographically as a recurrent occlusion. Only the direct Doppler-ultrasound-sonography or the angiography show the patency of the primary bypass, which can flow through small collateral vessels or backward over the distal anastomosis. This paper is meant to be a contribution to the operative treatment of this occlusion kind in case of missing autologous graft after a short femoro-popliteal vein bypass.

From 1980-1982 45 transluminal angioplasties were carried out intraoperatively (ITA) in 42 patients with a mean age of 59 years for the improvement of the inflow or outflow in connection with conventional reconstructive techniques (n = 26), as angioplasty alone with surgical exposure of the arteries for introduction of the catheter material (n = 10) and after thrombectomy for elimination of the cause of occlusion (n = 9). The pelvic vascular bed was dilated eight times, the femoropopliteal vessels 30 times and a stenosed hemodialysis shunt was dilated five times. Intraoperatively, perforation occurred once in the pelvic region. Four occlusions (1 X pelvis, 3 X femoropopliteal) could not be passed with instruments. In 8.8% immediate occlusions always occurred femoropopliteally. The causes were vessel wall dissection and calcification. One patient died for cardic reasons 14 days postoperatively. We saw one recurrent occlusion in the postoperative observation period of 9.7 months (0.5-28 months), also in this case in the femoral region. Since all recurrent occlusions occurred femoropopliteally in this region the indication for ITA must be made strictly. The dilatation of the pelvic arteries displays good long term results with a slight risk and should even be used intraoperatively as the treatment of first choice in the presence of appropriate morphology.