We found no significant decrease in CV events or CV-associated deaths with intensive therapy, possibly because our between-group difference of LDL-C was lower than expected (27.7 mg/dL at 36 months of treatment). The potential benefit of achieving LDL-C <70 mg/dL in a treat-to-target strategy in high-risk patients deserves further investigation.

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Aneurysmal rupture into the intestinal tract is a rare but disastrous complication of an internal iliac artery aneurysm. We report herein the successful surgical repair of a fistula between a huge aneurysm of the right internal iliac artery and the rectum in an 81-year-old man. After a femoro-femoral cross-over bypass had been performed, the aneurysm was opened and its patent arterial branches were ligated with sutures. The fistula was then intra-aneurysmally sutured and covered with an omental flap. The diagnostic and therapeutic approaches to this severe complication are discussed with a review of the literature following the presentation of this case.

From 1959 to 1991, 93 patients underwent vascular reconstruction for Takayasu arteritis at our institution. The details of the cases were as follows: 16 were of type I (brachiocephalic ischemia), 48 type II (hypertension), 13 type III (extensive lesions with cerebral ischemia and hypertension), and 16 type IV (aneurysms). Carotid reconstruction, repair of atypical aortic coarctation, renovascular reconstruction, and aneurysm repair were performed independently or in combination. Nine operative deaths occurred, 8 cases of which were operated before 1970. The most serious of the delayed complications was suture line aneurysm formation, which was encountered in ten cases. The aneurysms were often found long after the operation, some of them developing even after more than 20 years. Takayasu arteritis is characterized by extensive inflammation and destruction of the medial elastic fibers and long term postoperative observation is mandatory to improve the late survival rate.