Aneurysms of the infrapopliteal arteries are rare and commonly associated with trauma. Most appear as false aneurysms. Because they are quite rare events, we describe for the first time in the English-language literature two cases of a combination of true aneurysms of the popliteal and tibial arteries. Symptoms at initial examination are calf mass and distal ischemia. Clinical features, radiographic findings, surgical management, and a review of the literature on true infrapopliteal aneurysms are discussed.

Three different methods of preoperative bowel preparation were tested in a prospective randomized trial examining efficacy and morbidity. In all, 163 patients were treated by gut irrigation with Ringer's lactate, Prepacol or polyethylene glycol (PEG). Fluid retention, cleansing effect, postoperative complications and subjective acceptance were documented. Relevant weight gain and decrease in haematocrit indicating fluid retention were seen only after the use of Ringer's lactate. There were no significant differences in bowel cleansing. In the Prepacol group the postoperative complication rate was significantly increased. Prepacol was tolerated best, with few side-effects. PEG was better tolerated than Ringer's lactate, but vomiting occurred in 2 and 21 per cent of patients respectively. PEG is most suitable for bowel preparation in patients undergoing colorectal surgery.

Aneurysms of the popliteal artery are rare. Their rate of incidence is reported from 0.1% up to 2.8%. Whereas surgical treatment in an asymptomatic stage bears no problems, the symptomatic stage in a high percentage of patients leads to extremity loss due to thrombosis or embolism. In these cases, amputation rates are reported from 16 to 69%. In the period 1981 - 1994 we saw 39 patients suffering from 58 popliteal aneurysms: 53.4% of these aneurysms were symptomatic. 24.1% of the popliteal aneurysms angiographically showed an occlusion of the popliteal and peripheral outflow tract with concomitant critical limb ischemia. By applying a preoperative local catheter fibrinolysis the outflow tract could be reopened in 13 ischemic extremities and a receiving segment could be recanalized for reconstruction. Following this procedure, in spite of the high number symptomatic cases we gained very good postoperative results in 70.7% of the treated extremities after a maximum follow-up time of 62 months. An aneurysm is commonly seen as a contraindication for the application of lytic therapy. But in the presence of critical extremity ischemia due to a thrombosed or embolizing popliteal aneurysm, preoperative catheter fibrinolysis can often help to save the extremity.

Despite the advances in reconstructive vascular surgery, anastomotic aneurysms,--particularly in inguinal position--have remained an unsolved problem. Between 1985 and 1992 in 46 patients who underwent aortoiliac or aortofemoral bypass grafting 58 anastomotic aneurysms were operated in our institution. The mean interval between primary reconstruction and onset was 65.0 months. In 54% we observed real suture aneurysms. Technical faults are supposed to be the most causative factor in development of anastomotic aneurysm. The rate of recurrence after repair was 10%. There was no postoperative mortality. It is concluded that comprehensive follow-up is required after aortofemoral grafting. Because of the risk of peripheral embolization and local disruption surgical repair has to be done soon after the diagnosis of anastomotic aneurysm.