A young woman with acute upper extremity edema and ischemia after intraarterial drug injection is presented. Unsatisfactory results from standard treatment were the reason for changing the therapy to temporary thrombolysis, which led to significant improvement. Some days later severe impairment forced another attempt at applying standard therapy, again unsuccessful. Only after continuous intraarterial infusion of Iloprost, a new improvement occurred and saving of the hand was possible. It became obvious that more effective therapeutic measures ought to be applied when severe hand ischemia following intraarterial drug injection is present.

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Buerger's disease is an inflammatory disorder that involves the vessels of the extremities, affects young smokers and frequently leads to critical limb ischemia. The operative procedures are an important share of the complex treatment but the results from surgical revascularizations are still debatable. The analysis presented covers a 12 year experience with the surgical revascularizations on 81 thromboangiitis obliterans (TAO) patients, out of a group of 165. A total of 47 sympathectomies and 42 arterial reconstructions, including arterial resections with autovenous interpositions, were performed. The follow up showed various cumulative patencies of the reconstructions, up to 59% for the first two years. In all but 2 cases with reconstructions major amputations were avoided. The sympathectomy alone could not save the legs in 5 cases. The operative revascularizations exhibited satisfactory results in 74 (91%) patients and were crucial for saving their legs, eliminating the pain and transferring them to ambulatory treatment. The clinical results of the operative revascularizations are quite satisfactory in spite of their relatively short-term effect. It could be explained with the benign course of the disease where after temporary worsening a reliable collateral network frequently restore the circulation to the extent of tolerable arterial insufficiency.

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