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A 47-year-old woman presented with a 2-year history of severe proximal claudication symptoms in both legs. Digital subtraction aortography (DSA) showed a localized occlusion of the infrarenal abdominal aorta. A longitudinal arteriotomy and an endarterectomy of the aorta were performed. The arteriotomy was closed with a polytetrafluoroethylene (PTFE) patch. Postoperatively, the follow-up demonstrated a normal aorta with all pedal pulses palpable. In patients with the above symptoms, middle aortic syndrome should be included in the differential diagnosis.

Malignant tumors of the vascular endothelium complicating lymphedema (Stewart- Treves syndrome) are very rare events. A 72-year-old woman and a 52-year-old man developed angiosarcoma of the right and left lower extremity, respectively, after long standing lymphedema. The first patient had pulmonary metastases and was initially treated with chemotherapy with no response. She died of her disease 5 weeks after the biopsy. The second patient underwent disarticulation of the left leg. Four months later he developed pulmonary metastases and died.

The aim of this open, perspective study was to determine the impact of risk factors, excluding the type of closure of the arteriotomy, in the development of recurrent carotid stenosis following carotid endarterectomy. One hundred and ninety-eight patients, who underwent a total of 221 carotid endarterectomies, were evaluated postoperatively with duplex scanning 1 month after the operation and every 6 months thereafter for a period of 6-120 months (mean duration of follow-up: 44 months). There were 149 (75.3%) men and 49 (24.7%) women with a mean age of 66.8 years (age range 38-92 years). Diabetes mellitus was present in 62 patients (31.3%), hypertension in 134 (67.7%), coronary artery disease in 130 (65.7%), hypercholesterolemia in 70 (35.4%), and smoking habit in 166 (83.8%). Indications for carotid endarterectomy were asymptomatic carotid stenosis > 70% in 20 (10.1%) patients and symptomatic stenosis > 50% in 178 (89.9%), 129 (65.2%) of whom had a history of transient ischemic attacks and 49 (24.7%) of previous stroke. General anesthesia was used in 197 (89.1%) operations and local anesthesia in 24 (10.9%). Deep endarterectomy with primary closure of the arteriotomy using 5/0 running suture was performed in this group of patients.One patient (0.5%) died during the perioperative period. Five (2.5%) patients had a transient ischemic attack and three (1.5%) a nonfatal stroke in the immediate postoperative period, six (3.0%) a persistent cranial nerve injury, and two a hematoma, and three patients had delayed postoperative recovery. Twenty-six (13.1%) patients were transferred to the Intensive Care Unit postoperatively. Recurrent carotid stenosis > 50% was identified in eight patients (4.0%) and it was asymptomatic in all cases. Mean interval between endarterectomy and development of restenosis was 47.4 months (range 6-118 months). Factors such as clinical presentation, age, sex, diabetes mellitus, hypertension, coronary artery disease, hypercholesterolemia, and smoking habit were not found to be significantly associated with the development of restenosis (Chi-square). Smoking, coronary artery disease, and normal cholesterol levels were connected with a statistically nonsignificant tendency toward higher rates of restenosis. Recurrent carotid stenosis following carotid endarterectomy was not significantly associated with any of the risk factors studied in this series.