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Patients with congenital vascular malformations often suffer from arthralgia, especially of the lower limbs. This orthopaedic disease pattern is defined as destructive, angiodysplatic arthritis or Hauert disease and leads to very early destruction of the joints. By presenting diagnostic and therapeutic algorithms, Hauert disease is emphasized as a possible differential diagnosis in order to minimize the risk of an incorrect diagnosis which might lead to under-, over-, or even incorrect treatment. A minimally invasive transathroscopic therapy in the early stages can lead to significant improvement of symptoms and prevention of progressive joint destruction.

On the basis of the Hamburg Classification from 1988 six different therapeutic tactics and surgical techniques have been proved in the treatment of vascular malformations. These are: 1) reconstructive surgery, 2) surgery to reduce the hemodynamic activity of the vascular defect, 3) surgery to extirpate the malformed vessels, 4) combined therapy, 5) unconventional therapy, 6) multidisciplinary treatment. More than 2500 cases had been worked out. In this survey the marginal vein and the embryonal vein respectively are of special interest. These veins are classified by morphologic radiologic criteria. The following types could be worked out: peripheral type, thigh type and pelvic type. Referring to these experiences the indications for vascular surgical treatment have to be distinguished precisely. In a retrospective European study the long follow-up results of all six therapeutic tactics had been registered and proved. 1378 cases were included. In 15% of the patients the results were excellent in 42% good, and in 34% an improvement could be observed. In 5% a relapse was stated and in 1.5% no change was registered.

Incidence, etiology, diagnostic procedures and therapy of venous aneurysms, basing on 152 own cases, are discussed. The main procedure for diagnosis is phlebography. It must be distinguished between aneurysms of epi- and subfascial veins. The localization determines the surgical procedure which represents the only successful therapy. Without proper treatment, venous aneurysms may be responsible for complications such as thrombophlebitis, thrombosis with pulmonary embolism, aneurysm rupture and compression of adjacent structures. The results of surgical treatment are excellent.

In 16 consecutive patients with diffuse peritonitis 93 staged lavages were undertaken. In a retrospective study the changes of some vital functions due to transport in the operating room and staged lavage were evaluated. 9 patients (56%) survived the diffuse peritonitis. The vital parameters showed no significant changes following staged lavages. Intraabdominal specimen cultures were positive in 62% of cases, showing no correlation of the underlying disease and mortality. Only an elevation of C-reactive protein and rise of thrombocyte count correlated significantly with the outcome of diffuse peritonitis.

Auto-alloplastic arterial prostheses with a dacron mesh of 1 or 2 layers according to Sparks were investigated by light and electron microscopy after variable times of incorporation and perfusion. At the end of the organization-period the characteristic structure of the wall is composed of three layers. The interior layer is adapted to the form of the mandril, which holds the place of the lumen, the medial layer is formed according to the inforcing dacron-mesh. With increasing duration of incorporation the granulation tissue shows somewhat less inflammatory cells and capillaries and more collagen fibres. There were some characteristic disturbances of healing only partly due to infection, which resulted in focal or total necrosis of the granulation tissue: Not all of these findings were of clinical importance. Already after a perfusion time of 10 months an atherosclerosis of variable degree was found. This atherosclerosis started from mural thrombi and showed in the electron microscope proliferations of modified smooth muscle cells. Advantages and disadvantages of the autoalloplastic arterial prostheses are discussed.

Case report about a 45 year old man with hyperkeratotic papules and plaques on both lower legs now persisting for more than 20 years. After detection of arterio-venous shunts the initial clinical and histological diagnosis of Kaposi-sarcoma had to be replaced by the diagnosis of pseudo-Kaposi's sarcoma, a benign reactive process. In the pathogenesis of this disease arteriovenous shunts are of great importance.

A method is described which allows one to correlate pulsephase dependant streaming and movement of the vessel wall by means of synchronous registration of pulse volume curves and the appearance of streaming as shown by serial angiograms. The results of this investigation in the femoral artery confirm the accepted view that the appearance of streaming depends on the movements of the vessel wall. The prognostic value for vessel reconstruction is discussed.

Increased blood and plasma viscosity was found in patients with chronic arterial occlusion in comparison with healthy probands. The measurements were done at high and low shear rates. Parenteral pentoxifylline (Trental) lowered blood and plasma viscosity of patients significantly, especially when measured at low shear rates. Application of bencyclane (Fludilat) produced variable results. A definite connection between rheological changes and alterations of the protein fractions in plasma could not be established.

Acquired arteriovenous fistulas should be surgically cured as soon as possible after the diagnosis. In all the patients we treated, the arteriovenous fistula had existed for quite a long time, i.e. up to 26 years. These arteriovenous fistulas were surgically closed by the separation-method, the resection of the vessels and vascular reconstruction, or by the transvenous technique. - Arteriovenous fistulas, which have been in existence for quite a long time, result in cardiac dilatation, which can be cured after closure of the arteriovenous fistula. Furthermore, there can be pathologic changes of the vein and artery wall: chronic venous insufficiency and arterial ectasia can result. - After closure of the arteriovenous fistula our patients no longer complained of venous reflux disturbances. Even after closure of the arteriovenous fistula, an arterial ectasia is not reversible. The reasons for this are discussed. Symptoms, which occur after the closure of an arteriovenous fistula, which had existed for a long period and had produced a severe arterial ectasia, are looked upon as an autonomous disease. During the progress of this disease many complications can occur, even the rupture of the ectatic artery. The question is therefore discussed, whether it is justified to resect the ectatic arterial segment together with the arteriovenous fistula and to implant an alloplastic vascular graft in its place during the initial operation.