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Interventional procedures on peripheral vessels are the field of a novel specialty dedicated to the diagnosis and minimally invasive endovascular treatment of diseases involving the cerebral, thoracic and abdominal arteries (including renal and visceral arteries), as well as the peripheral arteries (femoro-popliteal arteries and the arteries below the knee). At present, physicians with three different types of medical training, each involving particular strengths and characteristics, specialize in endovascular treatment of patients with peripheral arterial disease: vascular surgeons, interventional radiologists and interventional cardiologists. Treatment of high-risk patients in terms of anatomical and clinical (serious comorbidities) complexity raised the need for the interventional cardiologist to face issues related to technical aspects of the procedure, multilevel pathology management and adequate indication. To achieve this goal, interventional cardiologists require particular facilities and clinical skills. The objectives of this position paper from the Italian Society of Interventional Cardiology (SICI-GISE) are (i) to define the theoretical background and practical training required to ensure that interventional cardiologists maintain high-quality standards also in the field of treatment of peripheral arterial disease, by establishing shared rules and drafting papers; (ii) to standardize the procedures of interventional cardiology operational units that treat patients with peripheral arterial disease in Italy on the basis of scientific evidence, and (iii) to establish common requirements in terms of facilities and regulations.

Repair of descending thoracic aneurysm or thoracoabdominal involves transient ischaemia of many organs with high risk of complications. The elderly patient may be more at risk depending on the presence or absence of significant comorbidity factors. Careful preoperative evaluation and patient selection considerably reduce the risk of operative mortality and morbidity. We review the management of thoracic and thoracoabdominal aneurysms in the elderly and briefly describe our surgical approach in order to minimize operative risk and improve surgical results.

Clinical evaluation of patients with peripheral arterial disease (PAD) is mainly based on Fontaine's classification, in which pain is the most important element. The use of objective techniques can allow a more precise evaluation, since pain is always subjective. In PAD patients, pain is frequently associated with early fatigue. Peripheral muscle fatigue can be easily assessed by a particular electromyographical method, based on the frequency analysis of the signal. In PAD patients, this method can provide objective information on muscular performance, with possible uses in medicine, surgery, rehabilitation and occupational medicine.

10 esophagojejunostomies by EEA Stapler were performed on adult patients (8 males and 2 females, mean age 54 years), after total gastrectomy for gastric cancer. No postoperative bleeding or stricture were observed. 2 anastomotic leaks occurred (20%). The major cause of anastomotic failure is probably technical (incorrect assembly or lubrication of the instrument). According to the our experience and to literary data, the use of stapling devices for performance of esophagojejunostomies is recommended.

In 16 patients affected by cancer of the mild or lower 3 of the rectum, has been performed a colorectal anastomosis by EEA Stapler, with abdomino-transanal approach. In the postoperative period no case of anastomotic bleeding or stenosis has been observed. 3 patients (18%) presented minor anastomotic dehiscence detected by radiologic examination, without clinical symptomatology. The EEA Stapler anastomosis seem sure almost as the traditional hand sutures, and allow the execution of anterior resection instead of abdominal perineal amputation of rectum.

In 4 patients who under went low anterior resection for cancer of mid and lower 1/3 of the rectum, with colo-rectal anastomosis by posterior transphinteric approach, anorectal pressure profiles have been studied by open tip technique 30 d. 6 months following operation. Bowel movements, gas and feces discrimination and anal continence were also controlled. Resting pressure, delta % pressure changes during recto-anal reflex, pressure in voluntary contraction, altered in the first post-operative period, become normal in 6 months. Although volume and pressure at urgent rectal sensation, volume and rectal sensation and compliance altered after surgery did not change after 6 months, suggesting that the reservoir function of the rectum is lost, patients achieved a good control of bowel movements, and a good gas and feces discrimination and anal continence within the first 6 months of operation.

The use of inert plastic (Prolene mesh, 0,027 inches in thickness fournited by Ethicon) as preperitoneal prosthesis in repair of incisional hernias and inguinal hernia recurrencies has been investigated in 28 patients operated upon then 1977 to 1984. In 9 patients the inguinal approach was used with one recurrence (11%). In 9 patients the posterior approach through a midline incision has been used with two recurrences (22%). In 10 patients with incisional hernias there was only one recurrence (10%). Total recurrences rate was 14%. Most recurrences occur in patients operated from 1977 to 1980 (40%). Patients operated in the last period from 1980 to 1984 had no recurrences.

Previous research has shown that MVO (Maximum Venous Outflow), VR (Venous Reflux), VE (Venous Emptying) and the respiratory waves recording are useful in differentiating occlusion and recanalization in postphlebitic syndrome. In the present work strain-gauge plethysmography was employed to quantitate the venous function after deep venous thrombosis of the legs. The studies were performed in a vascular laboratory with controlled temperature (23 to 25 C); records were obtained by a plethysmograph Parks mod. 270 connected to a Hewlett-Packard multi-channel mod. 7700. 17 patients (12 males, 5 females), mean age 55 years (range 24-75) that presented femoropopliteal thrombophlebitis documented by phlebography at the admission to the hospital were examined. MVO with and without superficial veins occlusion was measured by a mercury in silastic strain-gauge placed circumferentially about the calf. A pneumatic cuff thigh was inflated to 60 mm Hg. VE was measured in patients lying in inclined bed with the lower extremities 100 cm below the heart level compressing the calf with a pneumatic cuff 10 times for 5 seconds; the strain-gauge was placed on the foot level. VR after Valsalva's maneuver and the respiratory waves were recorded by a strain-gauge positioned at the maximum girth about the calf in patients lying on inclinated bed with the lower extremities 50 cm below the heart level. The result are here indicated: (Table: see text) There was differences in the evolution of venous function after deep venous thrombosis of the legs for each patient. Strain-gauge plethysmography may become evaluable non invasive technique in the evaluation of deep venous thrombosis evolution in the legs. The therapeutic assessment of postphlebitic syndrome.

In order to demonstrate the relationship between sexual impotence and penile-brachial index 142 patients with arteriosclerotic disease of the legs and 15 control patients have been studied. Penile-brachial index has been evaluated by Doppler ultrasound, while sexual impotence has been graded on the basis of clinical history. Patients with arteriosclerotic disease have been further divided into 2 groups: patients with normal sexual potence and patients with sexual impotence. Penile-brachial index resulted 0,87 +/- S.D. 0,16 in the former group, while it resulted 0,59 +/- S.D. 0,22 in the latter. The present data seem to suggest that in patients with arteriosclerotic disease of the legs a positive relationship exists between penile-brachial index greater than 0,80 and a normal sexual potence, while a penile-brachial index less than 0,60 strongly indicates the possibility that the main factor responsible for sexual impotence is vascular insufficiency.