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To regain blood shed intraoperatively, two different systems are clinically established: washing and centrifuging red blood cells to produce autologous erythrocyte concentrates and devices for immediate reinfusion of whole blood after mere filtration. In a prospective-randomised study to compare both methods regarding their efficiency, adverse effects, and economy, 20 patients of our department undergoing elective aortoiliac surgery received intraoperative autotransfusion by means of either cell-washing (CS) or salvage of whole blood (WB). Patients were preoperatively randomized into one of the two groups and were evaluated with respect to standard metabolic and haematological laboratory parameters preoperatively, during surgery, after transfer into the recovery room, 24 h after surgery, after transfer into the recovery room, 24 h after surgery, and at discharge. Both patient groups were well comparable in demographics, preoperative laboratory data, and indication for operation. Handling was easier, the set-up time was shorter with the whole blood filtration device (10.2 +/- 2.3 versus 21 +/- 1.9 min, p = 0.0023), and no additional personnel was needed to run the system. The whole blood device also allowed a greater percentage of aspirated blood to be returned intraoperatively compared to cell washing (73.5% +/- 7.2 versus 51.1% +/- 6.5, p = 0.03). Thrombocytopenia occurred in 7 (CS) and 3 (WB) patients intraoperatively with a significant difference in platelet count between the two groups (118 +/- 17 [CS] versus 170 +/- 12 [WB]*10(9)/L, p = 0.025). Expected changes in the perioperative course of the clotting parameters such as highly increased PTT levels and moderately prolonged prothrombin times occurred in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoperative angioscopic control was performed in an early series of 27 patients undergoing peripheral vascular surgery. The majority were complex or re-do operations; reversed saphenous vein and PTFE-grafts were used as bypass material exclusively. Angioscopic findings were compared to conventional angiography with respect to the detection of technical problems leading to further surgical procedures. Angioscopy was feasable in 92.5%, it failed twice due to irrigation problems, which was before we used a dedicated angioscopy roller-pump. In 6 patients relevant findings requiring further surgical manipulations were only detected angioscopically, in 2 patients such findings were detected by angioscopy as well as by angiography. Such findings included technical problems (graft rotation [n = 1], anastomotic narrowing [n = 2]), balloon catheter injuries after thromboembolectomy (n = 2) and residual thrombi after local thrombectomy (n = 3); 5 of these patients had undergone previous vascular procedures in the same operation field. After local correction (n = 5) or placement of a new bypass (n = 3) there was no early graft failure. This early angioscopic experience confirmed previous reports that satisfactory visualization and specific recognition of angiographically unsuspected problems after peripheral reconstructions can be obtained by intraoperative angioscopic control. This was seen very distinctively in more complex and re-do operations, which we see as the cases most needing routine angioscopic control.

In a high risk patient an extended extraanatomic PTFE (ring armored) bypass was performed for limb salvage. The right subclavian artery served as donor vessel to the left tibial anterior artery in a crossover suprapubic fashion. A total of 7 anastomoses in this subclavian bifemoro-crossover popliteo-crural reconstruction yielded a high flow situation as well as good function with a palpable dorsalis pedis artery pulse and a postoperatively increased ankle-brachial pressure index of 0.9, 8 months postoperatively. During the 9th postoperative month the distal part of the reconstruction occluded and the left leg was amputated below the knee. However, limb salvage was achieved for 9 months. Several points are discussed in connection with long-term functioning.