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A 47-year-old patient developed severe digital arteritis after complementary bleomycin treatment following surgery for esophageal cancer. Arteriography images showed extrinsic stenosis of the digital arteries, results of other investigations suggesting development of a sclerodermic process due to bleomycin. Ischemic lesions regressed after thoracic sympathectomy. Similar cases have been well documented but cases of associated cancer and digital ischemia lacking iatrogenic features have also been reported. The pathogenic role of bleomycin appears to be established in the present case, but the possibility of the digital ischemia developing within the framework of a paraneoplasic syndrome is discussed.

Case reports of 176 patients from a total of 385 operated upon for arteritis, and in the over 70 age group, were analyzed; operations for sympathectomy and to treat ruptured aortic aneurysms were excluded from the study. Of particularly poor prognosis were cases of acute ischemia and very severe ischemia requiring immediate amputation. In a general manner, amputations were of poor prognostic significance: in comparison, reconstructive surgery resulted in a lower mortality rate. Figures for mortality as a function of age showed that recovery surgery is often possible in patients of 80 or over. Moderate-term results were good in from 55.5% to 80.9% of cases as a function of type of operation performed. Continued progress during the 5-year period covered by this study has led to diminished mortality and a reduction in the number of amputations necessary.

The present study involved 18 cases f axillo-femoro-distal bypass performed to revascularise either a popliteal artery (8 cases) or a leg artery (10 cases). The postoperative mortality (2 cases) was not directly related to the operative procedure. This type of operation was performed in particularly grave situations of severe ischaemia or sepsis. The results obtained were interesting in two-stage operations (7 good results in 11 operations) for ischaemia. In one-stage operations, corresponding to particularly grave situations, as well as in operations for sepsis (2 cases with 2 failures), the failure rate was by contrast very high. The results obtained were compared with those found in the literature. Such very long bypasses would finally appear to be justified in very grave situations in which there is no possibility of direct surgery with the aorta as the proximal source.