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A case of intrapericardial giant lymph node hyperplasia (localized hyaline-vascular variant of Castleman's disease) is reported. The large tumor was successfully removed, and at a twelve-year follow-up there are no signs of recurrence. This is the first case reported in the literature of an intrapericardial Castleman's disease localization. Embryologic, surgical, and prognostic implications of this finding are briefly discussed.

An axillodistal abdominal aorta bypass graft is proposed as an alterative procedure for revascularization of the lower limbs when intraabdominal and intrathoracic approaches are not feasible. This simple and safe procedure is proposed instead of the axillobifemoral bypass graft for the treatment of selected patients with abdominal aortic occlusive or aneurysmal disease and aortic graft infection. A case of a patient who underwent axilloabdominal aortic grafting because of a ruptured infrarenal abdominal aortic aneurysm, combined with severe chronic obstructive pulmonary disease, is reported.

A case of a popliteal aneurysm presenting as a deep vein thrombosis of the lower extremity is reported. Venous insufficiency symptoms, like presenting symptoms of a popliteal artery aneurysm, are an uncommon occurrence but often cause a wrong or delayed diagnosis with severe consequences for limb salvage. The importance of an accurate diagnostic study in any patient with a suspected deep vein thrombosis is emphasized in this report.

In order to determine factors influencing operative and long-term patency of bypass grafting for upper extremity ischemia, a fifteen-year experience with 39 bypass grafts was reviewed. Etiology of the lesions included atherosclerosis in 17 limbs, thoracic outlet syndrome in 7 cases, violent or iatrogenic trauma in 12 cases, and arteritis in 3. Primary lesions affected the innominate, subclavian, axillary, and brachial artery in 2, 19, 8, and 10 cases respectively. All patients had a complete follow up (mean seventy-one ± forty-four months). The thirty- day, one-year, and five-year patency rates were 92%, 81%, and 78%, respec tively. Indications for operation and type of onset of ischemic symptoms significantly influenced graft patency (p

From January, 1973, to December, 1987, 63 arterial revascularization procedures were performed in 50 pa tients suffering from brachial artery injuries following cardiac catheteriza tion. There were 15 occlusive compli cations (30%) after the primary attempt to revascularize the damaged brachial artery. Thrombectomy asso ciated with a simple repair of the arte rial cutdown (Type IA) led to 8 compli cations of 9 procedures performed. Technical details of repair of the dam aged artery—debridement, venous patch graft, resection, end-to-end anastomosis, and venous bypass inter position—were found to be important and led to long-term patency.

During the last fifteen years, we performed a total of 855 aortofemoral re constructions. Fifteen (1.75%) grafts were surgically removed (completely or partially) owing to a severe infection (Szilagyi: Grade 3) at a mean of 66.3 months (SD ± 37.9) after their implantation. Diagnosis was always clinically evident. In 10 patients, the graft was partially removed (one or two limbs). In 3 of the 10, graft infection progressed requiring complete graft removal after a mean of 18.6 days. In the other 5 patients, the graft was removed "in toto" at the time of the first operation. In 9 cases, revascularization was accomplished by means of a "remote" takeoff reconstruction (thoracic aorta or axillary ar tery), whereas in 8 cases (3 recurred) reconstruction was performed with a "local" takeoff reconstruction (stump or aortoiliofemoral arteries). One patient was not revascularized, because the limb was already amputated. Recurrence of infection was higher in the patients treated by partial removal of the graft (p < 0.05), even though the stump sterility was always evaluated by means of intraoperative culture. The mortality of patients with recurrence of infection was 66.6%. Multiple operations of the femoral site were considered a factor in causing aortofemoral graft infection (p < 0.01). Diabetes was not considered a factor in causing infection (p n.s.). Grafts with remote takeoff reconstruction have better long-term results in terms of limb salvage and survival when compared with local takeoff recon struction (p < 0.05).