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The femoral region is the most common site of development of anastomotic pseudoaneurysms that represent a relatively frequent complication of reconstructive vascular surgery. Clinical examination alone generally is sufficient to diagnose these lesions because they usually appear as a pulsatile inguinal mass not accompanied by pain. Echography and angiodynography permit a better evaluation of size and blood flow. CT is useful to evaluate proximal aortic anastomosis specially in pseudoaneurysms with septic pathogenesis. Rupture or thrombosis are rare clinical presentations. Vascular reconstructive surgery is always suggested in this sort of pathology. In this paper the Authors report the clinical experience acquired from 1980 to 1990 in the General and Cardiovascular Surgery Department of the University of Milan (Head: Prof. Ugo Ruberti) is 34 cases of femoral anastomotic aseptic pseudoaneurysms, analyzing the pathogenesis of this sort of lesion, describing the surgical solutions adopted and reporting the immediate and late results.

On the basis of 4 patients affected by a multiple pheochromocytoma personally observed, this very uncommon pathology, which can be the cause of secondary hypertension, is discussed.

Clinical employment of selective hypogastric arteriography has been instrumental in the detection of stenosing and obliterating lesions of the pudenal arteries and their penile branches capable of giving rise to impotentia erigendi as the sole symptom. Differentiation of psychogenic and vascular impotence is now possible through non-invasive instrumental examinations such as the nocturnal penile tumescence test, and Doppler ultrasonography of the penile arteries. Arteriography to confirm the diagnosis was only employed when a suspicion was aroused by these two examinations. An account is given of the technique employed for selective hypogastric arteriography and the angiogaphic results obtained.

An attempt is made to identify the factors responsible for pelvic haemodynamic modification following aorto-iliac reconstructive surgery. 24 patients submitted to operation for aorto-iliac arterial lesions have been assessed pre- and post-operatively as regards capacity of erection. The penile-brachial index obtained by way of a Doppler sound technique is used as a parameter. The type of reconstruction, extent and bilaterality of the lesions are the factors influencing a change in the index after. intervention. Although there are many causes underlying erection, a reduction of this index should not be provoked below given values that are in themselves capable of conditioning vascular-based impotence.

Penile systolic pressure has been evaluated by the Doppler-sonographic method in 15 diabetic patients suffering from erectile impotence. Urodynamic tests have also been carried out in some patients for a diagnosis of neurological impotence. The results obtained show the possibility of a double or sole origin (neurogenic or vascular, or both) in the pathogenesis of this symptom in diabetic subjects

The aneurysms of the internal iliac artery are rare and very often asymptomatic. Because of the anatomic location of this artery, it can be difficult to diagnose this kind of aneurysm, when isolated. Frequently it is diagnosed in consequence of aneurysmatic complication, such as rupture and/or impending rupture. In this work we report our experience concerning 6 cases of ruptured aneurysm of the internal iliac artery, observed in 5 patients. In three of these cases the lesion was isolated. In two cases the patients had already been operated on for abdominal aortic aneurysm, 4 and 6 years before. All the five patients were operated on. In 5 cases we ligated the aneurysm, without using any vascular graft. In one case where the external iliac artery was involved, we used a vascular graft between the common iliac and common femoral artery, in order to repair the vascular axis. One case of mortality was observed and a rare complication occurred in one case. An 83-year-old man treated in emergency for ruptured aneurysm of the left internal iliac artery, with regular post-operative course, was hospitalized again 24 days later with sepsis and pain in the left lower abdomen. A CT scan and a following urography showed a urinary fistula probably due to an ischemic necrosis of a segment of the ureter. A percutaneous nephrostomy has been performed and the patient successfully discharged.

An unsuspected left-sided inferior vena cava (IVC) can present a formidable challenge for the surgeon attempting abdominal aortic surgery. The incidence of congenital anomalies of the post-renal (infrarenal) vena cava is approximately 3%, with double inferior vena cava most frequently occurring. The authors refer to a case of isolated left-sided vena cava in a 53 year old man who underwent an aorto-femoral bypass graft for aorto-iliac occlusive disease. On the basis of a literature review the authors recall the incidence and the embryology of this anomaly, and analyze its surgical implications, with particular reference to abdominal aortic surgery.

Inflammatory abdominal aneurysms (AIAA) represent a clearly defined clinical entity with an incidence ranging between 1.2% and 15%. In spite of the increasing number of observations reported in recent years, the etiopatholgenesis and natural history have not been defined. The lesion can present in an acute, subacute or chronic manner and the histopathological studies reveal prevalently two components: an inflammatory infiltrate and a diffuse fibrosis, in varying degree. This study aimed to analyze the more recent imaging procedures in order to correctly diagnose this lesion. In our experience the incidence of AIAA is about 2.5%. On the basis of macro microscopic pictures the authors divided patients into two groups: one constituted by the acute or subacute inflammatory forms, the other by chronic clear inflammatory aneurysms. All patients underwent on operative treatment. The surgical adopted techniques and the obtained results are reported.