During the past thirteen years, 75 patients (97 limbs) with femoropopliteal occulusive disease due to arteriosclerosis were treated by surgical reconstructions. The 75 patients consisted of 70 men and 5 women with an age range of 32-83 years (mean±SD: 65.9±9.6 years). Regarding the indications for operation, intermittent claudication was found in 46 patients (61%), rest pain in 24 patients (32%) and gangrene in 5 patients (7%). As the atherosclerotic risk factors, cigarette smoking and hypertension were present in high rates, and ischemic heart disease was complicated in 31.4%. Endarterectomy with vein angioplasty was performed for 31 limbs and bypass operation usually using EPTFE grafts was for 66 limbs. Cumulative patency rate at five years was 72.6% in endarterectomy group, and 48.1% in bypass group. At ten years, 72.6% and 36.1%. Comparisons of the patency rate between two technics, endarterectomy was significantly better than bypass oparation in late postoperative period. Endarterectomy is recommended as the treatment of choice for femoropopliteal occulusive disease, because of the long-term patency.

From 1976 to 1993, 13 patients with high aortic occlusion were treated surgically. Bypass grafting from infrarenal abdominal aorta to the iliac or femoral arteries was performed in 9 patients, endarterectomy with patch angioplasty in 2, thrombectomy followed by straight graft replacement in 1 and bilateral axillo-femoral artery bypass grafting in 1. In 9 patients, femoro-popliteal run-off was determined by arteriography before or during operation. Occlusion of the femoral artery was detected in two patients, and femoro-popliteal bypass grafting was simultaneously performed with aortic revascularization. Two patients died in the early postoperative period (1: fulminant hepatitis, 1: cerebral infarction), and 4 patients died in the late postoperative period (2: ischemic heart disease, 1: cerebral bleeding, 1: malignant tumor). In one patient the iliac artery occluded 13 years after endarterectomy. All other patients showed patent grafts and satisfactory conditions. In cases of high aortic occlusion, late postoperative results were satisfactory after anatomical revascularization. Ischemic heart disease and cerebral vascular accident were important concerning late complications. Postoperative careful follow-up is necessary.

A 71-year-old man who had been on peritoneal dialysis for 6 years was referred to our hospital for renal transplantation from a living donor. Preoperative echocardiography revealed diffuse severe hypokinesis, a left ventricular ejection fraction (LVEF) of 25%, and a pedicled floating mass in the right atrium. He had not exhibited positive symptoms of active endocarditis or metastatic malignant tumor, and the causes of cardiomyopathy seemed to be uremic and/or ischemic factors. Renal transplantation was postponed, and the extirpation of the mass in the right atrium was scheduled. LVEF improved to 48% 2 months following the induction of hemodialysis before the cardiac operation. Pathohistological findings of the extirpated intra-atrial mass showed sphachelus and fibrotic thrombus, which meant asymptomatic healed infective endocarditis. He recovered uneventfully, and underwent a living renal transplantation from living donor 5 months after the cardiac operation. LVEF further improved better to 56%, and his performance status was remarkably improved. These results imply that renal transplantation and hemodialysis in peritoneal dialysis patients with uremic cardiomyopathy can achive improvement of cardiac function and enable a safe cardiac operation.

Five patients with vascular graft infections were surgically treated over a 16-year period. Primary diseases were arteriosclerosis obliterans in 3 cases and invasion of malignant diseases in 2 cases. The most common site of infection was the groin (3 of 5). Staphylococcus aureus was the most common pathogen. Administration of antibiotics, drainage and lavage with povidone iodine solution were performed in 4 patients (40-64 days). All patients underwent graft resection and reconstruction. Infected parts of the previous grafts were removed. Total removal of the previous graft was performed in 2 cases and partial removal was performed in 3 cases. To avoid re-infection, long extra-anatomical bypass was performed in 4 cases. The post operative courses of the five patients were uneventful.