A case of a reflex sympathetic dystrophy syndrome (RSD) asscciated with the internal iliac arterio-venous fistula was reported. The patient was a 36-year old woman, and had the left oophorectomy at 21-year old and the lumbar laminectomy at 36-year-old. She complained of coldness and paresthesia of the right lower extremity 14 days after the lumbar laminectomy. A stenosis or occlusion of the arteries in both legs were not demonstrated by arteriogram. The coldness and paresthesia disappeard after the epi-dural block. RSD of the right leg was diagnosed which occurred at the lumbar laminectomy. Lumbar sympathectomy (L2∼L4) was performed simultaneously with closure of the internal iliac arteriovenous fistula. Postoperative clinical course was uneventful. Symptoms we were immediately disappeared. Sympathetic ganglion block has same efficiency as lumbar sympathectomy. Therefore sympathetic ganglion block is more suitable if patient has RSD only.

It is known that the prognosis of preductal type coarctation of the aorta is poor because cardiac malformation is frequent in these cases. There have been very few reports on adult cases of the coarctation. We have recently carried out aneurysmectomy and reconstructed the descending aorta by a 30mm Veri-Soft tube graft for one adult case of descending aortic aneurysm associated with coarctation of the aorta. The patient was 49-year-old female. Segmental stenosis 5cm in length was demonstrated in the thoracic descending aorta immediately below the bifurcation of the left subclavian artery. The poststenotic dilatation was shown at the distal portion of the segmental stenosis. The postoperative clinical course was uneventful.

Preoperative and operative evaluation of the arterial reconstructive tract is very important to obtain a high reconstructed graft patency rate after femoro-popliteal bypass. We analyzed the graft patency rate of 40 cases in which the graft flow was measured immediately after completion of arterial reconstruction. The mean graft flow was 122.6ml/min in patients with above-knee (AK) reconstruction and 57.4ml/min in those with below-knee (BK) reconstruction. In cases with AK reconstruction, the three-year cumulative patency rates of grafts with a blood flow of 120ml/min or more (n=12) or less than 120ml/min (n=11) were 100% and 80.8%, respectively (p<0.05). In cases with BK reconstruction, the three-year cumulative patency rates of grafts with a blood flow of 55ml/min or more (n=9) and less than 55ml/min (n=8) were 62.2% and 50.0%, respectively. All early occlusions (n=5) occurred in patients with BK reconstructions. Despite having a blood flow greater than 55ml/min, two cases became occluded in the early stage due to knee joint bending. It is considered that intraoperative measurement of the graft flow is one index to predict graft patency.

We investigated the quality of life (QOL) after thoracic or thoraco-abdominal aneurysmectomy in patients who had undergone the procedure within the past 15 years. We compared preoperative to postoperative performance status (PS). Defining PS in the following manner: one increase in that PS grade indicated mild worsening while an increase is by 2 or more indicated severe worsening. Maintenance was indicated by no change of PS after surgery. The QOL maintenance rate was calculated based on the following formula.
QOL maintenance(%)=No. of no change case/No. of operated cases-No. of death×100
There were a total of 74 cases in whom follow-ups could be carried out after surgery. Among them, there were ascending and aortic arch aneurysms in 19 cases, descending aortic aneurysms in 20 cases, dissecting aneurysms in 27 cases and thoraco-abdominal aortic aneurysms in 8 cases. The QOL maintenance rate in the type B dissecting aneurysms was comparatively high (85.7%). There were cases of severe worsening of PS in the ascending and aortic arch aneurysms and type A dissecting aneurysms and the QOL maintenance rate was 50% in each other. We should obtain high operative results due to improve the QOL maintenance rate, and devise the operative procedure without functional disorders of the organs after surgery.