We did a retrospective review of 83 femoropopliteal bypasses with grafting of saphenous vein performed for two groups of limbs: those with arteriosclerosis obliterans (n=71) and thromboangiitis obliterans (n=12) over the past 15 years. The purpose of the study is to assess factors that influence long-term graft patency. We also examined methods used for reoperation. After a mean follow-up of 35 months (ranges, 1-164), the cumulative patency rate was 79% at 5 years and again 79% at 8 years, which was better than the patency of PTFE grafts or other prosthetics reported by other authors. The two groups were compared for the severity of ischemia, condition of the outflow tract, and whether anastomosis was above or below the knee. These factors were different between the two groups, but the difference in patency was statistically not significant. Two reoperations for claudication were needed. One was carried out with use of the bilateral saphenous veins from below the portions used earlier. The other was done for obstruction of a PTFE graft; anastomosis was done at the mid portion with the use of Vitagraft.

Adrenal venous sampling (AVS) is the key procedure for lateralization of primary hyperaldosteronism (PA) before surgery. Identification of the adrenal veins using computed tomography (CT) and intraoperative cortisol assay facilitates the success of catheterization. Although administration of adrenocorticotropic hormone (ACTH) has benefits such as improving the success rate, some unilateral cases could be falsely diagnosed as bilateral. Selectivity index of 5 with ACTH stimulation to assess the selectivity of catheterization and lateralization index (LI) >4 with ACTH stimulation for unilateral diagnosis is used in many centers. Co-secretion of cortisol from the tumor potentially affects the lateralization by the LI. Patients aged <35 years with hypokalemia, marked aldosterone excess, and unilateral adrenal nodule on CT have a higher probability of unilateral disease. Patients with normokalemia, mild aldosterone excess, and no adrenal tumor on CT have a higher probability of bilateral disease. Although no methods have 100% specificity for subtype diagnosis that would allow bypassing AVS, prediction of the subtype should be considered when recommending AVS to patients. Methodological standardization and strict indication improve diagnostic quality of AVS. Development of non-invasive imaging and biochemical markers will drive a paradigm shift in the clinical practice of PA.