Anastomotic aneurysms after vascular reconstruction: problems of incidence, etiology, and treatment.

To gain a better understanding of the pathogenesis, natural history, therapeutic response, and the potential of prevention of anastomotic aneurysms in general and those following aortofemoral interventions in particular, we have reviewed 4,214 reconstructive vascular operations performed in the past 15 years during which procedures (prosthetic bypass, autogenous vein graft, and endarteriectomy) of fairly uniform technical details have been used. Among these operations representing 9,561 anastomotic sites, we encountered 205 anastomic aneurysms, a per site incidence of 1.7 percent. By far the most common site of occurrence was the femoral artery following Dacron bypass procedures, with a per site incidence of 3.0 percent. The lowest rate of incidence was observed after endarteriectomies, regardless of anatomic location (0.4 percent). The most frequent causative factor was found to be structural deficiency of the parent artery, which accounted for 30.7 percent of the aneurysmal lesions. Other etiological agents, in order of importance, were arterial hypertension, mechanical stress, defect of the graft material, and noninfective healing complications. The therapeutic approach was an aggressive one and only patients with prohibitive operative risks were treated conservatively. In the elective surgical cases the rate of good results was 81.6 percent, with no operative deaths.

Lobular carcinoma of the breast in situ. Are we too radical in its treatment?

Twenty-four patients (average age, 46 years) with 29 instances of lobular carcinoma in situ of the breast have been treated from 1952 to 1971 at the Henry Ford Hospital (incidence, 1%). Six patients had bilateral lesions, one synchronous and 5 metachronous. The initial complaint in 23 of 24 patients was a mass in the breast. Diagnosis was based on permanent histologic section as mammorgraphy and frozen section analysis were inconclusive. Treatment consisted of radical mastectomy in six, modified radical mastectomy in five, and simple mastectomy in 20. All lymph nodes recovered showed no metastatic disease. All patients are alive and well with no evidence of disease. Based on our experience, we recommend a simple mastectomy for treatment of lobular carcinoma in situ with contraleteral bipsy examination in those instances when clinical or roentgenographic evidence suggests a pathologic process.