[An unusually painful leg ulcer in an 81-year-old patient: an interdisciplinary challenge]. / Außergewöhnlich schmerzhaftes Ulcus cruris bei einem 81­jährigen Patienten ­ eine interdisziplinäre Herausforderung.

An 81-year-old male patient with a history of peripheral arterial disease (PAD) was admitted to the authors' outpatient clinic with a painful lower leg ulcer. As the degree of PAD did not correspond to the clinical findings, multiple biopsies were taken from the base and edge of the ulcer. This resulted in the histopathological and clinical diagnosis of pyoderma gangrenosum (PG). Since PG is often associated with numerous underlying diseases, further thorough examinations were performed. A mass in the gastric antrum suspicious for malignancy was histopathologically identified as gastric cancer (signet ring cell carcinoma). The PG was successfully treated with cortisone p.o. and tacrolimus ointment. Since the cancer was locally limited, the patient underwent surgery involving gastric resection with D2 lymphadenectomy and gastrojejunostomy (Roux-en­Y anastomosis).

[Young Women - Problematic Patients in Vascular Surgery]. / Junge Frauen - Problempatientinnen in der Gefäßchirurgie.

The treatment of peripheral arterial disease (PAD) in young women between 40 and 60 years of age represents a difficult challenge for the vascular surgeon. Excessive smoking, an early menopause and the unfavourable anatomic proportions of thinner arterial vessels or vein grafts during peripheral bypass-surgery lead to a higher rate of complications or re-occlusion following invasive therapy in comparison to male patients. A special anatomic manifestation appearing nearly only in women around the 6th decade is the so-called aortoiliac hypoplastic syndrome with a high rate of re-occlusion after balloon-dilatation or local thrombendarteriectomy and bypass grafting, respectively. Variabilities in coagulation and the undertreatment of classical risk factors of PAD by medical drugs lead to poorer results in the treatment of PAD in young women. Therefore a conservative therapy - whenever feasible - should be the first choice for treating PAD in young women.

[Endovascular therapy of an iatrogenic renal-artery-perforation after fenestrated-aortic-repair (fEVAR)]. / Endovaskuläre Therapie einer iatrogenen Nierenarterienperforation nach fenestrierter Aortenprothese (fEVAR).

HISTORY AND ADMISSION FINDINGS: A 75-year-old patient was initially hospitalized for therapy-evaluation of a an acquaint infrarenal abdominal-aortic-aneurysm, with a maximum diameter of 5.3 cm. Medical history showed a known contained rupture of the aneurysm. Except for a substituted Hypothyroidism and a COPD Stadium II (GOLD), there were no other previous diseases known. EXAMINATIONS: Laboratory showed a slight normochrome, normocytic anemia (hemoglobin 13 g/dl, MCV and MCH were normal) together with a decreased total amount of erythrocytes of 3.89/pl. TSH value was increased significantly at 7.960 mU/l. Initially creatinine was measured at 1.02 mg/dl. Sonography and CT-scan of the abdominal vessels had shown no new insights other than the aneurysm of the abdominal aorta. A surgical revision was indicated. TREATMENT AND COURSE: After primarily uncomplicated implantation of a fenestrated EVAR, the patient showed a progressive hemoglobin loss concomitant with a considerable increase of renal retention parameters. A "spurium"/false aneurysm of the right renal artery was found, which moreover showed a retroperitoneal bleeding. The patient subsequently underwent successful endovascular therapy in our clinic and was dismissed from the hospital in good condition and without further complications. Follow up controls showed no signs of new pathologies. CONCLUSION: "Direct" post-operative complications after EVAR are a rarity. In our case, the interventional endovascular approach of the bleeding from the right renal artery was a successful and sufficient treatment of the potentially life-threatening complication.