[Reconstruction of unilateral iliac vein occlusion]. / Rekonstruktion des unilateralen Beckenvenenverschlusses.

From 1 July 1971 through 6 June 1987, 46 of 10,644 reconstructive vascular interventions were Palma-operations. The morphological operability was ascertained by ascending phlebography and the functional indication by phlebodynamometry. The autologous contralateral saphenous vein was used in 19 patients as a transplant, whereas 27 patients received a spiral-wrap polytetrafluoraethylene (PTFE) prosthesis. All patients were given a temporary av-fistula. Followup was possible in 15 of the 19 autologous operations and in 25 of the 27 PTFE operations. Ten vein transplants and 21 PTFE transplants were still patent.

Direct reconstructive venous surgery.

Unilateral occlusions of the pelvic veins may be corrected by a Palma operation. In the classic Palma operation the contralateral long saphenous vein is suprapubicly led to the opposite side and is anastomosed end-to-end or end-to-side with the common femoral vein of the occluded side. Just lately, spirally wall reinforced PTFE grafts showed more favourable results than Palma grafts. Circumscribed occlusions of the superficial femoral vein can be interposed by the May-Husni operation. Thereby the ipsilateral long saphenous vein is implanted end-to-side into the popliteal vein. We perform the Palma operation as well as the May-Husni operation under the protection of a temporary av-fistula. The ascending venography only permits to make a statement on the morphological operability, whereas the functional operability is indicated by means of phlebodynamometry. Phlebodynamometry and plethysmography are the best means to judge the functional result of the operation which is of importance for the patient. The results of the Palma operation can be regarded as very satisfactory, provided that the morphological and functional indication for the operation was correct. The use of the endothelium protective operative technique by Robert Mays as well as the application of a temporary av-fistula yield a success that is above 80 p.c. As against that, the May-Husni operation achieves less than 50 p.c. success, even if a temporary av-fistula is established in the area of the ancle. Less favourable are the results obtained by direct restorative interventions on the subclavian vein, so that these operations should only be indicated in exceptional cases.

[10 years' experience with the in situ bypass]. / 10 Jahre Erfahrung mit dem in situ-Bypass.

From October 1, 1974 to March 31, 1984 467 femoropopliteal and femorotibial in situ vein bypasses were performed. Valvular incompetence is produced by the use of modified Hall strippers. The intraoperative angiography is mandatory to localize the tributaries and to detect pathological findings of the vein and technical errors. Overall cumulative patency rates were 84, 76, 71, and 67%, at 2, 5, 8 and 10 years. Cumulative patency rates for 117 tibial bypasses separately were 72, 68, and 68% at 2, 5 and 8 years.