Reduction of the risk of surgery for abdominal aortic aneurysms by extended coronary diagnostics and therapy.

The morbidity and mortality in the surgery of abdominal aortic aneurysms are essentially determined by the coronary risk profile of the patient. Preoperative coronary artery diagnostics with the potential consequence of a coronary revascularization as procedure before the aneurysmectomy seems to be mandatory to decrease the risk of treatment. Out of 223 patients treated at our institution for abdominal aortic aneurysm, 68 (30.5%) had to undergo extended cardiological diagnostic procedures, and 37 (16.6%) needed a coronary angiography; in 23 patients (10.3%) myocardial revascularization was performed prior to the aneurysmectomy. Since routinely performing this thorough investigation of the coronary risks, the mortality of surgery for aortic aneurysm has been clearly reduced.

Pathogenesis and changes in the aetiology of arterio-venous fistulae.

There has been a marked shift in the causes of arterio-venous fistulae. Gunshot and stab wounds used to be the most frequent cause but iatrogenic fistulae, especially those arising as a result of reconstructive skeletal operations or following diagnostic and therapeutic procedures, are now becoming increasingly common. If morphological vascular changes have not yet occurred and cardiac volume overloading has not led to permanent damage, a recently established arterio-venous fistula can be easily corrected by resection and oversewing of the artery and vein. The special cases of arterio-venous fistulae arising as a result of catheter procedures in the groin have to be identified in terms of cause and morphology in order to facilitate early surgical correction.