Blood glucose at sixty, ninety, and one hundred twenty minutes after a standardized oral glucose load was compared in healthy middle-aged men and patients with intermittent claudication. No difference was found when the authors compared blood glucose at zero and sixty minutes. At both ninety and one hundred twenty minutes, however, they found a relative hypoglycemia in patients with peripheral arteriosclerotic disease in an early stage.

The acute thrombogenicity of a new polyurethane urea graft has been compared with polytetrafluoroethylene (PTFE) grafts using labelled homologous platelets in the carotid arteries of sheep in a low-flow model. There was no difference in patency. Thrombus weight and thrombus free surface were the same in both types of graft after 4 h. The accumulation of homologous 32P platelets was measured at the 2 anastomoses and at a midgraft position. At no point was there any statistically significant difference between the 2 grafts, but the activity was always somewhat higher in the polyurethane grafts. Although more compliant, in this study polyurethane urea grafts behaved much like PTFE ones.

During an 11-year period 117 extraanatomic reconstructions were made for aorto-iliac arteriosclerosis; 36 axillofemoral and 81 femorofemoral crossover bypasses. The patients were old and had several factors making them poor risks for surgery. Axillofemoral grafts were more often used in patients with malignant disease. Postoperative mortality was 10% without difference between the two types of reconstruction. Both early and late complications were significantly more frequent in patients with axillofemoral bypass. Reoperations for occlusion and symptoms from the donor side also were significantly more common among axillofemoral patients. Life table analysis showed a higher survival and patency rate among patients with crossover grafts.

The influence of diabetes on leg blood flow in intermittent claudication has been assessed by comparing the systolic arm-ankle pressure gradient at rest and resistance to blood flow during reactive hyperemia in patients with non-insulin dependent diabetes and non-diabetic controls. Cases and controls were matched for age and sex. Smoking habits, blood pressure, and blood lipids didn't differ in the two groups. Diabetes was associated with a higher resistance to blood flow during reactive hyperemia and a greater arm-ankle pressure gradient at rest. Resistance to blood flow during reactive hyperemia was in the non-diabetics strongly correlated to the arm-ankle pressure gradient at rest (r=0.84). Corres ponding correlation coefficient was in diabetics 0.04. In one of four diabetic legs a high resistance to blood flow during reactive hyperemia didn't correspond to a big arm-ankle pressure gradient. The results in this study support the concept of both macro- and microvascular disease in diabetes.

Three hundred and forty-nine patients with the diagnosis intermittent claudication (IC) based on Rose's questionnaire were all found to have clinical abnormality based on pulse palpation, and/or auscultation in lower abdomen and groin. The diagnosis was in the majority of cases (87-95%) confirmed by standardized walking test (WT), ankle pressure index (AI) and venous occlusion calf plethysmography (VOP). In clinical abnormality based on bruit only in groin, AI and VOP confirmed the diagnosis less frequently than in the other clinical abnormalities (p less than 0.01).

Four cases of vascular complications in connection with total hip replacement are reported and another 25 cases from the literature summarized. Acute intraoperative injuries most often give rise to severe haemorrhage. Delayed injuries with pseudoaneurysm formation or thrombosis give rise to hip pain, distal ischaemia or haemorrhage when a prosthesis is extracted. There is a dominance of female patients and left-sided operations and cases complicated with infections and reoperations. Aetiologic and therapeutic considerations are discussed.

Of 229 carotid artery reconstructions, 67 were performed in patients after a minor stroke. In this group of patients the operative mortality was 5.9 per cent, compared with 1.8 per cent in the group of patients without preoperative minor stroke operated upon during the same period of time. The 5-year survival in the stroke group was 86 per cent and in the non-stroke group it was 65 per cent. Excluding the postoperative mortality, the survival increases to 90 and 68 per cent respectively. The difference, which is significant at 6 years (P less than 0.05), is explained by a higher incidence of coronary artery disease in the non-stroke group. The postoperative annual stroke frequency was 2.3 per cent in the stroke group and 2.4 per cent in the non-stroke group. The stroke frequency on the operated side during follow-up was 1.6 per cent per year for both groups together. It seems that a minor stroke is no contraindication to carotid artery reconstruction provided the timing of the operation is correct and other contraindications are considered.

Over a 10-year period, 116 arterial operations in the upper extremity were performed. Sixteen patients had suffered from trauma, 52 from gross embolism, and 48 from chronic ischemia. The groups differ in age, duration of symptoms, and localization of the lesion. In patients with chronic ischemia, the most common lesion was a left-sided subclavian stenosis, with microembolization to the fingers as the most prevalent symptom. Several types of reconstructions were used with satisfactory results. One patient in each group underwent amputation. The mortality rate in the group of patients with gross embolization was high, both postoperatively and during follow-up.

The arm-ankle systolic pressure gradient was measured in 165 male patients with intermittent claudication and was correlated with different combinations of known cardiovascular risk factors. The pressure gradient increased with increasing number of risk factors. We conclude that intermittent claudication may be used as a simple model for studies of arteriosclerosis, the arm-ankle systolic pressure gradient being a measure of the degree of arteriosclerosis between heart and ankle.

During an 8-year period 149 patients underwent 167 carotid operations. TIA or amaurosis fugax was the operative indication in 60% of the cases and TIA-IR (minor strokes) in 25%. The operative mortality was 4.2%. New neurological permanent deficits appeared in connection with the operation in 4.2%. They were all of benign character. The mean follow-up time was 23 months with a range from 4 months to 8 years. The postoperative follow-up revealed a 10% frequency of strokes during a 6-year period, i.e. 1.6% per year. The 5-year survival for the whole material was 71% and for patients without signs of coronary artery disease, operative mortality excluded, it was identical with the 5-year survival for the normal population in the same area, i.e. 85%.