Patients with PAD present endothelial dysfunction, but this does not seem to determine the severity of the disease.

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A second unique advantage of the hybrid operating environment is in providing less-invasive therapeutic options. As in our patient, surgical graft revision would have required a second period of cardiopulmonary bypass and aortic clamping, and this was avoided by electing to perform a less-invasive percutaneous intervention. This resulted in a dramatic improvement in the graft flow and distal runoff with recruitment of collaterals and immediate resolution of the patient's mitral regurgitation. Moreover, the hybrid environment will undoubtedly lead to more liberal use of minimally invasive valve operations combined with percutaneous coronary interventions and combined surgical and percutaneous revascularization techniques. 3 References 1. Byrne JG, Leacche M, Unic D, Rawn JD, Simon DI, Rogers CD, et al.Staged initial percutaneous coronary intervention followed by valve surgery ("hybrid approach") for patients with complex coronary and valve disease.

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Treatment with statins lowers plasma nitrite and CRP levels in patients with PAD. Our data support the effects of statins in vivo that have been demonstrated on the endothelium ex vivo, suggesting a beneficial effect by acting on the initial processes that trigger the disease, reducing oxidative stress (increase in the bioavailability of nitric oxide as peroxynitrite levels decrease) and curtailing the inflammatory processes which perpetuate the disease.

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The large size of some retroperitoneal tumors and the complex anatomy of the retroperitoneal structures often require en bloc resection of contiguous organs and, sometimes, resection of critical vascular structures. Vascular reconstructive techniques allow reconstruction of major vascular structures, and autologous vein grafting is the preferred option. Although great saphenous vein can be used in select cases, other options must be explored in cases of caliber mismatch between saphenous vein and native vessel. In addition, the use of synthetic grafts should be avoided in potentially infected vascular beds. The use of the superficial femoral vein in such settings is well documented especially in relation to treatment of infected aortic grafts and has the added advantage of appropriate size match for reconstruction of the major abdominal and pelvic vascular structures. Here, we present a case of a 56-year-old woman with a local recurrence of urothelial cancer in the pelvis after radical cystectomy and radiotherapy. Computed tomography (CT) angiography showed the right iliac artery directly involved by the tumor, and vessel resection was necessary to achieve oncologic surgical margins. The tumor was excised en bloc, and vascular reconstruction using the reversed contralateral superficial femoral vein in an end-to-end fashion was performed. The postoperative course was uneventful. Patient was maintained on low-molecular-weight heparin for 1 month and then on low-dose (100 mg acetylsalicylic acid) antiplatelet therapy and compression stockings. Six months later, the patient is asymptomatic, without leg swelling, and the CT scan shows patency of the vascular repair and no tumor recurrence.