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Based on the own experience and on an intesive study of the literature with a total of 52 patients with an aortic aneurysm and a horseshoe kidney the problems of operative treatment are discussed. The conclusion is made, that the treatment of this rare combination has its special difficulties in nearly 2/3 of all cases, but the same results as conventional surgery of aortic aneurysms, when the renal artery abnormalities are respected and treated with adequate vascular surgical skill.

The treatment of infection after vascular operations depends on the severity and extent of this complication. In infections of low virulence an attempt to prevent progression of the infectious involvement should be made with the help of antibiotics and immobilization. Suppurating infection involving a vascular graft but not yet causing bleeding can be treated successfully by drainage and antibiotic irrigation. In case of bleeding at the site of an infected anastomosis it is sometimes possible to prevent further bleeding and to cure the infection by wrapping omentum round the anastomactic lines. Severe infection and repeated hemorrhage require sacrifice of the reconstructed vessel to prevent loss of limb and even life: arteries reconstructed with the use of autogenous material must be ligated; any implanted synthetic material has to be removed. In these cases limb salvage can be accomplished using a remote bypass (axillo-femoral bypass, obturator-bypass, crossed bypass, etc.).

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Neurogenic and vasculogenic impotence after aortoiliac reconstruction is an unpleasant problem in vascular surgery. The importance of maintaining or restoring intraoperatively a sufficient hypogastric artery blood flow is emphasized. Postoperative neurogenic sexual disabilities are irreversible and are due to interruption of sympathetic nerve fibers supplying the genital system. Dissecting the terminal aorta and the iliac arteries the hypogastric sympathetic plexus--which descends across the bifurcation--can be easily damaged. This is the cause of the high incidence of failure of ejaculation after aortoiliac surgery. In order to avoid this neurogenic sexual dysfunction a retromesenteric approach to the aortoiliac region is anatomically suggested by A. v. Hochstetter. It enables the exposure of the abdominal aorta and the iliac arteries without disrupting the superior hypogastric plexus and its variants. Respecting the integrity of the sympathetic plexus and a sufficient flow in the internal iliac artery the frequency of postoperative disturbances of erection was reduced from 17% (1199 patients) to 12.3% (570 patients). The incidence of postoperative loss of ejaculation in the same groups of patients decreased from 81% to 20%.

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