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In reconstructive vascular surgery several intraoperative investigations are in use to check-up and secure full blood flow restoration (angiography, ultra-sound, electro-magnetic flowmeter etc.). In the last years endoscopical lumen control, introduced 1969 in clinical praxis, could be remarkably simplified and improved. For vascular endoscopy three technical prerequisites are necessary: a) temporary interruption of blood flow using clamps or balloon catheters, b) replacement of the blood by a transparent medium via pressure controlled saline perfusion, c) availability of suitable special endoscopes. The main application of vascular endoscopy includes: a) semi-closed thromboendarterectomy (aorto-iliac or femoropopliteal), b) arterial embolectomy, c) lumen control of inserted grafts including the anastomosis and the distal run-off vessels, d) venous thrombectomy. The availability of small-calibre endoscopes (external diameter: 1.7-2.7 mm) enables the extension of lumen control to small vessel areas such as the tibial and coronary arteries. Compared with angiography vascular endoscopy offers several convincing advantages such as a more reliable three dimensional lumen control, easy performance, saving time and the avoidance of any additional X-ray exposure. Technical faults or overlooked concomitant vascular lesions can be diagnosed and corrected immediately.

The authors describe a new variant of the popliteal artery across the lateral head of the gastrocnemius muscle. Therefore a new more simple classification is proposed: type I-III. A further differentiation in subgroups as Ia, IIa according to Insua has no clinical value. A posterior approach to the popliteal artery gives a detailed view of the anatomic structures such as muscle and band origin. A medial incision should be chosen if crural reconstruction is expected.

Among 15 patients with acute thrombotic disease of pelvic veins who had been submitted to operative thrombectomy and creation of arteriovenous fistula in the groin, 12 presented with stenotic lesions 3 months later. These stenoses were submitted to percutaneous angioplasty. If angioplasty failed, percutaneous placement of a vascular stent (wall stent) was performed immediately (n = 7). Stenting in cross-over-technique proved practicable in all cases. Secondary stenotic disease in the exclusively dilated area was observed in 3/5 cases and was also treated with a wall stent. In one patient with recurrent stenoses who refused stenting, extended thrombosis occurred after occlusion of the AV-fistula. At mid-term PTA was successful in only two cases. Intimal hyperplasia was observed in only one wall stent treated patient. Percutaneous treatment of iliacal stenoses in patients with postthrombotic syndrome may be performed safely under the protective effect of the fistula. With the presented technique, patency of pelvic veins could be restored in 11/12 patients with postoperative significant venous stenoses.

Crural reconstruction is a suitable method for peripheral arterial occlusive disease to prevent amputation, particularly in diabetics.

The late results of venous thrombectomy could be remarkably improved by routine use of intraoperative vascular endoscopy and additional temporary a.v.-fistula. Long-term follow-up (mean 8 y.) of 119 patients (Ulm 1970-1983) showed full patency in 75% (phlebography) and very good function in 63% (phlebodynamometrie). With improved surgical technique the preservation of values is possible. Mortality was 1,8% and the incidence of clinically relevant postoperative pulmonary embolism was lower than 2%.

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