method for intraoperative monitoring, but the optimal method would be to have both haemodynamic and morphological information. [Q10: A, D, E]

As there is a 30% risk of developing neointimal hyperplasia and graft stenosis within the first postoperative year, duplex surveillance is considered an essential part of postoperative care. All the suggested duplex criteria are indicative of vein graft stenosis, but none of them can be 100% sensitive in detecting stenosis.16 Our case demonstrates that using liberal duplex criteria, false positive findings are easily encountered as the angiography was deemed normal. [Q11: A, B, C, D]

References

 1. LoGerfo FW, Coffman JD. Vascular and microvascular disease in the diabetic foot: implications for foot care. N Engl J Med. 1984;311:1615-1619.

 2. Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system. Diabetes Care. 1998;21:855-859.

 3. Levin ME, O´Neal LW. The Diabetic Foot. St Louis: Mosby; 1983.

 4. Lundin M, Wiksten JP, Peräkylä T, et al. Distal pulse palpation: is it reliable? World J Surg. 1999;23:252-255.

 5. Lehto S, Niskanen L, Suhonen M, Rönnemaa T, Laakso M. Medial artery calcification. A neglected harbinger of cardiovascular complications in non-insulin-dependent diabetes mellitus. Arterioscler Thromb Vasc Biol. 1996;16:978-983.

 6. Takolander R, Rauwerda JA. The use of non-invasive vascular assessment in diabetic patients with foot lesions. Diabet Med. 1996;13:S39-42.

 7. Veves A, Sarnow MR. Diagnosis, classification and treatment of diabetic peripheral neuropathy. Clin Pod Med Surg. 1995;12:19-30.

 8. International Working Group on the Diabetic Foot. International consensus on the diabetic foot. Netherlands: International Working Group on the Diabetic Foot, 1999.

 9. Smith FCT, Shearman CP, Simms MH, Gwynn BR. Falsely elevated ankle pressures in severe leg ischaemia: the pole test – an alternative approach. Eur J Vasc Surg. 1994;8:408-412.

10.Reiber GE, Lipsky BA, Gibbons GW. The burden of diabetic foot ulcers. Am J Surg. 1998;176(2A):5S-10S.

11.LoGerfo FW, Gibbons GW, Pomposelli FB, et al. Trends in the care of the diabetic foot. expanded role of arterial reconstruction. Arch Surg. 1992;127:617-621.

12.Lepäntalo M, Tukiainen E. Combined vascular reconstruction and microvascular muscle flap transfer for salvage of ischaemic legs with major tissue loss and wound complications. Eur J Vasc Endovasc Surg. 1996;12:1-5.

13.Luther M, Lepäntalo M. Femorotibial reconstructions for chronic critical leg ischaemia: influence on outcome by diabetes, gender and age. Eur J Vasc Endovasc Surg. 1997;13:569-577.

14.Biancari F, Kantonen I, Albäck A, Ihlberg L, Lehtola A, Lepäntalo M. Popliteo-to-distal bypass grafts for leg ischaemia. J Cardiovasc Surg. 2000;41:281-286.

15.Albäck A, Mäkisalo H, Nordin A, Lepäntalo M. Validity and reproducibility of transit time flowmetry. Ann Chir Gynaecol. 1996;85:325-331.

16.Sladen JG, Reid JD, Cooperberg PL, et al. Color flow duplex screening of infrainguinal grafts combining low and high velocity criteria. Am J Surg. 1989;158:107-112.

Part IV

Surgery of the Major Branches of the

Infradiaphragmatic Aorta