Abstract The increasing incidence of arteriosclerotic occlusive disease of the arterial system parallels our ageing population. Until the etiology, course, and duration of this vascular problem are understood, the role of the surgeon in its treatment, albeit palliative, will continue to be of paramount importance. At present no single revascularization procedure is intrinsically ideal; various combinations of techniques are being used depending upon the extent of the arteriosclerotic process. This study presents our experience with gas endarterectomy (the injection of a bolus of carbon dioxide gas to dissect the thrombotic of an artery) in 36 patients with limb ischemia due to arteriosclerotic occlusive disease. Whereas intervention on injured or diseased blood vessels has been practiced for centuries, the first successful deliberate reconstruction of a blood vessel was accomplished in 1905 with the introduction of autogenous vein grafts by Carrel and Guthrie.1 It was the pioneering of dos Santos,2 who, References 1. Carrel, A., and Guthrie, C.C.: Transplantation biterminale complete d'un segment de veine sur une artere , Comp Rend Biol 59:412-413, 1905. 2. dos Santos, J.C.: Sur la desobstruction des thromboses arterielles anciennes , Mem Acad Chir 73:409-411, 1947. 3. Reboul, H., and Laubry, P.: Endarterectomy in the Treatment of Chronic Endarteritis Obliterans of Limbs and Abdominal Aorta , Proc Roy Soc Med 43:547-552 ( (July) ) 1950. 4. Rob, C.G., and Downs, A.R.: Chronic Occlusive Disease of the Aorta and Iliac Arteries (Treatment and Results) , J Cardiovasc Surg 1:57-64 ( (July) ) 1960. 5. Cannon, J.A.: Rationale of Endarterectomy , Western J Surg 64:321-328 ( (June) ) 1956. 6. Edwards, W.S.: Composite Reconstruction of Small Leg Arteries After Endarterectomy , Surgery 51:58-61 ( (Jan) ) 1962. 7. Le Veen, H.: Technical Features in Endarterectomy , Surgery 57:22-27 ( (Jan) ) 1965. 8. Cannon, J.A.; Barker, W.F.; and Kawakami, I.G.: Femoral Popliteal Endarterectomy in the Treatment of Obliterative Atherosclerotic Disease , Surgery 43:76-93 ( (Jan) ) 1958. 9. Harrison, J.H.; Jordan, W.D.; and Perez, A.R.: Eversion Thromboendarterectomy , Surgery 61:26-30 ( (Jan) ) 1967. 10. DeBakey, M.E.; Creech, O., Jr.: and Cooley, D.A.: Occlusive Disease of the Aorta and Its Treatment by Resection and Homograft Replacement , Ann Surg 140: 290-310 ( (Sept) ) 1954.Crossref 11. Voorhees, A.B.; Jaretzki, A.; and Blakemore, A.H.: The Use of Tubes Constructed From Vinyon "N" Cloth in Bridging Arterial Defects , Ann Surg 135:332-336 ( (March) ) 1952.Crossref 12. Szilagyi, D.E.: Ten Years Experience With Aorto-iliac and Femoro-popliteal Arterial Reconstruction , J Cardiovasc Surg 5:502-508 ( (Nov) -Dec) 1964. 13. Kunlin, J.: Le traitement de l'ischemie arteritique par la greffe veineuse longue , Rev Chir Orthop 70:206-235, 1951. 14. Sobel, S., et al: Gas Endarterectomy , Surgery 59:517-521 ( (April) ) 1966. 15. Van Slyke, D.D., et al: The Solubility of CO2 at 38 Degrees in Water, Salt Solution, Serum and Blood Cells , J Biol Chem 78:765-799 ( (Aug) ) 1928. 16. Nelson, R.M., and Sanders, B.C.: Carbodissection of Perivascular Tissue , J Thorac Cardiovasc Surg 48:964-968 ( (Dec) ) 1964. 17. Chochinov, H., and Van Wijhe, M.: The Plane of Dissection in Endarterectomy , Canad J Surg 8:10-14 ( (Jan) ) 1965.
Archives of Surgery – American Medical Association
Published: Jun 1, 1969