Abstract The difficulties involved in operating upon the small distal arteries of the leg have led to general pessimism and even to the idea that it is not really feasible to restore circulation by grafting distal to the level of the knee. To the factor of increased technical difficulty as vessel size becomes smaller is often added diffuse and distal atherosclerotic occlusions so that "run-off" circulation is poor. Any tiny clot which forms is apt to block the small lumen and lead to failure. The relatively gross technique possible in aortic procedures must be considerably refined to permit successful small arterial repair. Delicate maneuvers are mandatory, for the margin for error is not large. Lack of appreciation of these factors has led to ill advised efforts by some to overextend certain procedures and to operate upon poorly chosen patients, with results which have raised doubts about the practicability of salvage of References 1. Dale, W. A.: Autogenous Vein Grafts and Related Aspects of Peripheral Arterial Disease , Springfield, Ill., Charles C Thomas, Publisher, 1959. 2. Dale, W. A.; DeWeese, J. A., and Scott, W. J. M.: Autogenous Venous Shunt Grafts: Rationale and Report of 31 for Atherosclerosis , Surgery 46:145 ( (July) ) 1959. 3. Dale, W. A., and Pridgen, W.: Failure of Composite (Teflon-Vein) Grafts in Human Arteries , Surgery 51:258 ( (Feb.) ) 1962. 4. Edwards, W. S.: Late Occlusion of Femoral and Popliteal Fabric Arterial Grafts , Surg. Gynec. Obstet. 110:714 ( (June) ) 1960. 5. Edwards, W. S.: Composite Reconstruction of Small Leg Arteries After Endarterectomy , Surgery 51:58 ( (Jan.) ) 1962. 6. Foster, J. H.; Ekman, C. A., and Scott, H. W.: Late Behavior of Vascular Substitutes , Ann. Surg. 151:867 ( (June) ) 1960.Crossref 7. Hafner, C. D.; Cranley, J. J.; Krause, R. J., and Strasser, E. S.: Radical Open Femoral-Popliteal Endarterectomy with Onlay Vein Graft , Arch. Surg. 85:730 ( (Nov.) ) 1962.Crossref 8. Linton, R. R., and Darling, R. C.: Autogenous Saphenous Vein Bypass Grafts in Femoropopliteal Obliterative Arterial Disease , Surgery 51:62 ( (Jan.) ) 1962. 9. McCaughan, J. J.: Successful Arterial Grafts to the Anterior Tibial, Posterior Tibial (Below the Peroneal), and Peroneal Arteries , Angiology 12:91 ( (March) ) 1961.Crossref 10. Morris, G. C.; DeBakey, M. E.; Cooley, D. A., and Crawford, E. S.: Arterial Bypass Below the Knee , Surg. Gynec. Obstet. 108:321 ( (March) ) 1959. 11. Morris, G. C., Jr.; Wheeler, C. G.; Crawford, E. S.; Cooley, D. A., and DeBakey, M. E.: Restorative Vascular Surgery in the Presence of Impending and Overt Gangrene of the Extremities , Surgery 51:50 ( (Jan.) ) 1962. 12. Ortner, A. B.; Berg, H. F., and Lebendiger, A.: Limb Salvage Through Small-Vessel Surgery , Arch. Surg. 83:414 ( (Sept.) ) 1961.Crossref 13. Palma, E. C.: Treatment of Arteritis of the Lower Limbs by Autogenous Vein Grafts , Minerva Cardioangiol. p. 36, 1960. 14. Pridgen, W., and Dale, W. A.: Composite (Teflon and Autogenous Vein) Grafts in Small Canine Arteries , Amer. Surg. 28:469 ( (July) ) 1962. 15. Roberts, B., and Hardesty, W. H.: Results Following Femoral and Popliteal Arterial Reconstructions , Ann. Surg. 154:68 ( (July) ) 1961.Crossref 16. Szilagyi, D. E., and Fallis, L. S.: Groin to Calf By-Pass Graft in the Treatment of Femoro-Popliteal Arterial Occlusive Disease , Minerva Cardioangiol. p. 150, 1960. 17. Warren, R.; John, H. T.; Shepherd, R. C., and Villavicencio, J. L.: Studies on Patients with Arteriosclerotic Obliterative Disease of the Femoral Artery , Surgery 49:1 ( (Jan.) ) 1961.
Archives of Surgery – American Medical Association
Published: Jan 1, 1963
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