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Limb Salvage in Occlusive Arterial Disease of the Lower Extremities: Recent Changes in the Surgical Approach

Limb Salvage in Occlusive Arterial Disease of the Lower Extremities: Recent Changes in the... Abstract Introduction During the past decade the development of techniques for direct reconstruction of peripheral arteries has permitted the salvage of an increasing number of limbs which would otherwise have been consigned to amputation. Although lumbar sympathectomy alone may have considerable value in the palliative treatment of occlusive arterial disease of the lower extremities, it has become apparent that direct restoration of blood flow in major vessels, when applicable, is more effective for limb salvage. However, is seems that bypass techniques currently employed are not practicable when arteriosclerotic involvement of the distal popliteal artery causes marked narrowing or occlusion of this vessel sufficient to prevent construction of an adequate distal anastomosis. Rather than to consign patients who have inadequate distal run-off to a painful, useless existence until amputation is inevitable, we have attempted to broaden the indications for reconstructive arterial surgery by offering "extensive" endarterectomy to such patients.We are indebted References 1. The ulcer later healed completely and the patient was discharged, fully rehabilitated, three months after presentation of this paper. 2. Barker, W. F.; Cannon, J. A.; Zeldis, L. J., and Ah'Tye, P.: Anatomical Results of Endarterectomy , S. Forum 6:266, 1955. 3. Cannon, J. A.; Barker, W. F., and Kawagami, I. G.: Femoral Popliteal Endarterectomy in the Treatment of Obliterative Atherosclerotic Disease , Surgery 43:76, 1958. 4. dos Santos, J. C.: Sur la désobstruction des thromboses arterielles anciennes , Mém. Acad. chir. 73:409, 1947. 5. Kunlin, J.: Résultats de l'endartériectomie expérimentale: étude histologique , Mém. Acad. chir. 74:557, 1948. 6. Leriche, R., and Kunlin, J.: Essai de désobstruction des artéres thrombosées suivant l'technique de Jean Cid dos Santos , Lyon chir. 42:675, 1947. 7. Richards, J. W.: Personal communication to the authors. 8. Warren, R.: Evaluation of Thromboendarterectomy for Arteriosclerosis Obliterans of the Femoral Artery , Surg. Gynec. & Obst. 104:571, 1957. 9. Warren, R., and Villavicencio, J. L.: Iliofemoropopliteal Arterial Reconstructions for Arteriosclerosis Obliterans , New England J. Med. 260:255, 1959. 10. Wylie, E. J., and Gardener, R.: Thromboendarterectomy: A Clinical Appraisal , Surgery 37:415, 1955. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Limb Salvage in Occlusive Arterial Disease of the Lower Extremities: Recent Changes in the Surgical Approach

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Publisher
American Medical Association
Copyright
Copyright © 1960 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1960.01300030017003
Publisher site
See Article on Publisher Site

Abstract

Abstract Introduction During the past decade the development of techniques for direct reconstruction of peripheral arteries has permitted the salvage of an increasing number of limbs which would otherwise have been consigned to amputation. Although lumbar sympathectomy alone may have considerable value in the palliative treatment of occlusive arterial disease of the lower extremities, it has become apparent that direct restoration of blood flow in major vessels, when applicable, is more effective for limb salvage. However, is seems that bypass techniques currently employed are not practicable when arteriosclerotic involvement of the distal popliteal artery causes marked narrowing or occlusion of this vessel sufficient to prevent construction of an adequate distal anastomosis. Rather than to consign patients who have inadequate distal run-off to a painful, useless existence until amputation is inevitable, we have attempted to broaden the indications for reconstructive arterial surgery by offering "extensive" endarterectomy to such patients.We are indebted References 1. The ulcer later healed completely and the patient was discharged, fully rehabilitated, three months after presentation of this paper. 2. Barker, W. F.; Cannon, J. A.; Zeldis, L. J., and Ah'Tye, P.: Anatomical Results of Endarterectomy , S. Forum 6:266, 1955. 3. Cannon, J. A.; Barker, W. F., and Kawagami, I. G.: Femoral Popliteal Endarterectomy in the Treatment of Obliterative Atherosclerotic Disease , Surgery 43:76, 1958. 4. dos Santos, J. C.: Sur la désobstruction des thromboses arterielles anciennes , Mém. Acad. chir. 73:409, 1947. 5. Kunlin, J.: Résultats de l'endartériectomie expérimentale: étude histologique , Mém. Acad. chir. 74:557, 1948. 6. Leriche, R., and Kunlin, J.: Essai de désobstruction des artéres thrombosées suivant l'technique de Jean Cid dos Santos , Lyon chir. 42:675, 1947. 7. Richards, J. W.: Personal communication to the authors. 8. Warren, R.: Evaluation of Thromboendarterectomy for Arteriosclerosis Obliterans of the Femoral Artery , Surg. Gynec. & Obst. 104:571, 1957. 9. Warren, R., and Villavicencio, J. L.: Iliofemoropopliteal Arterial Reconstructions for Arteriosclerosis Obliterans , New England J. Med. 260:255, 1959. 10. Wylie, E. J., and Gardener, R.: Thromboendarterectomy: A Clinical Appraisal , Surgery 37:415, 1955.

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1960

References