Surgical Treatment of Arteriosclerosis Obliterans

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ENCOURAGING results have been noted in the majority of patients who during the past six months have received surgical treatment for arteriosclerosis obliterans of the aorta, the iliac, or the femoral arteries. The disease has been treated by resection of the occluded segment and establishment of continuity of the vessel with a frozen-dried arterial graft. In 12 of the 14 patients receiving the surgical treatment, the postoperative courses have so far been favorable.

Arteriosclerosis obliterans may be diffuse or segmental in nature. It tends to be diffuse in patients 60 years of age or older; whereas the segmental form usually occurs in patients 40 to 50 years of age in whom the arteries are otherwise mildly involved. Our preliminary report is limited to cases of the segmental form, since only this type is amenable to the surgical procedure of grafting.

In the segmental form of the disease, the presenting complaint is intermittent claudication of the back, buttock, hip, thigh, or calf, the location depending upon the vessel occluded. The principal finding is the absence of pulses below the point of occlusion in an otherwise essentially normal limb.

Angiographic visualization of the anatomic pattern reveals the details of the occlusion, which determine operability. A typical example of angiographic visualization is shown in figure 1: the occlusion is at the aortic bifurcation, extending approximately 2½ inches down the common iliac artery. The other vessels appear to be normal. Figure 2 shows the resected specimen, the graft used, the operative procedure, and the . . .



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