Arteriosclerosis and its Surgical Treatment

動脈硬化症と外科治療 : とくに下肢閉塞性動脈硬化症について

Arteriosclerosis and its Surgical Treatment

Creators Esato Kensuke

Creators Mohri Hitoshi

In this view, surgical treatment of obliterative arterial disease of the lower extremity was discussed in connection with pathologic condition, etiologic, diagnosis and laboratory evaluation. Age, sex, diet, diabetes mellitus, smoking and local trauma are believed to gradually aggravate or influence adversely the incidence of the disease. The diagnosis can be made by the history alone or by the physical examination alone in most patients. The two major symptoms are intermittent claudication and ischemic rest pain. It is important to differentiate this disease from thromboangitis obliterans, popliteal artery entrapment syndrome and neurogenic claudication. The final diagnosis can be made by an arteriography, showing calcification, irregular wall, stenosis and occlusion in the involved arterial segment. Alternative treatments include indirect arterial surgery, lumbar sympathectomy, and direct arterial surgery such as thromboendarterectomy and bypass of an occluded arterial segment. The results following direct arterial surgery are so dramatic that there can be no doubt of its value. The choice of whether to perform thromboendarterectomy or by pass grafting is controversial. Generally speaking, many vascular surgeons prefer to insert a bypass graft from the aorta to the common femoral artery, and from the common femoral artery to the popliteal artery, endarterectomizing the artery at the site of the anastomosis. Distal grafting below the knee is difficult in arterial reconstruction. Basically, the most fundamental determinant of successful direct arterial surgery is an adequate inflow and outflow of blood. In our clinical cases, early and late patency of bypass grafts was high in patients with three patent arteries below the knee. Autogenous vessels, biografts and synthetic grafts have their widest application in arterial reconstructive surgery. Autogenons vessels, the saphenous vein, are superior to synthetic tubes in peripheral arterial surgery, while synthetic grafts were usually used in surgery of the thoracic aorta, the abdominal aorta and the iliac arteries.

[ISSN]0513-1731

[NCID]AN00243156