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Surgical treatment of occlusive arterial disease of the legs
Abstract:
During the period 1959-68, a total of 982 patients were submitted to treatment for arteriosclerotic vascular lesions in the lower limbs in Department M, Bispebjerg Hospital, Copenhagen. Conservative treatment solely was undertaken in 425 cases, while in addition 271 limbs were amputated after varying periods of conservative therapy or observation. Primary lumbar sympathectomy was undertaken in 25 patients. In the remaining 261 patients, indications were found for arterial reconstruction. In 25 cases explorative intervention only was undertaken. In the remaining 236 patients, 255 reconstructive interventions were undertaken during the period. These comprised 113 thrombendarterectomies, 71 of which were in vessels distal to the inguinal ligament, and 142 by-pass operations. In the latter procedures, five bifurcation prostheses were introduced, 40 simple prostheses with proximal anastomosis to the aorta or the iliac arteries, and 53 synthetic prostheses and 44 venous prostheses with proximal anastomoses to the femoral artery. Eight patients (3.4 percent) died postoperatively, while amputation had to be resorted to in 20 (8 percent). On discharge, pulsation distal to the site of operation was found in 61 percent of the patients discharged, one year later in 44 percent of the survivors and five years later in 23 percent. A total of 62 (24 percent) limbs were amputated on an average of 14 months after operation. 224 cases could be assessed after an average of 4 4/12 years. In 58 cases there was definite clinical improvement and pulsation distal to the site of operation. In 44 cases, pulsation had been present after operation and definite clinical improvement, but no pulsation distal to the reconstructed vessel was found at the follow-up examination. In 122 cases no evident beneficial effect of operation could be demonstrated at follow-up examination. The indications for operation and the incidence of operation are discussed, and the results compared with those of previous publications.