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[Indication and results of surgical treatment of intermittent claudication]
S Ishimaru1, T Shimizu, T Yamazaki
1Department of Surgery, Tokyo Medical College, Japan.
Insights
Surgical intervention, including bypass surgery and laser angioplasty, effectively treats arteriosclerosis obliterans (ASO) causing intermittent claudication. Procedures improved patient quality of life with low graft occlusion and mortality rates.
Area of Science:
- Vascular Surgery
- Cardiology
- Geriatrics
Context:
- Intermittent claudication due to arteriosclerosis obliterans (ASO) significantly impacts patient quality of life.
- Surgical interventions are considered for ASO, but their indications and efficacy require clarification.
- Co-existing conditions like coronary artery disease and intellectual dysfunction influence treatment decisions.
Purpose:
- To evaluate the appropriateness of surgical treatment for ASO-related intermittent claudication.
- To define indications for vascular reconstruction in ASO patients.
- To assess the impact of surgical interventions on patients' quality of life.
Summary:
- 188 ASO patients were studied; 149 underwent bypass surgery or laser angioplasty (PTLA), while 39 received conservative treatment due to high-risk factors.
- Anatomical bypass was performed in 88 patients, and extra-anatomical bypass in 61. Graft occlusion occurred in 8 cases.
- Postoperative follow-up at 32 months showed a 96.6% patency rate for anatomical bypass and 91.8% for extra-anatomical bypass, with a 2.7% operative mortality rate and no major amputations due to graft occlusion.
Impact:
- Surgical reconstruction, including anatomical and extra-anatomical bypass, is a viable treatment for ASO with favorable long-term patency rates.
- Laser angioplasty (PTLA) and bypass procedures offer effective management for intermittent claudication, improving patient outcomes.
- Careful patient selection, considering factors like coronary artery disease and intellectual dysfunction, is crucial for successful surgical intervention in ASO.
Abstract:
In order to clarify the propriety of surgical treatment for intermittent claudication caused by arteriosclerosis obliterans (ASO), indication for vascular reconstruction and efficacy of surgery on patient's quality of life were investigated. Bypass surgery or laser angioplasty (PTLA) was undertaken in 149 of 188 ASO patients. Because of high risk factors (renal failure, ischemic heart disease, cerebro-vascular disturbance or malignant tumor), 39 patients were treated conservatively. Intellectual dysfunction in aged patient was evaluated by Okabe's brief mental scale test. Coronary artery disease was revealed by coronary angiography performed next to routine dipyridamole-loaded ECG in 19 to 78 patients. CABG or PTCA was performed prior to peripheral vascular reconstruction in 3 patients with serious coronary disease. Extra-anatomical bypass or PTLA was indicated mainly in patients with coronary artery disease or intellectual dysfunction. The anatomical bypass and the extra-anatomical bypass were undertaken in 88 and 61 patients respectively. Graft occlusion was observed in 8 cases. Patency rate of the anatomical bypass was 96.6% and that of the extra-anatomical bypass was 91.8%, at 32 months of postoperative mean follow-up period. The operative mortality rate was 2.7%. There was no major amputation due to graft occlusion.