[Spontaneous course of peripheral, stenosing arteriosclerosis and the effect of catheter interventions]

Peripheral obliterating arteriosclerosis tends to progress. If it was previously a mainly unilateral disease, similar alterations on the opposite side are to be expected in the near future. This applies in particular to the most frequent incidence, occlusion of the femoral artery, which only rarely remains unilateral. Clinical symptoms of stenotic lesions are often found in the still-patent femoral artery, and the tendency to complete obliteration can be appraised from these lesions. The progression appears to be slower in patients in whom endogenous risk factors are present than in patients in whom smoking is regarded as the crucial factor. In the region of the pelvic arteries, the tendency to bilateral obliteration is considerably less. Stenoses of the iliac artery also have a less pronounced tendency to occlusion than do stenoses of the femoral artery. Manifestation of the disease in a different segment of the artery is far rarer and mostly develops proximal to the already existing obliteration. Occasional regressions of the stenoses probably result from the reduction of thrombotic deposits. Catheter interventions may affect the spontaneous course in various ways. It appears possible that the imminent complete obliteration can be delayed or prevented by stretching of the stenosis. After elimination of an isolated arterial occlusion, the collateral dilatation regresses. If a further obliteration is situated distal to the reopened section of the artery, an additional collateral dilation develops there. A reobliteration develops relatively frequently after catheter recanalization of the femoral artery and may have an unfavorable effect on the further course.