[Peripheral arterial occlusive disease of the lower extremities]

Disturbance of the arterial perfusion of the lower limbs with occlusion in the aorto-iliac area presents a broad field of operative treatment in younger patients below 70 years of age. In older people caution is necessary depending on preexisting multiple morbidity. If necessary, extra-anatomic bypass operations have to be taken into consideration in order to save a jeopardized leg. Limb salvage should be accomplished whenever possible. In case of involvement of the femoro-popliteal region even in old age patients aggressive surgery for limb salvage is important because of high mortality due to primary amputation and last not least because of better life quality and for cardiovascular training. Conservative treatment of occlusions in the aorto-iliac area is not promising much success. Therefore in this area vascular surgery is the treatment of choice. In contrary arterial occlusion of the femoro-popliteocrural region--especially if both are combined--can be positively influenced by conservative angiological regimen. Hence conservative therapy should always be tried first, before difficult and long lasting vascular reconstructions are taken into consideration. One should not forget that surgery of occlusive vascular disease is only a symptomatic therapy, not a curative one. Life expectancy is not enhanced, but only ability of walking is saved. Generally spoken, the patient with occlusive vascular disease of the lower limbs nowadays can be offered a differentiated and individualized therapy including, also, non-surgical procedures. Well planned reconstructive vascular surgery has a good long time prognosis saving the physical integrity and efficiency of the older patient suffering from disabling vascular alterations.