[Surgical treatment of arteriosclerotic arterial occlusive disease]

Various kinds of surgical technique have been utilized for vascular reconstruction for arteriosclerotic arterial occlusive disease (ASO). In general concept, application of thromboendarterectomy is limited to the segmental occlusive aortoiliac atherosclerosis and bypass surgery can be used for almost all types of arterial occlusion. Patency result after bypass surgery are well established and the five year patency rates reveal more than 90% in aortoiliac disease, 75-80% in femoropopliteal disease, and around 70% in crural reconstruction respectively. Despite of these recent advances of reconstructive vascular surgery, there have been augmented several controversies in surgical treatment of ASO. How to treat multisegmental lesion which is characterized by high incidence of ischemic ulcer or gangrene. What is the treatment of choice for high risk patient especially with ischemic heart disease. In Japan, aged patient over 80 have been increasing and they are frequently complicated with limb threatening ischemia and usually grouped into high risk patient. Endovascular intervention, which is developed under the basis of recent technology, is the one of the topics of treatment of peripheral vascular disease. Its long term results, however, are not sufficiently evaluated and how to select the proper reconstructive procedures including the endovascular intervention for high risk patient is remained to be controversy.