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.

Adult↗

PubMedDate not supplied

Percutaneous transluminal angioplasty of iliac and femoral arteries in severe lower-limb ischaemia.

Percutaneous transluminal angioplasty was performed 92 times in 86 patients with severe lower-limb ischaemia (40% occlusion), giving rise to rest pain and/or gangrene. The patients were thereafter observed for periods up to 5 years. Criteria for success were appearance of normal groin pulse (iliac angioplasty) or persistent greater than or equal to 0.15 rise in arm/ankle blood pressure index (femoropopliteal angioplasty). The respective technical success rates were 82% and 64%. The complication rate was 10.9%, including 5.4% distal embolization. Patency rates were higher in iliac than in femoropopliteal lesions, in stenotic than occluded vessels, and also when the lesion was shorter than 5 cm and if there was good run-off. Limb salvage exceeded patency by 10% in the iliac procedures and by 15% in the femoropopliteal. Percutaneous transluminal angioplasty is recommended for selected cases of severe lower-limb ischaemia, and should always be considered for limb salvage. Reocclusion does not necessarily imply clinical failure. Technical failures should be included in calculated patency rates in order to document the method's limitations.

Adult↗

PubMedDate not supplied

Arterial pressure measurements correlated to symptoms and signs of peripheral arterial disease.

The systolic pressure observed in 150 patients with peripheral arterial disease has been compared to their symptoms and signs. In patients with claudication the ankle mean pressure was 58 mmHg. In patients with rest pain it was 33 mmHg and in patients with chronic ulcerations it was 20 mmHg. In these 3 groups the mean ankle-foot pressure gradient was low (2-10 mmHg) were detected at the level of the iliaco-femoral and femora-popliteal segments. In the group of diabetic patients an high gradient was observed. Patients with peripheral arterial disease can be divided in four symptomatic groups but the angiographic and physiological patterns of patients with rest pain and ischemic ulcerations are similar and they are the best candidates to reconstructive arterial surgery.

Arterial Occlusive Diseases↗

PubMedDate not supplied

Hemodynamics of critical arterial stenoses.

The mechanics and the physiological problems related to critical arterial stenosis have been investigated by mathematical, biological and clinical models in experimental and clinical conditions. The value of critical stenosis has been defined in many ways but all the previous report on this subject agree in defining critical stenosis a reduction in section of the artery that can alter the poststenotic flow and pressure. Experimentally appreciable changes in pressures and flow do not occur until the cross-sectional area of a vessel has been reduced by more than 75% and these data are comparable to clinical situations. The data of several reports on this subject are plotted and compared and the different experiences are analysed to evaluate the best criteria to define the critical value of one stenosis and the clinical utilizations.

Arterial Occlusive Diseases↗