J.Jpn. Surg. Soc.. 81(12): 1585-1589, 1980

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Original article

RECONSTRUCTIVE SURGERY FOR PERIPHERAL ARTERIOSCLEROSIS OBLITERANS WITH CARDIAC OR CEREBROVASCULAR INSUFFICIENCY

From May, 1967 through August, 1979, reconstructive surgery was performed on 145 limbs in 98 patients with arteriosclerosis obliterans. Among them, 25 cases presented with cardiac insufficiency, 5 patients with cerebrovascular insufficiency, and 4 patients with the both insufficiency. Among these 34 cases, 29 patients presented with hypertension, 21 patients with hepatic or renal insufficiency, and 4 patients with diabetes mellitus. All patients were followed up to 80 months (mean: 19.4 months).
The patency rate (life table method) was 56.4% at 6 months and 43.7% at 5 years. The survival rate decreased significantly to 69.5% at 6 months and 32.1 % at 5 years. Four of 6 patients with cardiac insufficiency who had received transperitoneal reconstruction under general anesthesia died by the end of this study. In the patients with cardiac insufficiency, extraperitoneal reconstruction under regional anesthesia is recommended.
Reoperations on the same limbs resulted in poor prognosis. Five of 8 patients who had received reoperation over 2 times died and all 3 patients who had received reoperation over 3 times died by 7 months. No relation between survival rate and time of operation or quantity of bleeding was observed.
Amputation may become first choice in the cases of failure.

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