ABSTRACT
To determine the usefulness of arterial reconstruction, we studied the outcome of 430 patients with arteriosclerosis obliterans who had received either arterial reconstructive surgery or medical treatment. Of the 430, 301 patients were treated for intermittent claudication and 162 for limb-threating ischemia (rest pain or ischemic gangrene). Of the intermittent claudication patients 274 underwent arterial reconstruction and 27 were treated with anticoagulant therapy. In limb-threating ischemia, 137 patients underwent arterial reconstruction and 25 were treated with anticoagulant therapy. Among the 274 intermittent claudication patients treated by arterial reconstruction, none required major amputation within 30 days after surgery. Operative mortality was 1.1%. Five- and ten- year comulative patency rates were 95.4%, 94.3% in aortofemoral bypasses, 72.7%, 67.5% in aortofemoropopliteal bypasses, 79.7%, 77.9% in femoropopliteal bypasses and 92.3%, 92.3% in femorotibial bypasses, respectively. On long-term results, 86.4% improved and 5.9% deteriorated. Five patients (1.4%) underwent major amputation during the follow-up period due to graft occlusion. Four of 5 amputations involved patients whose initial reconstruction method was femoropopliteal bypass. In 27 patients treated medically, 77.8% did not show any change in symptoms and 22.2% deteriorated during the follow-up period. Two patients (5.6%) underwent bypass grafting in the late phase. Of 137 patients with limb-threating ischemia treated by arterial reconstruction, 3.3% required major amputation in the early postoperative period. Operative mortality was 5.1%. Five- and 10-year cumulative patency rates were 83.3%, 79.7% in aortofemoral bypasses, 65.5%, 65.5% in aortofemoropopliteal bypasses, 76.2%, 63.9% in femoropopliteal bypasses and 38.6% in femorotibial bypasses, respectively. In long-term results, 62.3% improved and 12.6% deteriorated. Thirteen patients (8.6%) underwent major amputation during the follow-up period. In 25 patients with limb-threating ischemia treated medically, 16.0% died during their hospital stay and 33.3% required major amputation during the follow-up period. Five- and 10-year cumulative survival rates in arterial reconstruction patients were 77.4%, 57.6% in intermittent claudication patients and 64.3%, 41.5% in limb-threating ischemia patients, respectively. The survival rate in limb-threating ischemia was significantly lower than that in intermittent claudication. The results of reconstructive surgery for intermittent claudication were better than those of medical treatment. However, 4 femoropopliteal bysass cases required major amputation in the late phase. This suggests that it is difficult to determine the indications for infrainguinal artery reconstruction in intermittent claudication. Arterial reconstructive surgery for limb-threating ischemia was useful for salvaging the limbs. In these patients, careful perioperative treatment was necessary. Limb salvage rate and survival rate in limb-threating ischemia patients were poorer than those in intermittent claudication patients. We recommend performing arterial reconstructive surgery for disabling claudication before the patient progresses to limb-threating ischemia.