The fate of patients with intermittent claudication managed nonoperatively.

Of 100 patients with intermittent claudication, followed an average of six years, a surprising 78 per cent either showed improvement or remained stable regarding the presenting complaint. However, 39 per cent showed evidence of further progression of atherosclerosis. In patients with femoropopliteal occlusion in one leg, almost 40 per cent had occlusion in the one leg, almost 40 per cent had occlusion in the other leg after two to six years. The amputation rate was 7 per cent but six of these seven patients had severe diabetes. This study suggests that we are not causing limb loss by adhering to stringent criteria for bypass grafting. It also suggests that the patient with intermittent claudication without associated grave signs has a better than 50 per cent chance of improving and a better than 60 per cent chance that his disease will not show evidence of significant progression during a five to six year period. Such data should be taken into consideration when patients are considered for arterial reconstruction.

Predictability of surgical response in renovascular hypertension.

One hundred sixteen patients underwent operation for renovascular hypertension from 1962 through 1975; 64% had aortorenal reconstruction and 36% had nephrectomy. Sixty-six percent were cured and 19% were improved. Rapid sequence intravenous pyelography, radioisotope renography, and renal arteriography were equal in ability to detect renovascular hypertension. Bilateral renal biopsy specimens had excellent prognostic value when performed in a graded semiquantitative manner. Plasma renin activity was the most consistently useful criterion for prediction of surgical cure if the following requirements were used: (1) elevated peripheral plasma renin activity, (2) elevated renin from the affected kidney, and (3) suppressed renin secretion from the contralateral kidney. An angiotensin II antagonist, saralasin acetate, used in six patients before operation in an attempt to identify those whose hypertension depended on angiotensin II activity, produced a depressor response correlating well with the surgical result.

Factors influencing patency of femoropopliteal artery bypass grafts.

An analysis of 276 femoropopliteal bypass procedures performed in 264 patients at the Columbia-Presbyterian Medical Center over the past two decades showed a direct relationship of graft patency to preoperative popliteal artery runoff. Fuctional results were better than patency results. Sympathectomy and anticoagulation did not improve graft patency. The risk of amputation is outweighed by the benefits of restoration of blood flow to the ischemic extremity by a byass procedure.