[Surgical treatment of sclerotic arterial diseases of the lower limbs]

Abstract

Among arterial reconstruction procedures, thromboendarterectomy has progressively left place to prosthetic grafts for aorto-iliac surgery. At infra-inguinal level, inversed or in situ venous grafts allow distal revascularisations down to the foot. Lumbar sympathectomy keeps some indications. Indications depend upon the level of arterial obstruction, the symptoms, and the operative risk of the patient. At aorto-iliac level surgery provides excellent results; indications for proximal surgery are large; operative risk is the main limiting factor. At infra-inguinal level surgery is well tolerated but permeability rates are not as good as with aorto-iliac surgery; distal surgery is appropriate only is case of critical ischaemia, when everything must be done for limb salvage.