Outcomes in Patients with Critical Limb Ischemia due to Arteriosclerosis Obliterans Who Did Not Undergo Arterial Reconstruction.

The prevalence of arteriosclerosis obliterans (ASO) and critical limb ischemia (CLI) is currently increasing, and arterial reconstruction is often attempted to salvage the limb. Some patients cannot undergo attempted revascularization because of contraindications, and they only receive conservative treatment. In this study, we investigate the comorbidities and survival rates of patients with CLI who receive conservative treatment. Thirty-five patients with CLI due to ASO, who had not undergone revascularization surgery (C group), were enrolled. As controls, 136 patients with CLI due to ASO who did undergo revascularization (R group), mainly via bypass surgery, were enrolled. Coronary artery disease, heart failure, and respiratory dysfunction were factors indicating conservative treatment. Limb salvage rates and survival rates were not significantly different between the two groups. Patients who had survived for less than two years after surgery had a higher prevalence of chronic heart failure, cardiovascular disease, and end-stage renal disease compared to patients who had survived for more than two years. The use of statins, dual antiplatelets, aspirin, or warfarin did not influence whether a patient survived for longer than two years. 77% of patients survived for more than two years after receiving only conservative therapies. Surgical revascularization did not improve the prognosis of patients with CLI as compared with the conservative therapy. Clinicians might start with conservative treatment while considering other treatment options for patients with CLI.

Baseline Characterization of Japanese Peripheral Arterial Disease Patients　- Analysis of Surveillance of Cardiovascular Events in Antiplatelet-Treated Arteriosclerosis Obliterans Patients in Japan (SEASON).

BACKGROUND: Despite mounting evidence of increased cardiovascular events in patients with peripheral arterial disease (PAD), the overall incidence of cardiovascular events in PAD patients has not been fully clarified in Japan. The prospective Surveillance of cardiovascular Events in Antiplatelet-treated arterioSclerosis Obliterans patients in JapaN (SEASON) is a prospective observational multicenter study and here we report the baseline clinical characteristics, including atherosclerosis risk factor prevalence, in PAD patients treated with antiplatelet agents. METHODS AND RESULTS: The SEASON registry enrolled 11,375 patients in 1,745 institutions and the data for 10,322 patients were analyzed. At baseline, the average age was 73.8±9.9 years, 60.0% were male and 83.9% were in Fontaine stage I or II. They had arteriosclerosis risk factors, such as current smoking (16.2%), hypertension (61.5%), diabetes mellitus (38.3%) and dyslipidemia (38.8%). There were complications including heart disease (29.7%), cerebrovascular disease (17.1%) and chronic kidney disease (14.3%). A subpopulation analysis revealed that the proportions of patients with risk factors were high in patients with lower ankle-brachial pressure index value. CONCLUSIONS: The baseline characteristics of the SEASON population demonstrate that real-world PAD patients have cardiovascular risk factors and comorbidities next to definite PAD patients. Further analysis of this database will contribute to understanding the real-world situation of PAD patients receiving antiplatelet therapy in Japan. (Circ J 2016; 80: 712-721).

Relationship between arteriosclerosis obliterans and the ratio of serum eicosapentaenoic acid to arachidonic acid.

PURPOSE: A low ratio of serum eicosapentaenoic acid to arachidonic acid (EPA/AA) has been associated with coronary artery disease. We retrospectively examined serum concentrations of polyunsaturated fatty acids in patients with arteriosclerosis obliterans (ASO) and in non-atherosclerotic patients. METHODS: From April 2011 to March 2012, serum EPA/AA was retrospectively examined in 33 consecutive outpatients with ASO complicated by intermittent claudication and 21 outpatients with hypercholesterolemia without ASO as controls. The Student's t-test was used for continuous variables and Chi-square test for categorical variables, with analysis of covariance adjusting for age, sex, body mass index, smoking, alcohol, and diabetes. RESULTS: The ASO group were significantly different with regard to mean age (71.5 vs. 63.9 year-old, p = 0.03), body mass index (21.3 vs. 24.1 kg/m(2), p = 0.002) and morbidity of diabetes mellitus (51.5 vs. 4.8%, p = 0.0004). Serum EPA/AA was significantly decreased in ASO (0.36 vs. 0.61, p = 0.03), when adjusted for age, sex, body mass index, smoking status and alcohol drinking, but was not statistically significant when adjusted for diabetes. CONCLUSION: Patients with ASO were more likely to have a low EPA/AA ratio and non- diabetic patients with ASO had a significantly reduced EPA/AA.

[Prevalence and risk factors of peripheral arterial disease in an outpatient screening campaign]. / Évaluation de la prévalence et des facteurs de risque de l'artériopathie oblitérante des membres inférieurs dans le cadre d'une campagne de dépistage ambulatoire.

BACKGROUND: Peripheral arterial disease (PAD) is an important predictor of cardiovascular disease with major medico-economic consequences. However, systematic screening of asymptomatic patients free from history of cardiovascular disease is debated. OBJECTIVE: Determining the prevalence, risk factors for PAD in a population of outpatients at intermediate or high-risk of cardiovascular disease, free from history of cardiovascular disease to assess the potential impact of PAD screening in such groups of patients. METHODS: Multicenter 1-day screening program of PAD conducted from 2008 to 2010 in a population defined by diabetes plus age greater than 50 years, positive active smoking status, or age greater than 70 years. PAD was defined as an ankle-brachial index (ABI) less than 0.9 measured as follows: lowest systolic ankle pressure divided by highest systolic arm pressure. RESULTS: Ten thousand six hundred and fourteen patients fulfilled study inclusion criteria: 16.7% (n = 1774) exhibited an ABI less than 0.9 and 3.8% (n = 407) an ABI less than 0.7. ABI greater than 1.3 was found in 7.7% of patients (n = 818). Age greater than 70 years, male gender, active smoking status, hypertension and diabetes (treated) were independent risk factors for PAD. CONCLUSION: Primary prevention outpatient screening of a population with intermediate or high cardiovascular risk can identify numerous patients with PAD. The medical impact in terms of cardiovascular mortality and morbidity of such a screening needs to be assessed.

[Influence of gender on development and prognosis of atherosclerosis obliterans].

OBJECTIVE: To evaluate the influence of gender on the development and prognosis of atherosclerosis obliterans (ASO). METHODS: Eight hundred and forty-two patients with ASO were treated from January 2000 to February 2007. The clinical data were retrospectively collected. And the influence of gender on the development and prognosis of ASO was investigated. RESULTS: Among the 842 patients, 661 were male and 181 were female. The ratio of male to female was 3.65 : 1.00, and the ratio decreased with increasing age. The mean age of male and female patients were (71.7 +/- 9.0) years and (75.7 +/- 6.8) years, respectively. Significantly more iliac lesions occurred in male patients than in female, while female patients experienced more infrainguinal lesions. The coexistence rate of diabetes and amputation rate were significantly higher in female patients than in male (46.4%/24.7% and 16.0%/9.1%, respectively). CONCLUSION: The female patients with ASO appear to have poorer prognosis than the male, despite their lower incidence of ASO.

Arterialization of the hand venous system in patients with critical ischemia and thrombangiitis obliterans.

The lesion of distal arteries in patients with thrombangiitis obliterans happened to looking for nondirect methods of blood supply improvement of the involved limb - transplantation of omental pedicle, arterialization of veins, thoracic sympathectomy, etc. From 1986 in the Department of vascular surgery of A. V. Vishnevsky Institute of Surgery we use method of arterialization of the venous system in patients with critical lower limb ischemia of differ etiology. Practically at the same time we applied this operation for patients with critical upper limb ischemia and thrombangiitis obliterans. In this paper we present our successful experience of 5 operations - arterialization of the hand venous system in 4 patients with thrombangiitis obliterans and critical upper limb ischemia. We reviewed in details the technique of performance of arterialization of the hand venous system and studied the long-term results of the treatment.

[Analysis of peripheral arterial obstructive disease related factors among diabetic population aged > or = 50].

OBJECTIVE: To analyze the peripheral arterial obstructive disease (PAD) related factors among diabetic population aged > or = 50 in China. METHODS: The clinical data of 1397 diabetic patients aged > or = 50 with at least one of the following risk factors: smoking, hypertension, and hyperlipidemia, from 15 Class III Grade A hospitals in 7 major cities of China were collected. Diagnosis of PAD was based on the ankle brachial index (ABI) < 0.9, and diagnosis of arteriosclerosis was based on pulse wave velocity (PWV) > 1400 cm/s. Regression studies were made to analyze the relations among PAD and various risk factors: age, sex, body mass index (BMI), smoking, hypertension, hyperlipidemia, history of cerebral vascular disease (CVD), history of ischemia heart disease (IHD) etc. RESULTS: The current prevalence rate of PAD was 19.47% among the 1397 patients, 18.3% (122/664) among the male patients, and 20.4% (150/733) among the female patients. The prevalence of PAD in the patients aged > or = 70 was as high as 31.9%. The duration of diabetes course was positively correlated with the prevalence of PAD (chi2 = 11.9, P = 0.0026). The ABI abnormality rate was 15.78% among those with a diabetic course of 5 years and was 23.84% among those with a diabetic course of 10 years. The abnormal ABI rate of the patients with CVD was 30.57%, significantly higher than that of hose without CVD (17.29%, chi2 = 21.49, P < 0.0001). The abnormal ABI rate of the patients with IHD was 24.64%, significantly higher than that of the patients without IHD (18.20%, chi2 = 5.85, P = 0.0155). The HbA1c value of the PAD patients was significantly higher than that of the patients without PAD (chi2 = 5.10, P = 0.0239) Odd risk analysis showed that age increase of 10 years increased the PAD risk by 1.64 times (OR = 1.6444, P = 0.0001). The PAD risk of the smokers was 1.68 times higher than that of the non-smokers (OR = 1.6852, P = 0.0001). Increase of 10 mm Hg in systolic blood pressure (SBP) increased the PAD risk by 1.19 times (OR = 1.1926, P = 0.01). The PAD risk of the patients with abnormal HbAlc was 2.44 times higher than that of the patients with normal HbA1c (OR = 2.4473, P = 0.0001). One-year's increase of the hypertension course increased the PAD risk by 1.02 times (OR = 1.0194, P = 0.03). Logistic analysis indicated that the relations among PWV and the risk factors were almost the same among ABI abnormality and the risk factors. CONCLUSION: Approximately one fifth of diabetic patients aged > or = 50 in China suffer from PAD. Age, course of diabetes, blood glucose level, SBP, IHD, and CVD are risk factors for PAD. Early intervention and treatment of hypertension and hyperglycemia, and quitting smoking are important in reducing the occurrence of PAD. ABI and PWV are not only diagnostic means for PAD, but also alarm guide indexes for cerebral vascular disease (CVD).

Atherosclerosis obliterans of the lower extremities in Thai patients.

BACKGROUND: Major limbs loss and high mortality rate were observed in the management of Thai patients with atherosclerosis obliterans (ASO) of the lower extremities. These were the results of delayed diagnosis and treatment together with the associated morbidities. There is a lack of information of this disease resulting in a lack of knowledge and awareness of this problem among general practitioners in Thailand. OBJECTIVES: The purposes of this study were (1) to identify the prevalence of this disease in a tertiary care hospital, (2) to enumerate the risk factors and comorbidities, (3) to identify clinical characteristics of the disease and (4) to evaluate the outcomes of treatment. MATERIAL AND METHOD: A prospective study ofpatients with ASO of the lower extremities was carried out between January 2000 and December 2004. Patients having clinical manifestations of chronic and acute arterial occlusion with the absence of ankle pulse were included in the present study. Evidence of atheromatous plaque by angiography, operative finding, and histopathology of arterial wall from amputated specimens were used to confirm the diagnosis. The selection of surgical treatments for this disease such as revascularization, major amputation, minor amputation and debridement depended on the severity of limb ischaemia, the status of distal artery and the patients' general condition. The risk factors, comorbidities, clinical manifestations, site of arterial occlusion, severity of ischaemia, types of surgical treatment and outcomes of management were analyzed. RESULTS: Four hundred and fourteen consecutive patients with ASO were diagnosed in the present study with a prevalence of 1.02:1,000. Femoro-popliteal arterial segment was the most common site (221 cases, 53.4%) of the affected arteries. Diabetes mellitus (253 cases, 61. 1%) was the most common risk factor of ASO followed by hypertension (217 cases, 52.4%), smoking (195 cases, 47.1%) and hyperlipidemia (172 cases, 41.5%). Ischaemic heart disease (108 cases, 26.1%) was the most common comorbidity of ASO followed by major stroke (56 cases, 13.5%) and chronic renal failure (20 cases, 4.8%). Patients with ASO presented mostly as chronic manifestations (385 cases, 93%) or with limb-threatening condition (326 cases, 78.7%). The clinical manifestations were ischaemic ulcer and/or digital gangrene (251cases, 60.6%), rest pain (182 cases, 44.0%) incapacitating claudication (62 cases, 15.0%) and acute ischaemic pain (29 cases, 7.0%). One hundred and thirty eight (33.3%) patients had significant lower limb infection at the time of admission. One hundred and seventy one (41.3%) patients underwent revascularization procedures as the major primary treatments to salvage the limbs. The success rate of limb salvage after revascularization was 76.6% (13 1/171). Major amputation after revascularization was 16. 9%(29/ 171). Perioperative mortality rate of revascularization procedure was 8.2 %(14/171). Major amputation was required as the primary treatment due to infective (18.4%, 76/414) and ischaemic process (6.5%, 27/414). The mortality rate of primary major amputation for infection and ischaemia were 19.7%(15/76) and 25.9%(7/2 7) respectively. The total mortality rate in the present study was 11.3% (47/414). The common causes of death were sepsis and ischaemic heart disease. CONCLUSION: ASO of the lower extremities is one of the major problems for national health care causing major limb loss and death. Arterial bypass surgery was the most effective treatment for limb salvage. Management of this disease at the terminal stage causes high morbidity and mortality. Hence, early detection of this disease and correction of the risk factors should be the most effective strategy to improve the overall outcome of the management of this complicated problem.

[Morbidity of lower limbs obliterating atherosclerosis in the population of Opole Region]. / Zachorowalnosc na miazdzyce zarostowa tetnic konczyn dolnych w populacji Opolszczyzny.

UNLABELLED: The objective of this study was to evaluate morbidity of lower limbs obliterating atherosclerosis in the population of Opole Region. The subject of the study was the population of patients admitted and treated in the Voivodship Medical Center in Opole between 1992-1994 (1st period) and 2000-2002 (2nd period). MATERIAL AND METHODS: Material includes detailed data about 1114 patients: 387 treated between 1992-1994 and 727 treated in period 2000-2002. The analysis was made on base of documentation of the Department of General and Vascular Surgery in the Voivodeship Medical Center in Opole. Patients filled special prepared questionnaires. The completed data were intoducted to the computer database and submitted to mathematical and statistical comparative analysis with regard to both examined periods. RESULTS: The study confirmed that the major cause of chronic lower limbs ischaemia is obliterating atherosclerosis. It was found in 91% of cases in both periods. Significant increase in atherosclerosis of the lower limbs morbidity was confirmed. The most voluminous group in this study ware patients more than 65 years of age, wih elementary or elementary professional education. Significant increase in incidence was also noted in patients inhabiting rural areas and in population of women. In between 2000-2002 the percentage of patients admitted with early phase of the disease increased significantly where compared to the first period. CONCLUSIONS: Significant increase of morbidity on atherosclerosis of the lower limbs needs planning of responsible local governors in Opole Region suitable financial expend to prevent and treat this disease.

[Why are cardiologists to be concerned about obliterating arterial disease of the lower leg?]. / Perché il cardiologo deve occuparsi dell'arteriopatia obliterante degli arti inferiori?

Peripheral arterial disease, which is caused by atherosclerotic stenosis or occlusion of the leg arteries, is an important manifestation of systemic atherosclerosis. The age-adjusted prevalence of symptomatic and asymptomatic peripheral arterial disease is approximately 12% in the general population. The overall prevalence and incidence of the disease is likely to increase with the aging of the population. Peripheral arterial disease is a relatively benign condition in terms of local disease. Five years after the diagnosis, 75% of the patients remain clinically stable. On the contrary, life expectancy, even in the absence of any history of myocardial infarction or ischemic stroke, has decreased by 10 years. These patients have approximately the same relative risk of death from cardiovascular causes as do patients with history of coronary or cerebrovascular disease. Moreover, the severity of peripheral arterial disease is closely associated with the risk of myocardial infarction and death from vascular disease. The lower the ankle-brachial index, the greater the risk of cardiovascular events. Furthermore, peripheral arterial disease is a significant independent predictor for cardiovascular mortality also in coronary patients. The risk factors associated with peripheral arterial disease are essentially the same as for coronary heart disease: older age, cigarette smoking, diabetes mellitus, hypertension, and hyperlipidemia. The excess morbidity and mortality for cardiovascular disease in these patients has not been fully explained. Patients with peripheral arterial disease show a systemic endothelial dysfunction and an increase in the serum concentration of activated white blood cells, endothelin, and C-reactive protein that may trigger acute coronary syndromes. In peripheral arterial disease the functional status is often severely impaired. Peak exercise performance has decreased to about 50% of that of age-matched controls, equivalent to moderate-severe heart failure. Epidemiological studies support the concept that patients affected by peripheral arterial disease, without established coronary heart disease, have a coronary heart disease high risk equivalent. In spite of this, peripheral arterial disease remains an underdiagnosed and undertreated disease. As the role of cardiologists is expanding, the purpose of this review was to awaken the clinician to the significance of lower limb atherosclerotic occlusive diseases.

The usefulness of dipyridamole thallium-201 single photon emission computed tomography for predicting perioperative cardiac events in patients undergoing non-cardiac vascular surgery.

UNLABELLED: The aim of this study was to evaluate the usefulness of dipyridamole Tl-201 myocardium single photon emission computed tomography (201Tl-SPECT) for predicting perioperative cardiac events in patients with arteriosclerosis obliterans (ASO) and abdominal aortic aneurysm (AAA) undergoing non-cardiac vascular surgery. METHODS: Preoperative dipyridamole 201Tl-SPECT imaging in association with clinical risk assessment was performed in 224 consecutive patients (97 ASO and 127 AAA). RESULTS: The patients were classified into three groups, including low-risk (n = 173, 77%), intermediate-risk (n = 39, 18%), and high-risk (n = 12, 5%) groups according to the clinical risk stratification. The prevalence of reversible Tl-201 defect was significantly higher in the high-risk group than that in the low-risk group (83% vs. 14%, p < 0.001). In 180 patients who underwent vascular surgery, 9 patients (5.0%) had perioperative cardiac events, including heart failure (n = 1), unstable angina (n = 2), and other cardiac events such as arrhythmias (n = 6). The clinical variables including the clinical risk stratification did not significantly correlate with the perioperative cardiac events. In contrast, the reversible defect on 201Tl-SPECT was the only variable to predict perioperative cardiac events by a stepwise logistic regression analysis (odds ratio 7.0, 95% confidence interval 1.7-28.0, p = 0.007). It was also a significant predictor of perioperative cardiac events in a subgroup of low risk patients (odds ratio 11.6, 95% confidence interval 2.3-57.4, p = 0.004). The sensitivity and specificity of the reversible defect for predicting perioperative cardiac events were 55.6% and 84.8% in all operated patients, and 57.1% and 89.7% in low risk patients, respectively. CONCLUSIONS: The preoperative dipyridamole 201Tl-SPECT was useful for predicting perioperative cardiac events in patients with vascular diseases, even in patients identified as having a low risk based on the clinical risk assessment.

[Epidemiology of and risk factors for lower limb arteriopathy obliterans]. / Epidémiologie et facteurs de risque de l'artériopathie oblitérante des membres inférieurs.

Peripheral arterial disease (PAD) is most frequently caused by atherosclerosis. The prevalence of intermittent claudication is about 3 to 6% of the men over 60 years. But recent epidemiological studies demonstrate that prevalence of asymptomatic forms is two to three fold higher--about 3.4 to 12.1%. The most relevant diagnostic criteria for asymptomatic PAD is probably the measure of the ankle/brachial index. Most important risk factors for PAD are smoking and diabetes mellitus. Improving symptoms or stabilization are a common fate (50%) in PAD. About 25% will experience revascularization procedures (angioplasty or surgery), 4% will have severe amputation and worsening symptoms occur in 15% of patients. Critical limb ischemia is mostly rare (1%). It is not surprising that fate of claudicant and mortality is determined by coronary events and cardiovascular diseases.

[Assessment of the prevalence of atherosclerotic lower limb arteriopathy in France as a systolic index in a vascular risk population]. / Appréciation de la prévalence de l'artériopathie oblitérante des membres inférieurs en France à l'aide de l'index systolique dans une population à risque vasculaire.

OBJECTIVE: Obliterative arteriopathy of the lower limbs is a severe disease. History taking often underestimates prevalence. In studies using the Rose questionnaire and examining the prevalence of symptomatic arteriopathy defined by the presence of intermittent claudication, prevalence has been rather constant, around 2% in the general population in industrialized countries. A more clinical approach searching for physical anomalies (absence of distal pulse) generally gives higher rates. The most recent data led us to conduct a study focusing on screening for arterial disease using the systolic index (the systolic index is the ratio between the ankle and humeral systolic pressure). A systolic index below 0.90 would be a sign of defective perfusion, increasing in severity with poorly compensated arterial lesions. METHOD: A survey was performed in a random sample of 150 practitioners using an allocation procedure to the nearest colleague in case of refusal. A data sheet containing demographic data and the main risk factors was established for each consulting patient aged from 40 to 80 years. The systolic index was measured in each patient with at least one vascular risk or who consulted for pain in the lower limbs. A simple sequential non-randomized patient recruitment scheme was used. RESULTS: The survey population included nearly 9,000 patients (8,987), 46% men and 54% women, mean age 64 years (table I). Patient risk factors including smoking, diabetes, hypertension, and physical exercise were adjusted for sex and age (table II-VI, IX). The systolic index was recorded in 41% of the population who had a vascular risk factor. Among these patients, nearly one-fourth had a systolic index under 0.90, giving a prevalence in the sample population of 11% (table VII). This rate was also assessed by age and sex (table VIII). Logistic regression evidenced a prognostic value (fig. 1) for smoking, hypertension and sedentary activity, and to a lesser extent, for age and sex. There was a significant difference by latitude, patients living in northern France having a higher risk than those living in southern France (table X). In addition, there was a relationship between the systolic index and spontaneous complaint, showing that this complaint is poorly specific for arterial disease (table XI, XII). CONCLUSION: This epidemiological approach to arteriopathy implemented by general practitioners searching for patients with a vascular profile and measuring systolic index is a novel method. It gave an estimation of prevalence at 11% in the French population, a rate compatible with that reported by other international teams. The method also allowed an analysis of factors affecting the rate.

[The current status of arteriosclerosis obliterans in Japan].

In Japan, the number of patients suffering from arteriosclerosis obliterans has increased remarkably in recent years, especially among the aged population. This paper presents an overivew of the current status of vascular surgery for atherosclerotic occlusive disease and the outlook for the future. It is important that endovascular surgery be further evaluated as an alternative to conventional arterial reconstruction, however, its precise indications and limitations can only be discussed with the accumulation of experience. The history of vascular surgery is extensive and not limited to the development of new techniques and methods of surgery alone. Further development in many fields will surely lead to great possibility in the future.

[Angiologic screening of postal workers]. / Angiológiai szürövizsgálat postai dolgozókon.

The authors present the results of an angiological survey conducted on 500 postal workers (374 males, 126 females, mean age 43.4 years). All subjects were interviewed about the history of cardiovascular diseases and risk factors. Clinical angiological examination, measurement of Doppler and oscillometric index, plethysmography (rest flow, peak flow, time to peak flow) were carried out. In 8.4% of the subjects (42 cases; 32 males, 10 females) peripheral arterial circulatory disturbance (PACD) was detected, seven of them (16.6%) had intermittent claudication. Frequency of smoking, hypertension and manual working proved to be significantly higher in the group of subjects with PACD than without PACD. Dorsalis pedis and/or tibialis posterior arteries were not palpable in seven (16.6%) of the patients with PACD, and in 25 (5.45%) of the subjects without PACD. The mean values of Doppler index, oscillometric index, peak flow, time to peak flow differed significantly between PACD "positive" and "negative" groups.

[Relation of angiographic changes to clinical data and risk factors in patients with arteriosclerosis obliterans]. / Arteriosclerosis obliteransos betegek angiográfiás eltéréseinek összefüggése klinikai adatokkal és kockázati tényezökkel.

The arteriographical changes of 66 patients with peripheral arterial obliterative disease and the relationship between the observed alterations and certain clinical and laboratory data as well as some risk factors were analysed. A score system was used to quantify the arteriosclerotic lesions. The arterial alterations of the examined 90 extremities were studied in the pelvic (common and external iliac arteries), femoral (common, superficial, deep femoral and popliteal arteries) and crural (anterior and posterior tibial arteries) regions. Pathomorphological changes in 433 of the investigated 720 arteries were shown, from among them plaque in 11.8%, stenosis in 22.3%, total occlusion in 26% were proved. Most frequently (89%) the superficial femoral artery was affected. As to the single vessels, the superficial femoral and posterior tibial arteries, while among the zones the femoral region proved to be most serious radiologically. The degree and extent of vessel lesions were related to age. The morphological severity was basically concordant with the results of clinical investigations (walking distance, ergometry, Doppler index). The separately examined risk factors (smoking, hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia) were not related consequently to the radiological changes, but in certain combinations, as heavy smoking with hypertension and heavy smoking with diabetes, the relationship proved to be statistically significant.

Clinical results of femoropopliteal bypass using externally supported (EXS) Dacron grafts: with a comparison of above- and below-knee anastomosis.

As of the end of September 1989, 52 EXS Dacron grafts had been implanted for femoropopliteal bypass operations. The distal ends of 27 grafts were anastomosed to above-knee popliteal arteries and those of 25 grafts to below-knee popliteal arteries. The cumulative patency rate of above-knee grafts was 71.3% at 54 months, and that of below-knee grafts was 78.8% at 48 months (n.s.). Kinking and stenosis of the arteriosclerotic proximal and/or mid popliteal artery when the knee was bent were angiographically remarkable. These changes may explain why some femoropopliteal grafts occlude with time and why the late results of above-knee grafts are not much better than those of below-knee grafts.