Modern Trends in Vascular Surgery

SUCH rapid advance has occurred over the past few years in the surgical treatment of disease of large arteries that this work is no longer experimental and is now soundly established. The majority of cases are due to arterio-sclerosis which involves certain segments of the vascular tree, leaving the remainder relatively free from disease. The most frequently involved segments are: 1. Superficial femoral artery and upper part of popliteal artery. 2. Common iliac artery. 3. Aorta up to the level of the renal arteries. 4.-Bifurcation of common carotid artery. 5. Origin of the vertebral artery. 6. Coronary arteries. 7. Cerebral arteries. While the disease is segmental it always involves multiple segments, and treatment of one segment must take into consideration any other segments involved. ARTERIAL DiSEASF AS IT AFFECTS INDIVIDUAL ARTERIES. 1. Femorro Popliteal Artery Femoral artery disease usually only causes symptoms when thrombosis of the affected area occurs, and these are intermittent claudication, rest pain, and gangrene. Intermittent claudication is due to the fact that the collateral circulation is unable to carry the large blood supply required for exercise, and rest pain occurs when the collaterals are themselves narrowed to such an extent that they are unable to supply enough blood for the limb at rest. The usual cause of gangrene is digital artery thrombosis following trauma and infection of a digit, as the blood supply required to combat infection is not available, and the infection spreads rapidly, causing thrombosis of the digital vessels. Emboli from the primary clot may also cause gangrene by blocking the digital vessels. If intermittent claudication is present in a patient without ischaxmic heart changes, then relief of the obstructed femoro-popliteal artery is justified, but if cardiac ischa!mia is present then relief of the intermittent claudication may permit the patient to walk so far that he dies of a coronary thrombosis. However, even in the presence of cardiac ischxmia, relief of an obstructed femoro-popliteal artery is justified for the presence of gangrene or threatened gangrene, as it may save a limb, and the operation itself does not cause any more upset to a patient than an amputation. As the superficial femoral artery and upper part of the popliteal 188