Progress in the Management of Peripheral Vascular Disease

Abstract

A search of the recent literature reveals a number of significant advances in peripheral vascular surgery. However, today's surgeon continues to find him self battling a disease process he does not understand with diagnostic tools which need improvement. The purpose of this paper is to outline progress in three areas; 1) diagnosis, 2) pathophysiology and 3) surgical therapy. The advances in diagnostic techniques have focused on three questions—(1) what is the nature of the vascular lesion so that an appropriate operation can be designed, (2) what is the status of the disease post-operatively, and (3) in the unreconstructable limb, what amputation may be successfully performed? The second section deals with our increasing knowledge of the underlying disease—atherosclerosis—and its modification through pharmacology. The final section is devoted to improvements in surgical therapy, from pre operative management to the technical details of the operation and post operative care. Concurrently, new ideas in graft preparation and new graft developments are discussed.