The management of chronic occlusive peripheral arterial disease: Impressions gained from six years of clinical study

Abstract

1. 1. There are no effective well-recognized specific means of treatment of the various types of chronic occlusive arterial disease. 2. 2. Rational treatment depends to a great extent on the results of a properly performed quantitative determination of the element of vasoconstriction in each extremity. 3. 3. For patients with little or no vasoconstrictor element circulatory exercises and suction pressure therapy may be beneficial. Ligation of the main vein to the extremity has given worthwhile results in certain carefully selected cases. 4. 4. For patients with a large or considerable element of vasoconstriction, conservative measures have been inadequate in the author's experience. 5. 5. Lumbar ganglionectomy gives a greater, more continuous, and more persistent increase in circulation to the lower extremity with pronounced vasoconstriction element, than any other type of treatment. Preganglionic cervicothoracic sympathectomy gives comparable results in the upper extremity. The operations have a low mortality. 6. 6. The vasodilatation following sympathectomy diminishes the likelihood of onset of thrombosis, and increases the collateral circulation, giving the greatest insurance against the serious complications of chronic occlusive arterial disease.