The surgical treatment of arteriosclerotic occlusive disease; thromboendarterectomy in selected cases.

Thromboendarterectomy appears to be the procedure of choice in the surgical treatment of localized obstructive arteriosclerosis in the aortoiliac area in a relatively young patient. Clinical follow-up over a three-year period demonstrated maintenance of a maximum benefit and suggested that the endarterectomized area will remain patent for the duration of the patient's life. In younger patients, it seems logical to reestablish vascular continuity with their own tissues by a careful endarterectomy rather than by homograft replacement because of the reported incidence of late thrombosis in the latter."Diffuse" arteriosclerosis definitely limits the potential benefit or effectiveness of thromboendarterectomy. However, lumbar sympathectomy may still bring about definite benefit in particular cases. The careful selection of patients with localized or segmental arteriosclerosis and well developed collateral circulation would seem to be the greatest factor in obtaining a maximum result by thromboendarterectomy.