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December 7, 1984

Evaluation and Treatment of Upper and Lower Extremity Circulatory Disorders

Author Affiliations

Evansville, Ind

JAMA. 1984;252(21):3026-3027. doi:10.1001/jama.1984.03350210068042

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The unalloyed joy of finding something new here awaits those who treat patients with ischemic fingers or toes. The first conceptual overhaul regards some biologic questions central to understanding circulatory insufficiency: namely, why do intraluminal obstructive lesions occur and how might they be avoided? Better ways to endothelialize prosthetic grafts and how antiplatelet drugs can prevent late graft occlusion are also clarified.

A second defection from orthodoxy concerns "unreconstructible" patients with limb-threatening ischemia. Previous contraindications to revascularization for early gangrene, such as absence of a plantar arterial arch, are systematically contradicted. To extend the frontiers of limb salvage further, useful advice about bypassing the blind popliteal arterial segment, and empirical details about unusual techniques (such as tibiotibial bypass) are delineated. Topics scantily covered elsewhere, such as atheromatous embolization of the hand, direct arm revascularization, or the current role and type of sympathectomy for causalgia, or spastic Raynaud's disease receive much