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Article
July 24, 1967

Limb Salvage in Diabetics With "Hopeless" Ischemia: Use of Autogenous Tissue Reconstruction (ATR)

Author Affiliations

From the Vascular Surgical Clinic, Yale—New Haven Medical Center, and the Section on Peripheral Vascular Disease, Department of Surgery, Hospital of St. Raphael, New Haven, Conn.

JAMA. 1967;201(4):251-254. doi:10.1001/jama.1967.03130040047012
Abstract

It is axiomatic in arterial reconstructive surgery that success is directly related to the size of the vessel and the adequacy of the "outflow tract" below the reconstructed segment. The results are always much more satisfactory in the large vessels of the aorto-iliac segment than in the smaller arteries at the femoropopliteal level.1-4

While success in varying degrees is reported when a femoropopliteal arterial block is relatively discrete and the outflow tract is good, these circumstances usually attend relatively minor degrees of ischemia such as that which is manifested by claudication. When diffuse arteriosclerosis exists with femoropopliteal blocks at multiple levels, the results have been far less sanguine. Unfortunately, these patients who have pain while at rest, ischemic ulcers, and gangrene are the ones who need help most.

The arterial lesions of diabetes tend to be very diffuse in the small and medium-sized vessels of the viscera and extremities.

References
1.
Szilagyi, D.E.:  Current Problems in Surgery—Peripheral Vascular Disease , Chicago: Year Book Medical Publishers, Inc., 1965.
2.
Muller, W.H., Jr.; Liddle, H.V.; and Edmunds, M.D.:  Surgical Management of Arterial Obliterative Disease ,  Ann Surg 147: 845-853 ( (June) ) 1958.
3.
Morris, G.C., Jr., et al:  Restorative Vascular Surgery in the Presence of Impending and Overt Gangrene of the Extremities ,  Surgery 51:50-57, 72-73 ( (Jan) ) 1962.
4.
Wylie, E.J.; Binkley, F.M.; and Albo, R.J.:  Femoropopliteal Endarterectomy ,  Amer J Surg 108:215-223 ( (Aug) ) 1964.Crossref
5.
Gensler, S.W., et al:  Study of Vascular Lesions in Diabetic, Non-Diabetic Patients ,  Arch Surg 91:617-622 ( (Oct) ) 1965.Crossref
6.
Partamian, J.C., and Bradley, R.F.:  Acute Myocardial Infarction in 258 Cases of Diabetes ,  New Eng J Med 273:455-461 ( (Aug 26) ) 1965.Crossref
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