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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.
Alderman DB. Limb Salvage in Diabetics With "Hopeless" Ischemia: Use of Autogenous Tissue Reconstruction (ATR). JAMA. 1967;201(4):251–254. doi:10.1001/jama.1967.03130040047012
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