Document Detail

Infrapopliteal intervention for the treatment of the claudicant.
MedLine Citation:
PMID:  17386363     Owner:  NLM     Status:  MEDLINE    
As the associated risks of infrainguinal balloon angioplasty and stenting have fallen and the relative success rates have risen in recent years, the threshold for offering endovascular treatment to patients with claudication has significantly decreased. Patients once considered appropriate only for risk-factor modification, exercise therapy, and medical treatment are now increasingly being offered percutaneous revascularization as a primary treatment option. Similarly, occlusive disease of the tibial vessels, once thought to be the exclusive domain of operative bypass, is increasingly being treated percutaneously. Over this same period, results of operative infrainguinal arterial reconstruction have also considerably improved. In modern times, excellent outcomes following bypass grafting with autogenous vein to the tibial level have been demonstrated, with morbidity, mortality, and long-term patency equivalent to that of more proximal bypasses. Evidence supports the view that the anatomic level of the distal anastomosis is less critical to the long-term outcome of the procedure than factors such as operative indication and conduit quality. Within the context of this changing climate, it is an appropriate time to examine and potentially redefine the role of both endovascular and open surgical intervention for a population that has not traditionally been offered revascularization, patients with claudication secondary to infrageniculate occlusive disease.
Matthew T Menard; Michael Belkin
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Seminars in vascular surgery     Volume:  20     ISSN:  0895-7967     ISO Abbreviation:  Semin Vasc Surg     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-27     Completed Date:  2007-05-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8809602     Medline TA:  Semin Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  42-53     Citation Subset:  IM    
Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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MeSH Terms
Angioplasty, Balloon*
Arterial Occlusive Diseases / complications*,  pathology,  surgery,  therapy
Arteries / pathology,  surgery*
Femoral Artery / surgery
Intermittent Claudication / etiology,  pathology,  surgery,  therapy*
Magnetic Resonance Angiography
Patient Selection
Popliteal Artery / surgery
Practice Guidelines as Topic
Prosthesis Design
Tibial Arteries / surgery
Treatment Outcome
Vascular Surgical Procedures / methods*
Veins / transplantation

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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