Semi-Closed Thrombendarterectomy in the Treatment of Lower Limb Arteriosclerosis

Abstract

One hundred and four cases of semi-closed thrombendarterectomy for lower limb arteriosclerosis are presented. The results are comparable to those obtained by femoro-popliteal bypass. The technique of semiclosed thrombendarterectomy is briefly described. The method is found convenient for the treatment of both aorto-iliac and femoro-popliteal arteriosclerosis. In the majority of operations, peroperative blood flow and pressure measurements were performed. Correlation of haemodynamic measurements with clinical results showed significantly lower blood flow rates in limbs where early re-occlusion occurred than in limbs with patent arteries.

For arterial reconstructions of the lower limb, the question of thrombendarterectomy versus bypass grafting with autologous vein is not settled. The long-term results of the two methods appear to be comparable (Vollmar et al., 1970; Cannon et al., 1958). The surgical technique of thrombendarterectomy has, so far, been more exacting than that of bypass grafting. The introduction of in-tima strippers, permitting semi-closed thrombendarterectomy to be performed through small arte-riotomies has, however, provoked increasing interest in this technique for the treatment of lower limb arteriosclerosis.

The purpose of this paper is to describe the operative technique of semi-closed thrombendarterectomy, and to present a material of patients treated with this technique. Finally, we wish to correlate peroperative measurements of blood flow and pressure with the early postoperative results.