Arterial XXXX . A 20-year perspective.

@entity1 @entity887 @entity1410 @entity1031 @entity8901 @entity731 @entity715
Our experience with 739 @entity1 with lower extremity @entity1031 since the advent of the balloon catheter has led us to several important observations: As the etiology has shifted from rheumatic to @entity731 , we treat a more complex group of @entity1 , one fourth of whom have severe, preexisting @entity8901 . Early diagnosis and treatment is essential to decrease the mortality and morbidity, which has ranged about 25% +/- 10%. Anticoagulation must be continued in the postoperative period, accepting wound @entity1410 as a fair "trade-off" to prevent recurrent @entity715 in areas inaccessible to the catheter. Postoperative use of heparin "buys time" to further assess marginal results of embolectomy allowing arteriography and careful planning of secondary operations to assure not only a viable but a functional limb. There is little mention in the literature to emphasize this approach, which we think is essential for long-term salvage. Early in the series, @entity1 were treated with heparin or embolectomy alone. There were 161 secondary operations in 135 @entity1 following embolectomy consisting of repeated thromboembolectomy, popliteal exploration, sympathectomy, bypass graft(s), angioplasty, and endarterectomy. Additionally, 44 @entity1 had a direct attack correcting the cardiac source of their @entity887 . Our overall mortality (12%) and limb salvage (95%) shows marked improvement compared with earlier reports. Therefore, we recommend combined embolectomy and heparin as the primary choice of therapy.
