1978 Volume 15 Issue 6 Pages 574-579
The long term results of treatement in 1339 patients with chronic arterial occlusive disease at the 1st Dept. of Surg., Univ. of Tokyo for 1955-1975, have been analysed. In this series, 449 patients with arteriosclerosis obliterans (A. S. O.), and 890 patients with thromboangiitis (T. A. O.) were included. Recently the number of patients with A. S. O. has increased remarkably.
In this paper, the characteristics of A. S. O. with special reference to its prognosis is reported comparing with T. A. O..
1) A. S. O. involved the males predominantly (ratio 6:1), and about 80 percent of cases was over 51 years of age.
2) Commonly, the ischemic skin changes of the lower extremity such as coldness and the intermittent claudication were regared as initial symptoms of this disease.
3) In 286 cases, hypertension was found by 66%, hypercholesterolemia by 38%, diabetes mellitus by 17%, and visceral vascular involvement by 30%. These highly associated abnormalities seemed to be rsik factors for the progression of atherosclerotic changes.
4) About 32 percent of cases with aorto-iliac occlusion were suitable for or required surgical treatment. However, patients with diffuse obstruction, severe associated disease, advanced age were not candidates for reconstructive operation, and treated with lumbar sympathectomy or conservative therapy. Reconstructive operation was entirely succesful in 70 percent of cases, whereas lumbar sympathectomy or conservative therapy was beneficial for ischemic skin changes with poor improvement for intermittent claudication.
5) In 417 cases, diabetes mellitus was observed in 71 (17.0%), cerebral vascular disease in 37 (8.8%), myocardial infarction in 24 (5.8%), angina pectoris in 18 (4.3), renal failure in 14 (3.6%), and malignant tumor in 18 (4.3), respectively. Visceral vascular involvement were associated with rather high frequency.
6) Over-all mortality rate for 10 years after the onset of symptoms were accounted for 40.2% and the cause of death were mainly attributed to cerebral, coronary and renal insufficiency.
Because the long term result of treatment in A. S. O. was closely related to advanced age, generalized atherosclerosis, and some risk factors stated above, the treatment should be based not only on the limb salvage, but also on the accurate estimation of general condition, Further, surgical intervention will be neccesary to suppress the progress of the atherosclerotic occlusion in the selected cases.
