[Vascular surgery reconstruction in chronic arterial occlusive disease of the lower extremities].

For the assessment of the indication for surgical intervention in chronic arterial occlusive disease, the patients complaints (clinical necessity), local operability and operative risk for the patient have to be considered. In stage II disease (intermittent claudication) the patients demand for symptom-free walking distance is decisive. A young, sporting patient will not accept a distance of 500 m whereas an old patient limited by cardiopulmonary insufficiency will accept less than 50 m. Stages III and IV mean marginal perfusion and endanger the extremity acutely. Persistent severe pain or trophic lesions force to surgical intervention. If vascular reconstruction is impossible amputation will become necessary although lumbar sympathectomy might be attempted before amputation. Because of better collaterals proximal arterial occlusions endanger the extremity less than more peripheral ones, even in the case of operative failure. At the pelvic level endarterectomy or prosthetic replacement are the choice procedures. Allografts are equivalent to autografts. Bypass is best used for the cruro-femoral region. The material of choice is the autologous great saphenous vein. Below the knee it can be used as "in situ" bypass. Artificial prostheses give less favorable results. Inhibitors of platelet aggregation are used for protection of the arterial wall, anticoagulants for prevention of venous thrombosis and arterial re-embolization.