title: [Surgical treatment of acute ischemia of the lower extremities (arteries and veins). Indications and results].
abstract: The indications and results of surgical treatment for acute ischemic lesions of the lower limbs are conditioned more by the previous state of the arterial wall than by the mechanism of the obliteration itself. Thrombosis and embolus development in atheromatous arteries is presently observed more frequently than emboli in healthy arteries, but prognosis is still mainly a function of the delay before active therapy is applied. Patients should be immediately placed on intravenous heparin therapy to provide cover during transfer to a suitably equipped center able to supply medical and surgical treatment. A choice has to be made between thrombolysis and surgery: thrombolysis, in the absence of general contraindications, is suitable mainly for cases with peripheral circulatory obstruction of diseased arteries unable to be restored by surgery. Treatment of emboli in healthy arteries has been transformed by the use of Fogarty's catheter; that of acute obstructions of diseased arteries has benefitted from progress realized in the performance of different types of surgical arterial reconstruction. Assuming that good operating conditions are available, thromboendarterectomies as well as autogenous or prosthetic venous by-pass operations can be perfectly well performed as emergency procedures, failures are due essentially to the fact that patients are still seen too frequently at the irreversible complete ischemia stage, and when their condition is poor: in certain cases the limb must be sacrificed immediately to ensure the vital prognosis.
mesh_terms: D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D013300:Streptokinase / Q000627:therapeutic use; D013923:Thromboembolism / Q000601:surgery; D013924:Thrombophlebitis / Q000601:surgery; D013927:Thrombosis / Q000601:surgery; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
chemical_list: D006493:Heparin; D013300:Streptokinase; D014568:Urokinase-Type Plasminogen Activator
vernacular_title: Traitement chirurgical des ischémies aiguës du membre inférieur (artères et veines). Indications et résultats.