title: Surgical treatment for intermittent claudication in patients who do not improve with clinical treatment.
abstract: OBJECTIVE
  To study the results obtained with surgical treatment of patients with intermittent claudication (IC) who did not clinically improve with conservative treatment, accompanied by a long follow-up (average 6 years).
  
  
  METHODS
  From January 1992 to January 2002, 26 patients treated surgically in a group of 1380 IC patient, representing 1.88% of the total.
  
  
  RESULTS
  Sixteen patients did not experience walking limitations after the surgery. Nine patients improved, however, with some degree of limitation. No intraoperative mortalities occurred. Three patients experienced thrombosis of the treated artery 6, 48, and 60 months after the procedure and started to suffer IC with onset at the same distances as before the surgery. During the long-term follow-up, we observed a mortality rate of 23.0% due to myocardial infarctions (4 patients), renal insufficiency (1 patient), and cerebral infarction (1 patient). Two patients underwent coronary bypasses 2 and 4 years after the vascular surgery, and one underwent coronary angioplasty after 3 years of follow-up. The mean follow-up was 73 months.
  
  
  CONCLUSIONS
  In our study, the results from surgical treatment of IC brought about a lasting regression of the ischemic conditions in a significant number of patients, with excellent patency rates (88.4%). We conclude that this is a good alternative for select patients, with low rates of complications and positive long-term results.
authors.affiliation: Disciplina de Cirugia Vascular, Hospital das Clínicas da FMUSP, São Paulo, SP, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Wolosker
authors.forename: Marco Antonio S
authors.initials: MA
authors.lastname: Munia
authors.forename: Ruben
authors.initials: R
authors.lastname: Rosoky
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Fidelis
authors.forename: Livio
authors.initials: L
authors.lastname: Nakano
authors.forename: Paulo
authors.initials: P
authors.lastname: Kauffman
authors.forename: Pedro
authors.initials: P
authors.lastname: Puech-Leão
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011446:Prospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency