Femoral–popliteal–tibial occlusive disease open surgical therapy

In this chapter we will discuss open surgical procedures for femoral, popliteal and tibial arterial occlusive diseases. Although some of these procedures may occasionally be performed for disabling intermittent claudication, the majority should only be performed for critical lower limb ischemia (CLI). This may be defined as sufficiently poor arterial blood supply to pose a threat to the viability of the lower extremity. Manifestations of CLI are true ischemic rest pain, ulceration and gangrene. These manifestations typically occur because of arteriosclerotic occlusive disease of large-, mediumand/or small-sized arteries, although other aetiologies may produce or contribute to these conditions. For example, many non-vascular causes may cause limb pain at rest, infection may cause or contribute to gangrene, and trauma and decreased sensation may produce ulceration. Although thromboembolism and other aetiologies can produce acute CLI, this chapter will only deal with chronic lower extremity ischemia due to obliterative arteriosclerosis. Over the last three decades, it has become increasingly apparent that limbs that are threatened by this process almost always have multilevel occlusive disease which often includes occlusions of arteries in the thigh, leg and foot.