Second stage obliterating arteriopathies of the lower extremities. The problem of indications for reconstructive arterial surgery in patients with claudication.

Out of 2500 patients suffering from chronic ischaemia of the lower extremities observed in the period 1970-76 in the Vascular Surgery Section of Padua University, 827 (33%) underwent revascularization (aortobifemoral by-pass, femoro-popliteal by-pass in reversed saphena or dacron, by-pass using Sparks-Mandrill prosthesis). 45% were operated for rest pains or the presence of trophic lesions, conditions constituting an absolute indication for revascularization apart from the prospects suggested by the angiographic picture and the features of the vessel in question. 170 patients underwent operation on the basis of tight claudication after 5-10 m, this too being an absolute indication. 192 arteriopathics underwent operation for claudication over 50-100 m and up to 1 km. This group is a 'luxury' indication where the symptomatology parameter, in relation to the patient's social and working needs must be considered in the light of arteriographic examination. Only in cases where arteriography suggests the possibility of risk-free operation as far as this is possible, and with a presumably good outcome over the long term, not just immediate, is it advisable to try and correct the impediment. Finally, 108 patients with claudication underwent operation using greater flexibility in considering this latter factor, on the basis of an angiographic picture which, quite apart from the symptomatology, constitutes a very serious indication for operation: the presence of a double iliac and femoral block or stenosis of the collateral circulation.