Results of Combined Surgical Therapy in Management of Peripheral Arterial Disease

Introduction  In spite of accumulating experience in the surgical treatment of arterial disease of the lower extremities, there is still no unanimity of opinion as to the most effective methods of therapy. This is particularly true in the application of lumbar sympathectomy, which is the most commonly performed procedure for this disease. Ziffren,¹ in 1957, reviewed the literature and noted wide variation in the results of lumbar sympathectomy. It is the opinion of Smithwick² that this discrepancy in the results of sympathectomy is largely due to lack of satisfactory methods of patient selection. The problems with endarterectomy and grafting procedures are different in that the indications for these procedures are perhaps more clearly defined,^3,4 but as to which procedure is the best there is still no definite answer.The question requiring solution at a clinical level is when to apply or not to apply combined surgical therapy