Peripheral Arterial Disease Yong Bok Koh, M.D. Department of General Surgery The Catholic University of Korea, College of Medicine, Kangnam St. Mary s Hospital E mail : ybkoh@catholic.ac.kr Abstract Peripheral arterial disease include disease all disorders involving carotid artery, vertebral artery, subclavian artery brached out from aortic arch, upper extremities arteries, thoracoabdominal aorta, its visceral arteries and lower extremities arteries. Rapid advances in vascular surgery (especially arterial surgery) began after World War II, beginning with the treatment of arterial lesions with vascular repair and with bypass procedures, and vascular diseases previously noted beyond the surgical treatment can be corrected by recent vascular surgery. This evolution of vascular surgery has attributed to the development of arteriography, anesthesia, blood transfusion, antibiotics, anticoagulation and synthetic graft materials. These advanced vascular surgical techniques have yielded a cornerstone for the development of the modern organ transplantations. Recently, the incidence of vascular diseases in Korea increased remarkably than before and clinicians should pay attention to make early diagnosis and to perform appropriate treatment for these diseases. Because the detailed descriptions regarding all these vascular diseases in is limited space are difficult, the author would like to describe clinical aspect of the commonly encountered peripheral arterial diseases such as atherosclerotic occlusive disease, abdominal aortic aneurysm, diabetic foot, cerebrovascular disease, Buerger's disease of lower extremities with introducing clinical manifestation of acute and chronic peripheral arterial occlusive disease. Keywords : Peripheral vascular disease; Atherosclerotic occlusive disease; Abdominal; Aortic aneurysm; Diabetic foot; Keywords : Cerebrovascular disease; Buerger's disease 636
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Trial evaluating surgery versus extremity. The STILE trial. Ann Surg 1994 ; 220 : 251-68 19. Sicard GA, Schier JJ. Thrombolytic therapy for acute arterial occlusion. J Vasc Surg 1985 ; 2 : 65-72 10. Charles GR. Clinical evaluation of patients with peripheral vascular disease of the Lower extremity, in Fredric J and Stanley H, eds. Vascular surgery of the lower extremity. St. Louis, Missouri : C.V Mosby 1985 ; 3-11 11. Ross R. Atherosclerosis An Inflammatory disease, N Engl J Med 1999 ; 340 : 115-26 12. Criqui MH, Langer RD. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992 ; 326 : 381-7 13.,,. Ischemic ulcer gangrene prostaglandin E1. 1986 ; 31 : 87-96 11..... :, 1984 : 1-3 12. Rich NM. Injuries of the abdominal aorta in vascular trauma, in Rich NB, Spencer FC, eds. Vascular trauma, Philadelphia : WB saunders, 1978 : 441-7 13. Kenneth O, Richard MG. Arterial disease, in Schwartz etc. in principle of surgery. 7th ed. New York : McGraw Hill, 1999 : 931-2 14. Billig DM, Hellman GL. Arterial embolism. Arch Surg 1967 ; 95 : 1-7 15. Fisher DR Jr, Clagett GP. Dilemmas in Dealing with the blue the syndrome. Aortic versus peripheral source. Am J Surg 1984 ; 148 : 836-41 16. Haimovici H. Peripheral arterial embolism. Angiology 1950 ; 1 : 20-4 17. Fogarty J, Cranly JJ. A method for extraction of arterial emboli and thrombi. Surg Gyn Obst 1963 ; 116 : 241-8 18. The STILE investigators. Results of a prospective randomized 14. Veith FJ, Gupta SK. Six year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafloroethylene grafts in infrainguinal arterial reconstructions. J Vasc Surg 1986 ; 3 : 104-10 15... 1998 ; 41 : 615-23 16. NASCET Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high grade carotid stenosis. N Engl J Med 1991 ; 325 : 445-53 17. Creech O Jr. Endo aneurysmorrhaphy and treatment of aortic aneurysm. Ann Surg 1996 ; 164 : 935-46 18. DeBakey MZ, Crawford ES. Aneurysm of abdominal aorta : analysis of results of graft replacement therapy one to eleven years after operation. Ann Surg 1964 ; 160 : 622-35 19. Szilagyi DZ, Smith RF. Contribution of abdominal aortic aneurysmectomy to prolongation of life. Ann Surg 1966 ; 164 : 678-89 20. Darling RC, Messina CR. Autopsy study of unoperated abdominal aortic aneurysms ; Circulation the case for early resec- 647
tion. 1977 ; 56 : (Suppl 2) : 161 21.,,,. 63. 1994 ; 1 : 70-9 22.,,,.. 1992 ; 1 : 80-5 23.,,,. Behset. 2003 ; 19 : 44-8 24. Wessler S, Ming SC, Gurewich V. A critical evaluation of thromboangiitis obliterans. N Engl J Med 1960 ; 262 : 1149-53 25... 1987 ; 30 : 486-90 26.. Buerger.. 1994 ; 47 : 1053-63 27. Shinoya S. Buerger's disease. Nagoya : Univ. of Nagoya Press, 1990 28.. ( ). 1998 ; 41 : 600-6 29.,,,. Buerger Prostaglandin E1 Opalmon, 1993 ; 44 : 938-48 30.,,,,. autogenous saphenous vein bypass graft. 1977 ; 19 : 1-10 648