[Recent advances and problems in peripheral arterial reconstruction].

Recent advances in the field of peripheral arterial reconstruction have been remarkable. These advances are mainly derived from the development of diagnostic technology such as Doppler ultrasound analysis, further refinement of surgical technique including surgical instruments and materials, and naturally improvement of patient care in the pre-, peri- and postoperative period. During the past 14 years we have performed peripheral arterial reconstruction in 1,200 cases (1,660 limbs) mainly with occlusive lesion due to arteriosclerosis obliterans. In our hand, aorto-iliac occlusive lesion has been routinely bypassed with Dacron prostheses and the secondary patency rate at eleven years reached 96.5%. The main problems encountered in this region were anastomotic aneurysm in the femoral artery (3.9%) and graft infection (1.2%). In the infrainguinal region there are still problems to be solved, although the primary (secondary) 5 year patency rates of reversed vein graft as well as in situ vein graft including femoro-popliteal below knee and femoro-crural bypasses have exceeded 70% (85%). First, there is no graft material comparable to the autogenous vein (AVG). Secondly, many of the AVG should suffer occlusive pathological changes from the environment in the long term following surgery. At the present time, we have no effective method to solve these problems, therefore we should follow up the patients heedfully to maintain the graft patency as well as to improve their quality of life and prognosis.