[Conservative surgical treatment in stage 4 arteritis of the lower extremities. Apropos of 26 cases].

The authors report 26 cases (average age 69 years) of stage IV atheroma of the leg arteries for which a conservative surgical operation was attempted. Aortography (18 times) or femoral arteriography (8 times) were performed without difficulty before operation. During the same operation, a single procedure was performed in 15 cases, 2 or 3 procedures were performed in 11 cases. Thus were carried out: sympathectomy in 7 cases, endarterectomy in 8 cases, a by-pass operation in 23 cases. There were 4 deaths (15%) during the postoperative period. In 18 of the 22 patients who survived the operation, trophic disorders completely disappeared, and the functional result assessed with an average follow up of 15 months (1 to 25 months) on the degree of intermitent claudication was judged good or very good in 16 cases, mediocre in 2 cases. In 4 of these 22 patients, the trophic disorders persisted or reappeared in the short term and amputation was then carried out in 3 of these 4 cases. Conservative surgery remains possible and useful in stage IV arterial disease of the lower limbs. It is however important to operate early in the course of the disease after failure of adequate medical treatment.