Current status in treatment of the Japanese with chronic arterial occlusive disease of the lower extremities.

For the clinical management of patients with a mild ischemia or intermittent claudication, ambulatory exercise plus the administration of antiplatelets and vasodilators is recommended. Patients with a ischemia related with small ulcer and slight pain at rest often show improvement while on conservative treatment. For patients with a severe ulcer and pain, reconstructive surgery has to be done. In management of patients with extensive or diffuse arterial occlusive lesions amenable to direct reconstruction, A-V shunt procedure, forced pulsatile perfusion technique and artificial CO2 baths have been devised. Tibial artery bypass associated with adjunctive arteriovenous fistula has also been recommended for those with poor distal outflow vessels. To assess the outcome of the reconstructed artery and to prevent early postoperative occlusion, flow waveform analysis is useful. This approach also aids in detecting preocclusive lesions of the reconstructed artery during postoperative follow-up.