[Therapeutic approach based on the results of examination of the vascular function in stage II arteriopathy of the limbs].

The therapeutic indications in stage II arteriopathy of the lower limbs take particular account of the walking perimeter. However, the lack of correlation on occasion between the walking perimeter and the haemodynamic data suggest the importance of an examination of vascular function, in particular in regard to the indications for restorative surgery. The medical approach may be advantageously adopted in cases where a walking perimeter in excess of 300 m on a horizontal belt is combined with an only slight decrease in the resting blood pressure (systolic index over 0.90) and a good stress tolerance (no great fall in the blood pressure). The surgical approach will be different in the case of lesions located above or below the crural arch. Sympathectomy may be envisaged in the case of thigh and leg lesions, accompanied by favourable haemodynamic indices (less than 50% fall in the blood pressure after effort), where the patient is handicapped by a short walking perimeter. Tests can be carried out to predict the effect of the sympathectomy. A collapse of the distal blood pressure, to values below 50 mm Hg, should suggest a restorative surgery. This approach is all the more likely to prove successful in the case of proximal lesions, where such lesions have affected the haemodynamic indices (a fall in pressure in the calf, accompanied by a satisfactory blood circulation higher up). Surgical intervention for the arterial condition should in this case give way to haemodynamic surgery.