Surgical management of intermittent claudication.

The distribution of claudication reflects the anatomic site of stenosis or occlusion. Palpable pedal pulses do not rule out proximal stenosis, nor do weak pulses certify leg pain as claudication. An initial conservative approach is not appropriate for patients with rest pain, ulcers, gangrene, rapid increase in discomfort or dangerous lesions involving major collateral vessels. Early surgical treatment is also advisable for patients whose occupations are in jeopardy. Complete arteriography is essential. Proximal disease must be corrected first.