From clinicopathological study, vasculitis of Buerger's disease seemed to start at small branch arteries and veins and progress to the trunk artery with thrombus. Progress of vascular lesions in trunk artery was gradual in general; the pathogenesis was briefly discussed.

In 23 of 148 patients with Buerger's disease, it was possible to undertake 27 arterial reconstructive procedures: bypass in 22 and thrombo-endarterectomy in 5. In a follow-up of 10 months to 8 years, the overall patency rate was 26 per cent. The long term patency rate of bypass grafting was good in obstruction of main vessels, but unsatisfactory with multiple occlusions. Bypass grafting was preferred to thromboendarterectomy. To obtain long term patency of revascularaized segments, complete abstinence from tobacco is absolutely essential. The preparatory manoeuvres for antogenous venous graft should be as atraumatic as possible. A functional diagnosis is indispensable when considering operative indications and for follow-up study of patients with peripheral arterial occlusive disease.

The pattern of arterial occlusion in Buerger's disease was analyzed by simultaneous bilateral femoral arteriography in 210 limbs of 105 patients with Buerger's disease. In 55 limbs of 42 patients, the femoropopliteal segment was affected in addition to the infrapopliteal arterial obstructive lesion. The pattern of crural arterial occlusion was similar in about 40% of both the patients with femoropopliteal occlusion and the patients with crural occlusion. Toes were ulcerated in 4 of 58 limbs with continuous arterial flow, and ulceration occurred in 86 of 152 limbs with a discontinuous flow. The rate of occurrence of bilateral trophic lesion in the group with an arteriographically similar occlusion pattern was not significantly higher than that in the group with a different pattern. The pattern of arterial occlusion in Buerger's disease seemed to be fixed mainly within 1 year after the onset of symptoms, and the skip-lesion in the main artery was favorable to proximal progression of the disease.

No abstract

Seventy-five limbs of 66 patients undergoing arterial reconstruction of the lower extremity were studied. In 41 of 64 limbs that were not involved in early failure, API returned to normal immediately and the increased API was maintained as long as grafts remained patent. The limbs exhibiting a rise in API of 0.1 or more following proximal reconstruction in the cases with combined iliac and femoral arterial occlusion or bypass grafting to an isolated segment obtained marked improvement of symptoms. Postoperative increase in TPI was not so marked as in API, and TPI remained very low in the limbs with arterial obstructive lesions below the ankle after successful reconstruction. Early or late failure could not be predicted on the basis of preoperative or postoperative API, TPI or A-T gradient. In the limbs with no recovery of TPI, blood flow or flow velocity in the foot was of value predicting which limbs would be salvaged.