Service Operations on the Limb Arteries

Abstract

“Service operations” are localized corrective procedures to relieve stenoses due to hyaline or connective tissue proliferation in a vein bypass graft, or endarterectomy [2, 3]. Performed promptly, these operations can recanalize vessels totally occluded by thrombosis and preserve the function of autologous blood conduits as long as possible. They are therefore an alternative to the implantation of synthetic prostheses. Extensive or polytopic hyperplasias must be bridged with a bypass during a second operation. However, if these myointimal proliferations are localized, they may be excised. Figures 17.7.1 a-17.7.4a schematically represent the arteriographic images of such stenoses. At short intervals between the primary operation and the service operation (less than 3 months), macroscopic ring-shaped ridges consisting of mural thrombi or mesenchymal connective tissue are found. In this initial stage of development, they may still be treated by PTA. After a longer interval (more than 3 months), these ridges form stenoses consisting of solid, collagenous connective tissue that must be removed sharply with a scalpel.