Indications for aortofemoral arterial reconstruction: A study of borderline risk

I nterest in defining the indications for aortofemoral arterial reconstruction derived initially from the problems attending the management of a group of elderly and surgically poor-risk patients seen on the Vascular Surgical Services of a large city hospital, Kings County Hospital. This particular group of patients was noted on physical and radiographic examinations to have far-advanced lesions of atherosclerosis-lesions considerably further advanced than are recommended for arterial reconstruction in surgical journals and textbooks. The patients in this group fall into the multiple-regional or generalized form of atherosclerotic obstructive disease.3 The majority of these patients presented with disease in both the iliac and femoral systems; many are diabetic with evidence of tibial and/or arteriolar obstructions. Since 1959 we have taken an aggressive approach to arterial reconstruction in these patients, an approach which can most accurately be described as salvage surgery from