Vascular surgery: Principles and practice Robert W.HobsonIIISamuel E.WilsonFrank J.Veith3rd ed2003Marcel DekkerNew York, NY1292 pages; $250

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Alternatives in the Management of Atherosclerotic Occlusive Disease of Aortic Arch Branches

• The cases of 62 patients with atherosclerotic occlusive disease at the origin of the aortic arch branches were reviewed. Thirty-six were initially without neurologic symptoms and in four (11%) intermittent neurologic symptoms without stroke developed during an average follow-up of 27 months. No patient had limb-threatening ischemia. Twenty-six operations were performed for neurologic symptoms or disabling limb ischemia, with one death. Five-year graft patency by life-table analysis was 81%. Preoperative or late postoperative stroke in three patients with occluded common carotid artery suggests this to be a more dangerous subgroup. We advise surgery for patients with disabling arm symptoms or with ischemic neurologic symptoms associated with multiple-vessel disease or with major lesions in the innominate-carotid circulation. We advocate selective revascularization with priority given to the innominate-carotid flow. Isolated subclavian lesions first seen as a single lesion or as the only residual lesion after reconstruction for multiple-vessel disease can be safely left unreconstructed.(Arch Surg 1981;116:1457-1460

Dependent Rubor as a Predictor of Limb Risk in Patients With Claudication

• We followed up 133 patients with claudication to determine the prognostic value of dependent rubor. Life tables analysis was used, with a threatened limb as the endpoint. A threatened limb was defined as the development of ischemic rest pain, skin ulceration, or gangrene. At four years, the rubor group had a limb-threat incidence of 25%, compared with only 9% in the nonrubor group. While not indicative of imminent limb loss, the presence of dependent rubor defines patients whose limb risk is greater than in those with claudication alone.(Arch Surg 1984;119:932-935