Arterial reconstruction for lower limb ischemia

The treatment of advanced atherosclerosis involving the lower extremities h as undergone considerable evolution over the last several decades. Current strategies hinge on an appreciation of the natural history of disease, the overall health status of the patient, and an armamentarium of endovascular and open surgical reconstructive techniques that may be tailored to optimiz e outcome for the individual patient. Patients with aorto-iliac disease hav e a variety of available options with generally good results. For infraingu inal disease, surgical bypass using autogenous vein is the mainstay of inte rventional therapy and will remain so for the foreseeable future. Increasin g medical and surgical challenges are presented by this population. particu larly as aggressive medical treatment of risk factors leads to an ongoing d ecline in cardiovascular mortality, combined with a dramatic increase in th e prevalence of diabetes. The future, which is now already at hand. will br ing the application of genomics. with a potential for altering the progress ion of disease as well as extending the long-term benefits of reconstructio n.