A 40 years old male, a chronic smoker presents with claudication and a medial leg ulcer. For the past one month, he is having rest pain. Which of the following procedures would not relieve his rest pain -
This patient is suffering from Buergers ds (also k/a Thromboangitis obliterans) Buergers ds is characterized by occlusive disease of the small and medium-sized aeries* (planters, tibialis and radial aery), thrombophlebitis of the superficial or deep veins and Raynaud's syndrome. As Buerger's disease involves the aeries beyond the popliteal aery, there would be no help from a femoropopliteal bypass. It is helpful if the aery is blocked proximally as in atherosclerosis. Not only femoro-popliteal bypass operation but any vascular reconstructive operation is not feasible in Buerger's ds, because the involvement of the small vessels of the extremity makes it difficult to locate suitable outflow sites for bypass grafts. Treatment of Buergers ds Stop smoking Sympathectomy - is used with some success. Amputation - is the only way out when gangrene occurs. Free omental graft - Microvascular transplantation of free omental grafts to areas notamenable to aerial reconstruction has been successfully tried. It appears that conservative amputation should not be used in this pt. who does not have gangrene, but a femoro-popliteal bypass has no role whatsoever and is the better answer out of the two options. Amputation can be used to relieve the patient of persisting rest pain. Ref : Schwaz 9/e p771
Lumbar sympathectomy
Amputation
Omentoplasty
Femoropopliteal bypass
Vascular surgery