Intra-arterial injections in the treatment of peripheral vascular disease.

Degenerative arterial disease is a pathological process which, in the present state of knowledge, remains a non-reversible infirmity. The pathological picture may vary, and accordingly methods of treatment are numerous, but in all instances there is ischaemia, and whatever the aetiology of the arterial obliteration, the immediate therapeutic problem is to overcome ischaemia. This may be attained by surgical or by conservative means-and in the latter method the usual practice is the administration of vasodilator drugs. Recently such drugs have been administered by the intra-arterial route and we think that this route has proved to be an advance. The intra-arterial method in the treatment of peripheral vascular disease has been practised for about a decade, though therapeutic substances were being introduced via this route as early as the turn of the century. In I899 Parlaveochio injected antiseptic solutions into the artery in a case of severe infection of the limbs, and in I906 Crile and Dolley showed that intra-arterial perfusion with Ringer's solution containing adrenalin and hirudin would overcome cardiac arrest due to anaesthesia. However, it is to the French school of Carrel and Leriche that modern advances in vascular concepts and peripheral arterial surgery are due. In 1923 Sicard and Forestier gave a further impetus by introducing direct angio,raphy with radio-opaque substances injected into :he arterial system, and in 1943 Singer seems to have been one of the first to use vasodilator solutions intra-arterially in the treatment of peripheral arterial obliteration.