Amputations in peripheral vascular disease.

Until the cause of organic occlusive vascular diseases is definitely estab­ lished, and prophylactic measures taken to prevent them; until lipid metabolism can be controlled to pre­ vent atherosclerotic plaques from ad­ hering to the intima of arteries; until thrombosis and embolism can be pre­ vented and it will be routine to excise arterial segments and replace them with homografts or plastic tubular substitutes; until all this happens, peripheral vascular specialists will be continually confronted with the prob­ lem of rescuing "medical" therapeu­ tic failures. These failures result in slow progressive ischemia and event­ ual death of tissues, with or without secondary infection intervening. In­ stances of sudden onset of gangrene of an extremity result from an acute occlusion, either thrombotic or em­ bolic, in which embolectomy may sometimes, but not always, prevent mortification of the tissues.