MILLER and Griepp1 presented a lucid description of the current state of the art in the surgery of peripheral vascular disease. Because of the authoritative nature of such an article, we believe that it is important to present a different point of view.
The authors have fallen prey to two fallacies—one fairly subtle, the other a more usual type. In the first instance, they convey the impression that the peripheral arteries are all equivalent. Methods of diagnosis and treatment that work for one should work for all. This ignores the exceedingly important differences between the structures and organs those arteries supply. The brain, which is supplied by the carotid and vertebrobasilar arteries, is totally different in its function and importance from either the foot or any of the viscera.
In our opinion, transposing surgical methods that may be effective in preventing gangrene of the foot to the extracerebral vasculature