One wonders if we will find that smoking decreases the elaboration or effectiveness of angiogenic growth factors. Like our other patients with serial arteriograms, he was a overall boot failure in that surgery was still necessary. Successful boot patients do not volunteer for serial arteriograms. In this patient, a medical approach and a surgical approach together saved his leg. Unfortunately, various specialties may view one another as competitors and not cooperate.
Cooperation does work.
For a few months we had people descending on Bryn Mawr from all over North America. They came with advanced inoperable disease hoping for a quick cure. We pumped on several a week or so, noted an improvement in their Doppler studies, repeated their arteriograms and successfully bypassed their legs.