Limb Salvage vs Amputation for Critical Ischemia

Abstract

Since 1980, 498 patients with 627 critically ischemic legs (rest pain, gangrene, ischemic ulcer, and ankle-brachial pressure index less than 0.40) were treated with revascularization regardless of operative risk or anticipated operative difficulty. Primary amputation was performed only when no graftable distal vessels were present (14 primary amputations [2.8%]) or in neurologically impaired, hopelessly nonambulatory patients. The mortality for revascularization was 2.3%, and the median hospital stay was 11 days. During follow-up, 41 limbs (7%) required amputation, 31 after failure of revascularization and 10 despite patent revascularizations. Renal failure had an adverse influence on limb salvage (67%) because of a significantly increased requirement for amputation despite patent revascularizations. We conclude aggressive limb revascularization in patients with critical lower-extremity ischemia results in low operative morbidity and mortality and excellent long-term limb salvage. Patients with critical leg ischemia and renal failure are at higher risk for limb loss than patients without renal failure.

Pedal Bypass for Limb Salvage: Impact of Diabetes on Long-Term Outcome

“…The negative impact of end-stage renal disease on limb salvage has also been established by Taylor and colleagues. 17 Several other series have also found identical limb salvage rates for diabetics and nondiabetics after infrainguinal reconstruction. 3,4,16 Seeger and colleagues, however, found that patients with diabetes mellitus had significantly decreased limb salvage rates at 6 months after infrainguinal vein bypass.…”

Critical limb ischemia

“…45 Yet, these are not randomized trials, and given the increased comorbidities in patients receiving primary amputations, if patients were to be randomized to revascularization or amputation, the mortality and long-term survival rates would likely be improved in the amputation groups. Still, current data that are available favor revascularization when feasible in terms of overall mortality.…”

Operations, total hospital stay and costs of critical leg ischemia

“…Many previous studies describing outcome after surgical intervention for CLI, focus on some specific surgical procedure in a selected patient group (Taylor et al 1991, Shah et al 1992, Pomposelli et al 1995. Results of treatment analyzed in a population-based material, including all vascular procedures and major amputations, as in our study, better reflect the actual conditions.…”