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Article
October 1991

Limb Salvage vs Amputation for Critical IschemiaThe Role of Vascular Surgery

Author Affiliations

From the Division of Vascular Surgery, Department of Surgery, Oregon Health Sciences University, Portland.

Arch Surg. 1991;126(10):1251-1258. doi:10.1001/archsurg.1991.01410340093013
Abstract

• Since 1980,498 patients with 627 critically ischemic legs (rest pain, gangrene, ischemic ulcer, and ankle-brachial pressure index <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.

(Arch Surg. 1991;126:1251-1258)

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