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October 1991

Limb Salvage vs Amputation for Critical Ischemia: The 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

• 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)