Limb salvage and selectivity.
In a group of properly prepared poor risk patients with advanced atherosclerosis of both the aortoiliac and femoropopliteal segments, a combined procedure, extra-anatomic bypass with an extended profundoplasty, was used for successful salvage of their ischemic--mean calf pressure=27 millimeters of mercury--limbs. Prediction of success versus failure could be determined on neither clinical nor angiographic-anatomic grounds but was possible using two simple measurements: a large aortoiliac differential pressure--deltaP--between inflow pressure obtained from a standard arm cuff and outflow pressure measured directly from the femoral artery, 89.3 millimeters of mercury versus 33.2 millimeters of mercury, p less than 0.001, and a potentially adequate outflow bed as determined by the percentage drop in outflow [(deltaPo/Po) per cent] upon papaverine injection, 36.3 versus 11.3 per cent, p less than 0.001. These values became an important part of the selection scheme developed in the approach to 24 ischemic limbs.
D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery; D001161:Arteriosclerosis / Q000601:surgery*; D001794:Blood Pressure; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D011379:Prognosis; D011859:Radiography; D014656:Vascular Surgical Procedures / Q000379:methods*