Influence of failed arterial reconstruction on the outcome of major limb amputation.
BACKGROUND
Unsuccessful vascular repair may further preexisting limb ischemia and thus increase the risk of revascularization procedures.


METHODS
The results of 94 primary major amputations (group A) have been analyzed and compared with 112 secondary ablations (group B) carried out after failed revascularization efforts. All patients suffered from chronic critical ischemia (grades III and IV) of the lower extremities. In group A the severity of ischemic symptoms was more pronounced (trophic changes in 80% vs 66% in group B), and a preponderance for older age, diabetes mellitus, and incidence of cardiac failure and cerebrovascular insufficiency was evident.


RESULTS
In patients undergoing secondary amputation the final transection level was adversely affected by preceding unsuccessful reconstructive attempts. In spite of the better risk profile, 30% of patients in group B were subjected to above-knee amputation compared with 13% of patients in group A. The aggravated limb ischemia caused by graft failure is reflected by the decrease of the mean ankle systolic pressure index from 0.27 to 0.13 (before and after failed revascularization attempts). Although more amputations at the below-knee level were performed initially in group A, primary wound healing was obtained among these subjects in 68% of patients (compared with only 39% for patients in group B).


CONCLUSIONS
In a substantial number of cases preexisting limb ischemia may be promoted by failed attempts at vascular reconstruction, thus leading to severe wound healing complications and a higher level of amputation.
Stirnemann
P
P
Klinik für Thorax-Herz-, und Gefässchirurgie Inselspital, Berne, Switzerland.
Walpoth
B
B
Würsten
H U
HU
Graber
P
P
Parli
R
R
Althaus
U
U
D000368:Aged; D000671:Amputation, Surgical / Q000534:rehabilitation; D001161:Arteriosclerosis / Q000601:surgery*; D001186:Artificial Limbs; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply; D011183:Postoperative Complications; D016896:Treatment Outcome; D014945:Wound Healing