Functional failure of patent femorodistal in situ grafts.
We have treated several patients who required major, proximal extremity amputations despite a patent infrainguinal in situ saphenous vein bypass graft. To determine those factors predisposing to such paradoxical limb loss, we studied a group of 45 patients who underwent 48 in situ, femorodistal bypass grafts for tissue necrosis and who maintained a patent graft throughout the perioperative period. Within this cohort, we compared two distinct subgroups: Group I, whose limbs (n = 8) ultimately required a major proximal amputation; Group II, whose limbs (n = 40) emerged with a viable foot and did not require a major amputation. There was no significant difference in the incidence of diabetes, renal failure, smoking, or postoperative ankle/brachial index between the two groups. The presence of gangrene (88% vs 45%), invasive sepsis (63% vs 23%), and combined gangrene and sepsis (63% vs 18%) was significantly (p less than 0.05) more prevalent in Group I versus Group II. Forty-three percent of patients with both gangrene and foot sepsis required a major proximal amputation despite a patent graft. Such patients are at high risk for limb loss even if they undergo successful revascularization.
Fowl
R J
RJ
Department of Surgery, University of Cincinnati Medical Center, Ohio 45267-0558.
Patterson
R B
RB
Bodenham
R J
RJ
Kempczinski
R F
RF
D000368:Aged; D000671:Amputation, Surgical; D000714:Anastomosis, Surgical; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005734:Gangrene / Q000601:surgery; D006801:Humans; D007866:Leg / Q000098:blood supply*; D007871:Leg Ulcer / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation; D014654:Vascular Patency