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Failed femorocrural reconstruction does not prejudice amputation level
G M Tsang1, M C Crowson, N C Hickey
1Department of Surgery, Selly Oak Hospital, Birmingham, UK.
The British Journal of Surgery
|December 1, 1991
Summary
Vascular reconstruction for critical limb ischemia, including femorocrural bypass, resulted in a favorable below-knee to above-knee amputation ratio (1.4). This suggests unselective reconstruction does not increase above-knee amputations.
Area of Science:
- Vascular Surgery
- Limb Ischemia Management
Background:
- Critical limb ischemia poses a significant risk for amputation.
- Vascular reconstruction is a key intervention to salvage limbs.
Purpose of the Study:
- To evaluate the impact of an unselective vascular reconstruction policy on amputation levels.
- To determine the below-knee amputation to above-knee amputation ratio (BKA:AKA) in patients with critical limb ischemia.
Main Methods:
- Retrospective analysis of 500 patients with limb-threatening ischemia from 1985-1989.
- Vascular reconstruction was attempted unless contraindicated.
- Data collected on primary amputations, vascular reconstructions (including femorocrural bypass), and secondary amputations.
Main Results:
- 450 patients underwent vascular reconstruction; 50 had primary amputations.
- The BKA:AKA ratio was 2.0 for primary amputations and 1.1 for secondary amputations.
- The combined BKA:AKA ratio was 1.4, comparing favorably to national data.
Conclusions:
- An unselective approach to vascular reconstruction for critical limb ischemia is associated with a favorable BKA:AKA ratio.
- This policy does not appear to increase the proportion of above-knee amputations.
- Vascular reconstruction remains a viable option for limb salvage in critical ischemia.