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Multilevel occlusive vascular disease presenting with gangrene
K S Scher1, T McFall, F J Steele
1Department of Surgery, Wright State University School of Medicine, Dayton, Ohio.
The American Surgeon
|February 1, 1991
Summary
Advanced age and comorbidities do not predict higher amputation levels. However, distal bypass is crucial for limb salvage in patients with multilevel arterial occlusion.
Area of Science:
- Vascular Surgery
- Lower Extremity Amputation
- Limb Salvage
Background:
- Review of medical records for lower extremity amputations over 3 years.
- Investigated predictors of amputation level and limb salvage outcomes.
Purpose of the Study:
- To identify risk factors influencing lower extremity amputation level.
- To evaluate the effectiveness of revascularization strategies for limb salvage in multilevel arterial occlusion.
Main Methods:
- Retrospective review of patient records.
- Comparative analysis of patients undergoing inflow procedures versus inflow plus distal revascularization for combined segment occlusive disease.
Main Results:
- Advanced age, comorbidities, and diabetes did not correlate with higher amputation levels (above knee).
- Prior arterial surgery did not increase the likelihood of above knee amputations.
- Patients with multilevel arterial occlusion undergoing only inflow procedures had significantly higher major amputation rates (56%) compared to those with additional distal revascularization (13%) at 1 year.
Conclusions:
- Presumed risk factors like age and comorbidities are not predictors of amputation level.
- Distal bypass in addition to inflow procedures is recommended for limb salvage in patients with tissue loss due to multilevel arterial occlusion.