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Progress in limb salvage arterial surgery: components and results of an aggressive approach
Insights
This study shows aggressive infrainguinal arteriosclerosis treatment successfully salvages limbs in 85% of patients. The approach offers a 66% limb salvage rate at 5 years with low mortality.
Area of Science:
- Vascular Surgery
- Arterial Reconstruction
- Limb Salvage
Background:
- Infrainguinal arteriosclerosis poses a significant threat to lower extremity viability.
- Effective limb salvage strategies are crucial for patients with threatened extremities.
Purpose of the Study:
- To evaluate the outcomes of an aggressive surgical approach for limb salvage in patients with infrainguinal arteriosclerosis.
- To assess the efficacy of various revascularization techniques, including bypass surgeries and angioplasty.
Main Methods:
- Retrospective analysis of 1,196 patients treated for infrainguinal arteriosclerosis over 9 years.
- Detailed review of revascularization procedures: femoropopliteal bypass, small vessel bypass, axillopopliteal bypass, and transluminal angioplasty.
- Life table analysis to determine cumulative survival, limb salvage, and graft patency rates.
Main Results:
- Immediate limb salvage was achieved in 85% of 679 patients undergoing revascularization.
- Five-year cumulative survival and limb salvage rates were 48% and 66%, respectively.
- Femoropopliteal bypass patency at 5 years reached 67% with reoperations; small vessel and axillopopliteal bypasses showed >50% patency at 2 years.
- 88% of patients who died within 5 years did so without limb loss.
Conclusions:
- An aggressive approach to infrainguinal arteriosclerosis can achieve high rates of limb salvage.
- Revascularization procedures, including bypass and angioplasty, are effective in preserving limb viability.
- This strategy is justified by successful limb salvage outcomes with acceptable mortality and morbidity.
Abstract:
In the past 9 years, 1,196 patients whose lower extremity was threatened because of infrainguinal arteriosclerosis have been treated at Montefiore Hospital. In the last 6 years, limb salvage was attempted in 679, or 90% of 755 patients. Femoropopliteal (318), small vessel (204) and axillopopliteal (29) bypasses were used along with transluminal angioplasty (128) and aggressive local operations to obtain a healed foot. Immediate (one month) limb salvage was achieved in 583, or 85%, of the 679 patients in whom revascularization was possible. The 30-day mortality rate was 3%. The cumulative life table (LT) survival rate of all the patients undergoing reconstructive arterial operations was 48% at 5 years. The cumulative LT limb salvage rate after all reconstructive arterial operations was 66% at 5 years. The cumulative LT patency rate of femoropopliteal bypasses was not influenced by angiographic outflow characteristics of the popliteal artery but was increased 15% by appropriate reoperations to 67% at 5 years. Cumulative LT patency and limb salvage rates of small vessel and axillopopliteal bypasses were more than 50% at 2 years. Of patients undergoing arterial reconstruction, 88% of those who died within 5 years did so without losing their limbs. Of all the patients in whom limb salvage was attempted, 68% lived more than one year with a viable, usable extremity, and 54% lived over 2 years with an intact limb. We believe this aggressive approach to limb salvage is justified, and can be undertaken with a low cost in mortality, knee loss and morbidity.