Level of amputation following failed vascular reconstruction for lower limb ischemia

The effect of a failed lower limb vascular procedure on the ultimate level of amputation in patients presenting with end-stage ischemia is an issue of ongoing controversy. A series of 71 patients with 75 lower extremity amputations over a 3-year period was reviewed to compare the level of amputation and morbidity between two groups of amputees: one that had vascular operations before amputation and the other undergoing primary amputations. Failed vascular reconstructions led to increased morbidity and poor healing, statistically significant increases in the level of amputation, and prolongation of hospital stay. The high price of failure must be considered in the evaluation of vascular operations in patients with tissue loss or infection.