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Updated: Dec 25, 2025
Minimally Invasive Isolated Limb Perfusion (MI-ILP) for Locally Advanced Melanomas and Sarcomas of the Extremity
Published on: January 31, 2025
[Does an attempt to save a limb always prolong the patient's life?]
Iu I Kazakov1, I B Lukin1, N Iu Sokolova2
1Tver State Medical University of the RF Ministry of Public Health, Tver, Russia; Regional Clinical Hospital, Tver, Russia.
Insights
Patients with critical limb ischemia and poor outflow experienced low survival and high cardiovascular events after revascularization. Repeat surgeries and amputations increased costs and worsened outcomes.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Health Economics
Background:
- Critical limb ischemia (CLI) with compromised outflow presents significant challenges.
- Femoropopliteal-tibial occlusive disease requires complex revascularization strategies.
- Low outflow competence portends a poor prognosis for lower limb revascularization.
Purpose of the Study:
- To evaluate overall survival in patients with CLI and poor outflow.
- To assess the incidence of major adverse cardiovascular events (MACE).
- To analyze economic expenditures associated with treatment strategies.
Main Methods:
- Retrospective study of 68 patients with CLI and low outflow competence.
- Primary arterial reconstruction in 48 patients; primary amputation in 20.
- Follow-up averaged 2 years, analyzing survival, MACE, and treatment costs.
Main Results:
- Redo arterial reconstructions and early amputation (within 11 months) correlated with reduced overall survival.
- High surgical risk and secondary interventions were linked to increased MACE.
- Secondary surgical interventions significantly escalated treatment costs.
Conclusions:
- Early revascularization failure and amputation in CLI patients with poor outflow negatively impact survival and increase cardiovascular risk.
- Repeat surgical interventions substantially increase healthcare costs.
- Optimizing initial revascularization is crucial for improving outcomes and managing costs in this high-risk population.
Aim:
The purpose of the study was to examine overall survival and the incidence of major adverse cardiovascular events, as well as economic expenditures for treatment of patients with occlusion of the femoropopliteal-tibial segment and critical ischaemia in low competence of the outflow channel, with a poor prognosis for endovascular or open revascularization of lower-limb arteries.
Patients And Methods:
We studied the results of treating a total of 68 patients with lower-limb critical ischaemia and low parameters of the outflow channel competence. Primary arterial reconstruction was performed in 48 cases. At various terms after revascularization due to thrombosis of the reconstruction zone and the development of gangrene, amputation of the lower limb was performed: at 3 to 11 (n=25) and at 12 to 24 (n=25) months. Primary amputation of the lower limb was performed in 20 patients. The endpoints of the study included overall survival, the incidence of major adverse cardiovascular events, and economic expenditures for the in-hospital treatment. The average duration of follow-up amounted to 2 years.
Results:
The obtained findings demonstrated that in patients with lower-limb critical ischaemia and low parameters of the outflow channel competence, redo arterial reconstructions and amputation within 11 months, as well as a high level of surgical risk were associated with a low overall survival rate and the development of major adverse cardiovascular events in the remote period. Secondary surgical interventions on the major vessels significantly increased the cost of treatment.
