Amputations due to lower-limb ischemia. Analysis of a 3-year series

Lower-limb amputation was performed on 261 patients from a catchment population of 232,500 in 1984-1986, and 253 of the amputees were retrospectively followed up. In 241 cases amputation was performed because of threatening or manifest gangrene, 95 of them without preceding consultation with vascular surgeons. In 19 cases amputation followed thromboembolectomy. Of the 127 patients seen by vascular surgeons, 66 were judged to be unsuitable for reconstructive surgery, 22 because of poor general health and 44 because of contraindicating vascular status. In the 61 patients with vascular reconstruction prior to amputation, the level of amputation did not differ from that in patients without such antecedent surgery. The proportion of cases rejected for vascular surgery rose from 18% in 1984 to 33% in 1986. The need for amputation could probably be reduced by earlier detection and vascular surgical evaluation of arterial insufficiency.