Limb salvage surgery in a district general hospital: factors affecting outcome

In many patients with critical limb ischaemia, vascular reconstructive surgery is the only alternative to amputation to relieve severe rest pain or treat ischaemic ulcers and digital gangrene. Over a 4-year period, 402 patients with critical ischaemia of the lower limb were seen in the Derby Hospitals. One hundred and forty eight of these patients required primary amputation, 52 were treated with radiologically controlled angioplasty and in the remaining 208 patients, 218 surgical procedures for limb salvage were carried out. The overall operative mortality of patients undergoing limb salvage surgery was 9% with 72% of patients surviving 2 years or more. Postoperative mortality was greater in those patients over 70 years (16% vs 6% P less than 0.02). Patient survival at 2 years was reduced in patients over 70 years at the time of surgery (49% vs 83% P less than 0.001) and in those with 2 or more medical conditions (57% vs 71% P less than 0.001) present in the perioperative period. Overall limb salvage in surviving patients was 92% at 1 year and 91% at 2 years following surgery. Successful limb salvage at 2 years following femorodistal surgery alone was lower and related and to both infrapopliteal run off (2-3 vessels 87% vs 1 vessel 68% P less than 0.01) and the graft material used (vein 87%, Dardik 76%, Goretex 58%, P less than 0.01).