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Prosthetic vascular graft management in above-knee amputations

Levent Umur1, Ismail Selçuk2

  • 1Department of Orthopaedics and Traumatology, Acibadem Kadikoy Hospital, Istanbul, Turkey.

Cardiovascular Journal of Africa
|February 25, 2022
PubMed

Insights

Multidisciplinary care for critical limb ischemia (CLI) patients with prosthetic grafts significantly reduces hospital stays and amputation levels. This approach is vital for managing complex CLI cases and improving patient outcomes.

Area of Science:

  • Vascular Surgery
  • Peripheral Arterial Disease Management
  • Limb Salvage Procedures

Background:

  • Critical limb ischemia (CLI) is a severe manifestation of peripheral arterial disease, often necessitating lower-limb amputation.
  • Prosthetic vascular grafts are a treatment option for CLI, but complications like infection or ischemia can still lead to amputation.
  • Effective management of CLI requires a comprehensive strategy to mitigate risks and improve patient prognosis.

Purpose of the Study:

  • To evaluate the impact of multidisciplinary planning and surgery on outcomes for critical limb ischemia patients undergoing prosthetic graft procedures.
  • To determine if a coordinated approach can reduce hospital stay duration, associated costs, infection rates, and the need for higher-level amputations.
  • To compare the effectiveness of partial versus total graft excision in managing CLI complications.

Main Methods:

  • A retrospective analysis of 42 patients with above-knee amputations who received prosthetic grafts.
  • Patients were divided into two groups: Group A (partial graft excision, n=24) and Group B (total graft excision with or without saphenous patch-plasty, n=18).
  • Key outcomes measured included wound culture growth, antibiotic therapy duration, conversion to hip disarticulation, and length of hospital stay.

Main Results:

  • Statistically significant reductions were observed in wound culture growth (p=0.007) and antibiotic duration (p=0.003) in the total excision group.
  • The rate of conversion to hip disarticulation (p=0.029) and the duration of hospital stay (p=0.0001) were significantly lower with total graft excision.
  • These findings indicate a clear benefit of the multidisciplinary approach in managing CLI patients with grafts.

Conclusions:

  • A multidisciplinary approach is crucial for managing complex critical limb ischemia cases and preventing adverse outcomes.
  • Meticulous surgical planning, including complete graft excision while preserving vascular supply, is essential for successful treatment.
  • This strategy effectively decreases complications, shortens hospital stays, and reduces the likelihood of higher-level amputations.
Abstract

Keywords:
above‐knee amputationcritical limb ischaemiamultidisciplinary approachprosthetic vascular graft

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