Second leg ischemia. Lower extremity bypass versus amputation in patients with contralateral lower extremity...

Unilateral amputees with second leg ischemia may miss consideration for anything but amputation. Justification for a reconstructive approach for these ischemic second limbs was sought from a retrospective study of 108 patients who underwent lower extremity distal bypass. Risk factors and results were compared for the 12 unilateral amputees and the 96 nonamputees. Age and relative incidence of rest pain, claudication, and tissue loss were not significantly different for the two groups. Diabetes mellitus was present in 41.6 per cent of amputees and 31.3 per cent of nonamputees. Preoperative, average ankle-brachial blood pressure ratios were equal for both groups (0.3). Angiography showed comparable distribution of patients between the two groups with regard to distal run-off vessels. Operative mortality was 8 per cent for amputees and 3 per cent for nonamputees. Cumulative survival at 25 months was 67.5 per cent for amputees and 82.4 per cent for nonamputees. Cumulative patency at 6 months was 71.5 per cent for amputees compared with 63 per cent for nonamputees and at 25 months was 58.5 per cent for amputees and 37.6 per cent for nonamputees (no significant difference). Unilateral amputees appear to have similar risks and results for lower extremity distal bypass as do nonamputees. An independent, aggressive approach for evaluation and surgical revascularization should not be overlooked for the ischemic, remaining lower extremity in the dysvascular unilateral amputee.