Level of amputation after failure of limb salvage procedures

It has been claimed that the level of amputation is rendered higher by unsuccessful limb salvage bypass procedures. To evaluate this premise, we analyzed 242 major amputations performed for atherosclerotic vascular disease. One hundred and sixty-one amputations were performed as primary operations--50 per cent being below knee and 50 per cent, above knee amputations. Eighty-one amputations followed failure of an arterial revascularization. Twenty-three amputations, 13 below knee and ten above knee, followed late closure of such bypass procedures. Early failure of the bypass in 58 patients resulted in 46 below knee and 12 above knee amputations. After failure of 45 bypasses to arteries distal to the popliteal, 14 of the patients required above knee amputation. Following 28 unsuccessful femoropopliteal bypasses, only two patients needed above knee amputation. Thus, the risk of jeopardizing the knee joint should not be considered a major contraindication to limb salvage procedures, especially if a femoropopliteal bypass is contemplated.