Critical evaluation of limb salvage concept and indication for infrapopliteal reconstructive surgery

A large number of surgical procedures aimed at revascularizing the popliteal and infrapopliteal arteries has been reported in patients affected by rest pain or gangrene of the extremities as well as intermittent claudication. In consideration of the high incidence of early and late unsuccessful results following this type of surgery as reported in the literature, we believe that peripheral reconstructions should be restricted to those patients presenting a clinical picture of such severity that major amputation is unavoidable in the short run. In these patients our choice of the appropriate surgical procedure is strictly related to the patency or not of the popliteal artery. The role of the above knee femoropopliteal bypass is discussed. A series of patients that we have operated upon according to these criteria is analyzed. The low number of cases in our group of patients and the high rate of postoperative failures reflect our policy on this matter.