Limb salvage: thrombolysoangioplasty as an alternative to amputation

This 5-year retrospective study evaluates the results of thrombolysoangioplasty (TLA) used as an alternative to major amputation in patients with severely debilitating, lower extremity, peripheral vascular disease. All patients in this study were originally designated for major amputation to treat their ischemic symptoms after all other surgical options were exhausted.

Twenty-one limbs in 20 patients with complete occlusions of the superficial femoral, popliteal and at least 2 of the 3 major branches below the popliteal trifurcation were attempted for thrombolysoangioplasty for limb salvage. The majority of patients had previous bypass procedures, and all patients had either nonhealing ischemic ulcers, tissue loss, and/or resting pain.

There were no primary failures. 17/21 patients were saved from major amputation. 4/21 patients were changed from an AKA to a BKA. 5/21 patients reoccluded within 1 year. 4/5 were successfully retreated via TLA. 1/5 required a major amputation. Life Table analysis demonstrated 63.6% (+/- 3.72)-12 months and 45.4% (+/- 3.78)-15 months primary patency rates. Limb salvage rates, however, were significantly better. Twenty-four month and 31 month rates of 75.5% (+/- 5.57) and 75.5% (+/- 6.44) were seen for complete limb salvage, respectively, while 24 and 40 months partial limb salvage rates of 94.7% (+/- 3.67) and 94.7% (+/- 4.27) were demonstrated. There were 2 complications; they were both retroperitoneal hemorrhages. Both patients recovered without sequelae.

In conclusion, these preliminary results indicate that TLA is an effective alternative to major amputation for patients with severely debilitating peripheral vascular disease.