[Prognosis for the critically ischemic lower extremity when surgical revascularization is not possible]

Area of Science:

• Vascular Surgery
• Vascular Medicine
• Ischemia Research

Context:

• Chronic critical ischemia of the lower extremity poses significant challenges.
• Infrapopliteal bypass surgery is a common intervention for limb salvage.
• A subset of patients are deemed technically inoperable for bypass surgery.

Purpose:

• To evaluate the outcomes of patients with chronic critical lower extremity ischemia who were considered technically inoperable for infrapopliteal bypass surgery.
• To assess the success of alternative management strategies and identify predictors of limb salvage in this challenging cohort.

Summary:

• Of 427 patients admitted for infrapopliteal bypass, 34 (8%) were inoperable due to severe runoff vessel disease or lack of suitable veins.
• These inoperable patients presented with rest pain or gangrenous ulceration.
• During follow-up (8-28 months), only 15% improved to claudication, while 74% underwent major amputation, and one patient died post-admission.
• Mortality was significantly higher in this inoperable group compared to those who underwent bypass surgery and the general population.
• Predictors for limb preservation could not be identified using ankle-brachial index or clinical evaluation.

Impact:

• This study highlights the poor prognosis for patients with chronic critical limb ischemia deemed inoperable for bypass surgery.
• It underscores the limitations of current non-invasive tests in predicting limb salvage in such cases.
• Findings suggest a need for novel strategies and improved predictive tools for managing this high-risk patient group.