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

Of 427 patients with chronic critical ischemia of the lower extremity admitted for infrapopliteal bypass surgery, thirty-four (8%) were considered technically inoperable: in 26 cases due to total occlusion of the runoff vessels, and in eight due to a poor runoff and no suitable vein. The symptoms were rest pain in 24 cases and gangrenous ulceration in ten. During a follow-up of eight to twenty-eight months five (15%) patients improved significantly, and complained only of claudication. Three patients, suffering rest pain, were unchanged at nine months follow-up, and 25 (74%) patients had a major amputation performed during the follow-up period. The remaining patient died the day after admission. The mortality rate of these patients was significantly increased compared to that of the 393 patients who underwent infrapopliteal bypass surgery, who in turn had a higher mortality rate than that of an age- and sex-matched Danish population. The group of patients who preserved their limb could not be identified by either ankle- and toe-pressure measurements or clinical evaluation.