Ten year experience with infrainguinal revascularization for limb salvage

Revascularization is the only alternative to amputation for patients with severe, symptomatic infrainguinal ischemia. It is the purpose of this study to determine the success of revascularization as defined by limb salvage in a personal 10-year operative experience.

Primary infrainguinal bypass procedures were performed on 312 threatened limbs of 271 consecutive patients in the period between January 1, 1983, and December 31, 1992. Repeat revascularization was performed for failing/failed grafts as long as the extremity was viable and an outflow vessel could be found by either preoperative or intraoperative angiography.

Ten patients died within 30 days of the primary procedure (4%) and the 5-year patient survival was 57%. Major amputations (AK or BK) were performed on 50 extremities over the 10-year period; cumulative 72-month limb salvage was 72%. Fifty-eight of the 312 extremities (19%) required 81 reoperations for failing/failed grafts, including a second procedure in 58, a third procedure in 14, and a fourth procedure in 9. Graft occlusions in which revision was either not attempted or was ultimately unsuccessful occurred in 72 extremities and led to 44 amputations. Cumulative primary and secondary graft patency for autologous conduit was clearly superior to nonautologous conduit (57% and 67% vs 20% and 21% respectively at 60 months).

We believe that this approach to infrainguinal revascularization is warranted as the mortality is low and the likelihood of success is high. A long term commitment to careful postoperative surveillance is mandatory as reintervention is frequently required to maintain graft patency and limb salvage.