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Limb loss after lower extremity bypass

T Reifsnyder1, J P Grossman, S A Leers

  • 1Division of Vascular Surgery, Western Pennsylvania Hospital, Pittsburgh, USA.

American Journal of Surgery
|August 1, 1997
PubMed
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Bypass thrombosis caused half of lower extremity amputations after infrainguinal bypass surgery. Even with a functioning bypass, limb salvage failed in a third of cases, leading to poor survival rates.

Area of Science:

  • Vascular Surgery
  • Limb Salvage Procedures
  • Diabetic Foot Complications

Background:

  • Infrainguinal bypass surgery offers a high limb salvage rate, approaching 90% at 10 years.
  • Despite advancements, limb loss can still occur after bypass procedures.
  • Understanding the causes of failure is crucial for improving outcomes.

Purpose of the Study:

  • To investigate the specific reasons for major lower extremity amputations following infrainguinal bypass surgery.
  • To analyze the outcomes and survival rates in patients who underwent amputation after bypass for limb salvage.

Main Methods:

  • Retrospective chart review of patients undergoing major lower extremity amputation post-infrainguinal bypass.
  • Data collected included patient demographics, bypass status, and reasons for amputation.

Related Experiment Videos

  • Life-table analysis was used to determine survival rates.

    • Main Results:

    • 67 major amputations occurred in 64 patients (83% diabetic, 16% on dialysis) after infrainguinal bypass.
    • Bypass thrombosis was the leading cause (49%), followed by lack of salvage despite patent bypass (34%).
    • Survival rates were poor: 56% at 12 months and 17% at 48 months, with worse outcomes for those with patent bypasses.

    Conclusions:

    • Bypass thrombosis accounts for approximately half of amputations after infrainguinal bypass for limb salvage.
    • A significant portion of amputations (one-third) occurred despite a patent bypass, often due to necrosis or infection.
    • Limb salvage failure after bypass surgery is associated with dismal survival, particularly when the bypass remains patent.