Failed femorocrural reconstruction does not prejudice amputation level

✍ Scribed by Mr G. M. K. Tsang; M. C. Crowson; N. C. Hickey; M. H. Simms

• Book ID: 101745248
• Publisher: John Wiley and Sons
• Year: 1991
• Tongue: English
• Weight: 285 KB
• Volume: 78
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800781223

✦ Synopsis

patients presented to a single vascular unit with limb-threatening acute or critical ischaemia. Vascular reconstruction was attempted unless the patient had insuficient viable tissue to permit weight bearing or complete absence of run-oflvessels in the calf. Fifty patients underwent a primary amputation and 450 patients underwent vascular reconstruction, of whom 265 had a jemorocrural bypass. Sixty secondary amputations were performed following femorocrural bjpass failure. The below-knee amputation to above-knee amputation -,atio ( P K A : A K A ) was 2.0 in the primary amputation group and 1.1 in the secondary amputation group. Direct comparison between the two groups is not valid as they are clinically diflerent. The combined BKA:AKA ratio was 1.4. This compares,favourably with the BKA : A K A ratio of recent published series andfigures from the National Amputation and Limb Fitting Services. It suggests that an unselective policy of vascular reconstruction for critical ischaemia does amputat ions.

Femorodistal reconstruction is an effective procedure for limb salvage in patients with critical lower limb ischaemia'. However, controversy remains concerning the application of the technique. In particular, it has been suggested that injudicious attempts at arterial reconstruction may adversely affect the subsequent level of amputation should the graft fail, therefore delaying rehabilitation'. It is the policy of this unit to attempt reconstruction whenever possible to offer the greatest probability of successful rehabilitation3. Data from all patients presenting with limb-threatening ischaemia over the last 5 years were reviewed to determine the effect of a failed attempt at reconstruction on the level of amputation.