Level Selection of Non-Traumatic Lower Extremity Amputations in Patients With Critical Ischemia

Abstract

Objective. To evaluate the informativeness of ultrasound scanning of the lower limb arteries and angiography in patients with critical ischemia for choosing the optimal level of extremity amputation.
 Methods. Treatment of 289 patients with obliterative diseases of the arteries of the lower extremities of various genesis with the indications for amputation of the damaged lower extremity was analyzed.
 Results. Ultrasound scanning of arteries could not always characterize the severity of collateral circulation, but indicated only the level of occlusion. However, the severity of chronic ischemia of the lower limb is determined not only by the level of occlusion, but also by the severity of collateral blood flow at the same level of damage. That is why, in our opinion, the results of an ultrasound examination of the lower limb arteries cannot be decisive when choosing the level of amputation. Angiography made it possible to characterize not only the level of occlusion or stenosis, but also the state of collateral circulation, which had a decisive influence on the choice of the method of limb amputation.
 Conclusion. Ultrasound examination of the lower extremity vessels allows to establish the level of occlusion, but is uninformative for the assessment of collateral anastomoses, which is an important factor in choosing the level of non-traumatic amputation of the lower extremity. In patients with critical ischemia, transtibial amputations should be avoided, as they show worse results. The operation of choice should be a transfemoral amputation or non-traumatic through-knee amputation.