Limb loss after lower extremity bypass

Predictors of limb loss despite a patent endovascular-treated arterial segment

“…[3][4][5] We also found several other factors that were common, including contralateral amputation, poor nutritional status, and peroneal-only runoff in patients with limb loss despite PETAS. Although nonsignificant in our series, contralateral amputation as an independent predictor has been reported, with a 20% to 24% incidence of contralateral amputation in patients with limb loss, 1,2,22 and is likely a reflection of the overall poor general condition of these patients. The peroneal artery as the only runoff has been reported as being adequate after open and endovascular revascularizations for limb salvage [23][24][25][26] and was not associated with limb loss despite a patent revascularized segment in the multivariate analysis in our series.…”

“…[1][2][3][4] The relative incidence of amputations performed with patent bypass is higher, at up to 50%, in certain subgroups, including patients with endstage renal disease, 5-7 diabetes mellitus, 2,8 and those with limited runoff. 9,10 The causes of limb loss in patients despite patent grafts have included extensive infection, poor pedal runoff, failure to reverse ischemia at the site of tissue loss, heel necrosis (Ͼ4 cm), and forefoot gangrene, especially in patients with diabetes and end-stage renal disease, 8 and primary amputation has been suggested in these patients.…”

“…9,10 The causes of limb loss in patients despite patent grafts have included extensive infection, poor pedal runoff, failure to reverse ischemia at the site of tissue loss, heel necrosis (Ͼ4 cm), and forefoot gangrene, especially in patients with diabetes and end-stage renal disease, 8 and primary amputation has been suggested in these patients. 1,5,7,8 The adoption of complex endovascular interventions has allowed limb salvage attempts in higher-risk patients who would otherwise not have been considered for revascularization, making the decision for primary amputation more complex. [11][12][13][14] Although the adoption of an aggressive endovascularfirst approach for all comers with critical limb ischemia has decreased the primary amputation rate from 15% to 4%, accompanied by a decrease in limb loss in patients in whom limb salvage was attempted, 13 we have found that most amputations occurred in patients with patent endovasculartreated segments (PETAS), which other authors have also described.…”

Impact of Femoropopliteal Bypass Surgery on the Survival and Amputation Rate of End-Stage Renal Disease Patients with Critical Limb Ischemia

“…Yet at this time we have no actual data available to support our observation. Our primary findings are in agreement with other studies that could not prove a better survival of ESRD patients with CLI after bypass surgery [3,5,7,8], and that showed a higher amputation rate after the procedure due to bypass thrombosis [4]. Our secondary finding showed that duration of dialysis is an independent predictor of death in our patient groups, significantly increasing the risk for every dialysis year by 17% (hazard ratio 1.17, see Table 2).…”

“…Treiman et al [2] stated that patients with impaired renal function are at increased risk for treatment failure due to potential impaired wound healing, but they nonetheless should not be denied revascularization surgeries, since the wounds may successfully heal. However, other investigators found that risk of death was higher after bypass surgery [3], especially after consecutive limb loss [4], and the risk of amputation increased depending on the procedure type and the diabetes status. Other authors discriminate between patients without and with renal insufficieny requiring dialysis in regard of bypass success, finding that patients with higher renal impairment were at significantly higher risk for amputation, therefore favoring primary amputation over bypass [5,6].…”