Limb loss with patent infra-inguinal bypasses

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] In our PETAS group, 58% of the limb loss occurred Յ3 months, and 79% were infectionrelated. Patients requiring early amputation had overwhelming infection that resulted in extensive tissue loss despite repeated débridements in an attempt to control infection.…”

“…[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.…”

Reduced primary patency rate in diabetic patients after percutaneous intervention results from more frequent presentation with limb-threatening ischemia

“…Lower extremity bypass has been applied very successfully even in difficult clinical scenarios, including the treatment of patients with diabetic foot gangrene and other conditions which carry a high risk of amputation. [15][16] Multiple authors have demonstrated comparable limb salvage rates in diabetics as nondiabetics despite the attendant comorbidities and the challenging pattern of arterial disease in these patients. [5][6][7] Recently, the treatment of chronic lower extremity ischemia has undergone a paradigm shift at many centers toward an endovascular approach.…”

Peroneal artery-only runoff following endovascular revascularizations is effective for limb salvage in patients with tissue loss

“…In addition, amputation with patent revascularization is not unique to the peroneal artery, and has been reported to occur in 17% of all tibial revascularizations, likely reflecting aggressive attempts at limb salvage. 24,25 On the other hand, it is impossible to dismiss the fact that all patients who underwent major amputations in the PAOR group, and 86% of all amputations in the OTHER group occurred in patients with DM, all but one with patent recanalized segments. Therefore, as suggested by Faglia et al, the adequacy of a reconstruction with peroneal-only runoff in some diabetic patients with infected gangrene and major tissue loss following debridement may not be adequate, and more direct blood flow to the involved angiosome 26 may be necessary, either with additional endovascular recanalizations or direct bypass.…”