Midterm Outcomes of Neuroischemic and Ischemic Wounds Treated by a Multidisciplinary Limb Salvage Service

Abstract

amputations, or deaths within 30 days. Residual stenosis was detected by DUS in seven patients; one had early endovascular reintervention and one had early surgical graft revision. Median follow-up time was 531 days.Kaplan-Meier analysis showed limb salvage rates of 93% at both 12 and 24 months; continued graft patency rates without need for reintervention were 29% and 24%. Receiver operating characteristic analysis identified that a lesion length of 1.5 cm maximized sensitivity and specificity in predicting restenosis (C statistic: 0.81); the restenosis rate for patients with lesions >1.5 cm was 100% at one year, and for lesions #1.5 cm was 43% at one year and 54% at two years (P < 0.001 by log rank test).Conclusions: In this single-center experience with endovascular therapies to treat failing infrapopliteal bypass grafts, 93% of limbs were preserved, but over 70% of patients developed graft restenosis within 12 months. In particular, stenoses longer than 1.5 cm did very poorly with endovascular treatment. These data suggest that interventions to restore or prolong graft patency are effective in preventing limb loss and that close follow up with vascular laboratory surveillance is essential.