Revascularization Techniques for Limb Salvage in Critical Limb Ischemia: A Single Institutional Study From Pakistan

Abstract

Objectives: The study aimed to determine the frequency of successful limb salvage in patients presenting with critical limb ischemia utilizing the available revascularization modalities. This descriptive cross-sectional study was conducted in the Department of General Surgery, Shifa International Hospital, Islamabad, from April 2017 to August 2017. Methodology: A total of 96 patients with critical limb ischemia requiring urgent surgery for limb salvage were included in our study. Patients who had undergone previous surgeries for limb ischemia involving the same limb, had concurrent venous disease, or suffered from acute limb ischemia were excluded. All patients underwent either endoscopic angioplasty or bypass surgery. All patients were followed up for six months for the success of limb salvage and the requirement for amputation. Data were analyzed by SPSS version 26.0 (Armonk, NY: IBM Corp.). Results: Our patients had a mean age of 62.03±8.46 years, of whom 63 (65.6%) were men. A total of 47 (49.0%) patients required surgery for a non-healing ulcer, while 49 (51.0%) had resting leg pain. In 55 (57.3%) patients, bypass surgery was performed, while 35 (36.5%) underwent endoscopic angioplasty. The remaining six (6.2%) patients received a combination of both procedures. Limb salvage was successful in 78 (81.3%) patients. There was no difference between outcomes across gender (p=0.122), nor was there any difference in outcome between bypass surgery and endoscopic angioplasty (p=0.665). Conclusion: Encouraging results can be obtained in treatment of critical limb ischemia if revascularization techniques are utilized prudently in a time-effective manner and individualized to each patient's requirements.

Understanding Gangrene in the Context of Peripheral Vascular Disease: Prevalence, Etiology, and Considerations for Amputation-Level Determination

“…Adequate restoration of blood flow to the affected limb is crucial for limb salvage and functional recovery. The effectiveness of revascularisation procedures hinges on factors such as the location and severity of arterial blockages and the patient's overall vascular health [ 52 ].…”