Surgical treatment of the severely ischaemic leg: II. Salvage rates

Abstract

SUMMARYThe salvage rates in 437 severely ischaemic legs (384 patients) treated by arterial reconstruction or by lumbar sympathectomy were studied by the life table method. The results were analysed in the surviving patients.Follo wiug arterial reconstruction, the salvage rate was 70per cent at 2 years and 60per cent at 5 years. The results were similar for aortofemoral reconstruction and for femoropopliteal bypass grafting. Following aortofemoral reconstruction the outcome was better for endarterectomy procedures than for Dacron grafts. The salvage rate for femoropopliteal bypass grafts with patent tibial vessels was higher than for grafts to an isolated popliteal segment or for femorotibial grafts. Late occlusion of a reconstruction frequently did not necessitate major amputation, whereas several amputations were required in spite of a functioning reconstruction.Following sympathectomy the salvage rate was 60per cent from I year onwards. The results were better for tibial artery disease than for femoropopliteal or aortoiliac disease. Failed sympathectomy frequently led to major amputation of the leg or death of the patient.The salvage rates after either reconstruction or sympathectomy were not influenced by age, sex or a prior history of clinical myocardial ischaemia, but the rates were worse in diabetics. The outcome of either operation was best when the procedure was performed for rest pain or ischaemic ulceration, satisjactory for limited gangrene but very poor for extensive gangrene.

The choice of operation in aortoiliac reconstructions for intermittent claudication

“…All patients studied in this review had aortoiliac reconstructions for severe disabling claudication due to atherosclerosis. The results of aortoiliac surgery for patients with rest pain or gangrene have been presented elsewhere [5,6].…”

The non-selective use of profundaplasty in lower limb ischaemia

“…A recent paper by Myers et al (1978) has assessed many of the factors influencing the rate of limb salvage in a large series of severely ischaemic limbs. Profunda revascularization by proximal endarterectomy or profundaplasty showed an encouraging salvage rate, by the life-table method, of 70% amongst survivors at 5 years.…”