AGGRESSIVE REVASCULARIZATION IN PATIENTS WITH CRITICAL LOWER LIMBS ISCHEMIA

Eitezaz Ahmed Bashir

Abstract


Background: This study was conducted to conduct an audit of our policy of aggressive arterial
reconstruction in patients with critical lower limb ischemia, so as to determine the success in
treatment of these cases in terms of limb salvage and patient survival. Methods: This study was
carried out at department of general and vascular Surgery, Combined Military Hospital
Rawalpindi from January 1995 to January 2000. A total of 114 cases were studied. All patients
were admitted for assessment of an ischemic leg. Pre operative angiography was routinely
performed. All patients underwent definitive treatment (bypass surgery, amputation and lumber
sympathectomy) within three days of admission. Pre operative risk factors including age, sex, preexisting diabetes mellitus, presenting symptoms, ankle systolic pressure were evaluated, with their
effect on limb salvage and patient survival. Results: Of the 114 cases included 102 (89.5%) were
males. Forty-six patients (40.3%) were diabetic. Revascularization was attempted in 76 limbs, 61
(80.3%) underwent femoropopliteal bypass and 15 (19.7%) underwent femorodistal bypass.
Twenty patients (17.5%) with Berger’s disease, of the 114 cases included, were treated by lumbar
sympathectomy. Eighteen limbs were beyond salvage necessitating amputation. Risk factors had
no effect on limb salvage or mortality. Overall mortality was 4% and over all 30-day graft patency
rate was 77.7%. One-year graft patency rate was 62.5%. Conclusion: By pursuing an aggressive
policy of revascularization, good results can be obtained in terms of limb salvage and survival
rates.
Key Words: Critical ischemia, femoropopliteal bypass, amputation, saphenous vein.

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