AMPUTATION LEVEL FOLLOWING UNSUCCESSFUL DISTAL LIMB SALVAGE OPERATIONS

  • 1 January 1980
    • journal article
    • research article
    • Vol. 87  (6) , 683-687
Abstract
Distal arterial grafting for limb salvage remains controversial. Among the criticisms is the potential adverse effect of failed distal bypass on subsequent amputation level. Measurement of popliteal pressure with Doppler ultrasound is useful in predicting healing at the below-knee (BK) level and, pressure of .gtoreq. 60 mm Hg was associated with 87% BK healing in 51 limbs undergoing amputation without prior distal bypass. The outcome in 40 limbs amputated after unsuccessful distal revascularization was examined and the final amputation level was compared with that predicted by populiteal pressure measurements obtained prior to bypass. Forty limbs underwent amputation after unsuccessful limb salvage following attempted femoropopliteal grafts (13), femorotibial grafts (10), a combination of both procedures (10) or tibial artery exploration alone (7). Of 33 limbs with initial pressure of .gtoreq. 60 mm Hg, eventual healing at the BK level was achieved in only 17 (52%). Of 7 limbs with initial pressures of < 60 mm Hg, 4 healed at the BK level, and increased popliteal pressure prior to amputation was shown in 3 of these. Of the total 40 limbs, only 21 (53%) obtained final healing at the BK level. Unsuccessful limb salvage attempts adversely affected ultimate amputation level in limbs initially considered to be candidates for BK amputation.