Prognosis for Limb Loss in Patients with Chronic Critical Ischemia Considered Technically Inoperable

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Abstract
Of 427 patients with chronic critical ischemia of the lower extremity, admitted for infrapopliteal bypass surgery, 34 (8%) were considered technically inoperable : in 26 cases due to total occlusion of the runoff vessels and in 8 due to a poor runoff and no suitable vein. The symptoms were rest pain in 24 cases and gangrenous ulceration in 10. During a follow-up from eight to twenty-eight months 5 (15%) patients improved significantly and complained only of claudication. Three patients, suffering rest pain, were unchanged up to nine months, and 25 (74%) patients had a major amputation performed. The remaining patient died the day after admission. The mortality rate of these patients was significantly increased compared with that of the 393 patients who underwent infrapopliteal bypass surgery, who in turn had a higher mortality rate than that of an age- and sex-matched Danish population. Clinical judgment, together with ankle and toe pressure measurements, could not identify the group of patients who preserved their limb.