• Eitezaz Ahmed Bashir


Background: This study was conducted to conduct an audit of our policy of aggressive arterialreconstruction in patients with critical lower limb ischemia, so as to determine the success intreatment of these cases in terms of limb salvage and patient survival. Methods: This study wascarried out at department of general and vascular Surgery, Combined Military HospitalRawalpindi from January 1995 to January 2000. A total of 114 cases were studied. All patientswere admitted for assessment of an ischemic leg. Pre operative angiography was routinelyperformed. All patients underwent definitive treatment (bypass surgery, amputation and lumbersympathectomy) within three days of admission. Pre operative risk factors including age, sex, preexisting diabetes mellitus, presenting symptoms, ankle systolic pressure were evaluated, with theireffect on limb salvage and patient survival. Results: Of the 114 cases included 102 (89.5%) weremales. 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 lumbarsympathectomy. Eighteen limbs were beyond salvage necessitating amputation. Risk factors hadno effect on limb salvage or mortality. Overall mortality was 4% and over all 30-day graft patencyrate was 77.7%. One-year graft patency rate was 62.5%. Conclusion: By pursuing an aggressivepolicy of revascularization, good results can be obtained in terms of limb salvage and survivalrates.Key Words: Critical ischemia, femoropopliteal bypass, amputation, saphenous vein.


European consensus on critical limb ischemia. Lancet 1989;


Luther M. The influence of arterial reconstructive surgery on

the outcome of critical limb ischemia. Euro J Vasc Surg 1994;


Albers M, De Fratezi AC, Luccia N. Assessment of quality of

life of patient with severe ischemia as a result of infrainguinal

arterial occlusive disease. J Vasc Surg 1992;16:54-9.

Pell JP, Donnan PT, Fowkes FOR, Ruckley CV. Quality of

life following lower limb amputation for peripheral arterial

disease. Eur J Vase Surg 1993; 7:448-51.

Tunes SR, Bass FB, Steinberg EP. The use of angioplasty,

bypass surgery and amputation in the management of

peripheral vascular disease. New Eng J Med 1991:325:556-62.

Veith FJ, Gupta SK, Wengerter KR, Goldsmith J, Rivers SP,

Bakal CW et al. Changing arteriosclerotic disease patterns and

management strategies in lower limb threatening ischemia.

Ann Surg 1990; 212:402-14.

Friedman SG, Kerner BA, Moccio CG. Limb salvage in

elderly patients; is aggressive surgical therapy warranted? J

Cardiovasc Surg (Torino) 1989; 30:849-51.

Ouriel K, Fiore Wm, Geary JE. Limb threatening ischemia in

the medically compromised patient, amputation or

revascularization? Surgery 1988;104:667-72.

Wolfe JHN. Define the outcome of critical ischemia; a oneyear prospective study. Br J Surg 1986;73:321.

Tyrrell MR, Wolfe JHN. Critical leg ischemia: an appraisal of

clinical definitions. Br J Surg 1993; 80:177-180.

Thompson MM, Sayers RD, Vasty K. Chronic critical leg

ischemia must be redefined. Eur J Vasc Surg 1993; 7:420-6.

Tooke JE. European consensus document on critical limb

ischemia: implications for diabetes. Diabetic Med 1990;


Hurley JJ, AuerAI, Hershey FB et al. Distal arterial

reconstruction patency and limb salvage in diabetics, J Vase

Surg 1987; 5:796-802.

Hall KV, Rostad H. Insitu vein bypass in the treatment of

Femoropopliteal atherosclerotic disease. A ten years study.

Am J Surg 1978;136:158-61.