AGGRESSIVE REVASCULARIZATION IN PATIENTS WITH CRITICAL LOWER LIMBS ISCHEMIA
AbstractBackground: 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.
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