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Órgano Oficial de la Sociedad Mexicana de Angiología y Cirugía Vascular

2006, Number 4

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Rev Mex Angiol 2006; 34 (4)

Risk factors of extremity loss after infrainguinal revascularization

González HR, Serrano LJA, Cossío ZA, Sánchez NNE, Huerta HH, Cal y Mayor TI

Language: Spanish
References: 51
Page: 153-160
PDF size: 64.97 Kb.


ABSTRACT

Background: Critical Limb Ischemia indicates amputation risk in the absence or a significant hemodynamic improvement. Graft occlusion, infection and tissue loss can negatively rebound, increasing both perioperative morbility and mortality, likewise the risk of extremity loss.
Methods: A total of 87 graft were performed to 80 patients (68.8% men and 31.2% women). Average age was 69.06 years (range 44-83). Common femoral artery was the most frequently used inflow artery (79%), whilst the below-knee popliteal was the most frequently used outflow artery (50.5%). All the grafts placed to below knee arteries were performed to diabetics patients. Sphenous vein was the most common graft (79.2%) and every patient whom a composite graft was applied had to suffer a later amputation (N = 4, p = 0.02), 90% of patients had a Diabetes Mellitus (DM) diagnostic. Extremity salvage rate was 62.5% for a year and total of 58.2%, with a 1 year permeability of 72% and a 5 years permeability of 47%. When surgery was indicated because of tissue loss, a statiscally significant association was found for amputation (p ‹ 0.001). When patient had the antecedent of renal insufficiency a significant association was found both for amputation (n=5) and for death (n = 5, p = 0.02).
Conclusion: Infrainguinal revascularization still being the most valuable resource to avoid amputation because of lower extremities critical ischemia, nevertheless patients with the presence of the most important associated risk factors, like renal insufficiency and extense tissue loss, should have the worst prognosis, consequently an early amputation could be able to avoid the accumulated risk of multiple operations.


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