This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

The Role of Vascular Surgery

Lloyd M. Taylor, Jr, MD; Daniel Hamre, MD; Ronald L. Dalman, MD; John M. Porter, MD

Arch Surg. 1991;126(10):1251-1258.

Abstract
• Since 1980,498 patients with 627 critically ischemic legs (rest pain, gangrene, ischemic ulcer, and ankle-brachial pressure index <0.40) were treated with revascularization regardless of operative risk or anticipated operative difficulty. Primary amputation was performed only when no graftable distal vessels were present (14 primary amputations [2.8%]) or in neurologically impaired, hopelessly nonambulatory patients. The mortality for revascularization was 2.3%, and the median hospital stay was 11 days. During follow-up, 41 limbs (7%) required amputation, 31 after failure of revascularization and 10 despite patent revascularizations. Renal failure had an adverse influence on limb salvage (67%) because of a significantly increased requirement for amputation despite patent revascularizations. We conclude aggressive limb revascularization in patients with critical lower-extremity ischemia results in low operative morbidity and mortality and excellent long-term limb salvage. Patients with critical leg ischemia and renal failure are at higher risk for limb loss than patients without renal failure.

(Arch Surg. 1991;126:1251-1258)

Author Affiliations
From the Division of Vascular Surgery, Department of Surgery, Oregon Health Sciences University, Portland.

Footnotes
Accepted for publication June 30, 1991.

Presented at the 62nd Annual Scientific Session of the Pacific Coast Surgical Association, Pebble Beach, Calif, February 19, 1991.

Reprint requests to Department of Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, OP11, Portland, OR 97201-3098 (Dr Taylor).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A prognostic model for amputation in critical lower limb ischemia
Klomp et al.
Vasc Med 2009;14:109-115.
ABSTRACT  

Impact of Endovascular Surgery on Management of Critical Lower-Limb Ischemia in a Vascular Surgery Department
Heredero et al.
VASC ENDOVASCULAR SURG 2005;39:429-435.
ABSTRACT  

Functional outcomes and quality of life in peripheral arterial disease: current status
Nehler et al.
Vasc Med 2003;8:115-126.
ABSTRACT  

Lower-Extremity Peripheral Arterial Disease among Patients with End-Stage Renal Disease
O'Hare and Johansen
J. Am. Soc. Nephrol. 2001;12:2838-2847.
ABSTRACT | FULL TEXT  

Patency and Limb Salvage After Infrainguinal Bypass With Severely Compromised ("Blind") Outflow
Desai et al.
Arch Surg 2001;136:635-642.
ABSTRACT | FULL TEXT  

Infrainguinal Bypass in Patients with End-stage Renal Disease: Survival and Ambulation
Nicholas et al.
VASC ENDOVASCULAR SURG 2000;34:147-156.
ABSTRACT  

Critical Limb Ischemia in Patients with End-Stage Renal Disease: Do Long-Term Results Justify An Aggressive Surgical Approach?
Dovgan et al.
PERSPECT VASC SURG ENDOVASC THER 1999;12:81-92.
ABSTRACT  

Diagnosis and Treatment of Chronic Arterial Insufficiency of the Lower Extremities: A Critical Review
Weitz et al.
Circulation 1996;94:3026-3049.
FULL TEXT  

Popliteal-Tibial Bypass Grafts in the Management of Limb-Threatening Ischemia
Ballard et al.
Arch Surg 1993;128:976-981.
ABSTRACT