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Extremity Salvage by Revascularization

Department of Surgery, Saint Louis University School of Medicine, and John Cochran Veterans Administration Hospital, St. Louis, Missouri

Donald L. Kaminski, M.D.

Department of Surgery, Saint Louis University School of Medicine, and John Cochran Veterans Administration Hospital, St. Louis, Missouri

Anne E. Ramey, B.A.

Department of Surgery, Saint Louis University School of Medicine, and John Cochran Veterans Administration Hospital, St. Louis, Missouri

Paul J. Garvin, M.D.

Department of Surgery, Saint Louis University School of Medicine, and John Cochran Veterans Administration Hospital, St. Louis, Missouri

George C. Kaiser, M.D.

Department of Surgery, Saint Louis University School of Medicine, and John Cochran Veterans Administration Hospital, St. Louis, Missouri

Vallee L. Willman, M.D.

Department of Surgery, Saint Louis University School of Medicine, and John Cochran Veterans Administration Hospital, St. Louis, Missouri

John E. Codd, M.D., F.A.C.A.

Department of Surgery Saint Louis University Medical School 1325 South Grand Boulevard St. Louis, Missouri 63104

Advances in prosthetic devices led to our analysis of revascularization in patients presenting with gangrene of the lower extremity. Between 1966 and 1976, 99 grafts were performed on 96 of the 249 patients treated by lower extremity revascularization who presented with the above criteria. Their mean age was 66 years; 46 (48%) were diabetic, 53 (55%) were over the age of 65, and 38 (40%) had angiographically proven disease with one vessel runoff. Initial therapy consisted of intravenous antibiotics and local debridement to control sepsis, followed by detailed arteriography. Femoral-popliteal bypass was per formed in 87 patients, and a more distal vessel was utilized in 9. There were 5 in- hospital deaths. Of these, 4 patients had come to major amputation. Four died as a result of myocardial infarctions, and 1 as a result of a cerebrovascular accident.

Immediate graft patency was achieved in 93 of 99 patients (93%). Minor amputations were required in 44 patients. Early graft failure resulted in major amputations in 7 patients. A late major amputation (mean 13 months) was required in an additional 28 patients, 15 because of graft failure and 13 because of nonhealing minor amputations. Extremity salvage at 2 years was achieved in 72 of the 99 patients (72%).

Vascular and Endovascular Surgery, Vol. 13, No. 2, 95-103 (1979)
DOI: 10.1177/153857447901300204


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