Progress in limb salvage arterial surgery: components and results of an aggressive approach.

In the past 9 years, 1,196 patients whose lower extremity was threatened because of infrainguinal arteriosclerosis have been treated at Montefiore Hospital. In the last 6 years, limb salvage was attempted in 679, or 90% of 755 patients. Femoropopliteal (318), small vessel (204) and axillopopliteal (29) bypasses were used along with transluminal angioplasty (128) and aggressive local operations to obtain a healed foot. Immediate (one month) limb salvage was achieved in 583, or 85%, of the 679 patients in whom revascularization was possible. The 30-day mortality rate was 3%. The cumulative life table (LT) survival rate of all the patients undergoing reconstructive arterial operations was 48% at 5 years. The cumulative LT limb salvage rate after all reconstructive arterial operations was 66% at 5 years. The cumulative LT patency rate of femoropopliteal bypasses was not influenced by angiographic outflow characteristics of the popliteal artery but was increased 15% by appropriate reoperations to 67% at 5 years. Cumulative LT patency and limb salvage rates of small vessel and axillopopliteal bypasses were more than 50% at 2 years. Of patients undergoing arterial reconstruction, 88% of those who died within 5 years did so without losing their limbs. Of all the patients in whom limb salvage was attempted, 68% lived more than one year with a viable, usable extremity, and 54% lived over 2 years with an intact limb. We believe this aggressive approach to limb salvage is justified, and can be undertaken with a low cost in mortality, knee loss and morbidity.