TY - JOUR
T1 - Limb loss after lower extremity bypass
AU - Reifsnyder, Thomas
AU - Grossman, Jordan P.
AU - Leers, Steven A.
PY - 1997/8
Y1 - 1997/8
N2 - BACKGROUND: Infrainguinal bypass now has a limb salvage rate approaching 90% at 10 years. This study helps elucidate the causes of limb loss despite bypass surgery. METHODS: A retrospective chart review of all patients undergoing a major lower extremity amputation after attempted bypass surgery. RESULTS: Between July 1987 and January 1997, 87 major amputations (52 below knee, 15 above knee) followed infrainguinal bypass for limb salvage in 64 patients. Of these patients, 53 (83%) were diabetic and 10 (16%) were on dialysis. The etiology of limb loss included thrombosed bypass (n = 33, 49%), lack of limb salvage despite patent bypass (n = 23, 34%), intraoperative bypass failure (n = 6, 9%), and exposed/infected bypass (n = 5, 8%). The 23 patients with patent grafts required amputations because of hindfoot necrosis (n = 6), persistent forefoot necrosis (n = 6), acute diabetic foot infection (n = 6), and various other reasons (n = 5). Using life-table analysis, survival for the whole group was 56% at 12 months and 17% at 48 months. Patients with limb loss despite a patent bypass fared the worst with survival of 21% at 2 years. CONCLUSIONS: Bypass thrombosis caused half of the amputations after limb salvage surgery. A patent bypass was functioning at the time of amputation in another third. Survival after failure of limb salvage was abysmal, especially in patients with patent bypasses.
AB - BACKGROUND: Infrainguinal bypass now has a limb salvage rate approaching 90% at 10 years. This study helps elucidate the causes of limb loss despite bypass surgery. METHODS: A retrospective chart review of all patients undergoing a major lower extremity amputation after attempted bypass surgery. RESULTS: Between July 1987 and January 1997, 87 major amputations (52 below knee, 15 above knee) followed infrainguinal bypass for limb salvage in 64 patients. Of these patients, 53 (83%) were diabetic and 10 (16%) were on dialysis. The etiology of limb loss included thrombosed bypass (n = 33, 49%), lack of limb salvage despite patent bypass (n = 23, 34%), intraoperative bypass failure (n = 6, 9%), and exposed/infected bypass (n = 5, 8%). The 23 patients with patent grafts required amputations because of hindfoot necrosis (n = 6), persistent forefoot necrosis (n = 6), acute diabetic foot infection (n = 6), and various other reasons (n = 5). Using life-table analysis, survival for the whole group was 56% at 12 months and 17% at 48 months. Patients with limb loss despite a patent bypass fared the worst with survival of 21% at 2 years. CONCLUSIONS: Bypass thrombosis caused half of the amputations after limb salvage surgery. A patent bypass was functioning at the time of amputation in another third. Survival after failure of limb salvage was abysmal, especially in patients with patent bypasses.
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U2 - 10.1016/S0002-9610(97)90074-X
DO - 10.1016/S0002-9610(97)90074-X
M3 - Article
C2 - 9293832
AN - SCOPUS:0030758432
SN - 0002-9610
VL - 174
SP - 149
EP - 151
JO - American journal of surgery
JF - American journal of surgery
IS - 2
ER -