IP207. Comparative Study of Postrevascularization Limb Salvage Rate Between Early and Delayed Presenters With Rutherford Class II Acute Lower Extremity Ischemia in a Tertiary Referral Center in India

Abstract Background: Popliteal vascular injury remains a challenging entity, and carries the greatest risk of limb loss among lower extremity vascular injuries. We aim to review our experience with complex penetrating popliteal vascular injuries, thereby focusing on therapeutic challenges, and early outcomes.Methods: From September 2015 to December 2019, we managed total of 728 penetrating vascular injuries with 163 popliteal vascular injuries presented to Authority of Althawra hospital in Taiz. Of 125 patients, 103 patients were fulfilling the inclusion criteria. Variables were retrospectively collected included patient demographics, mechanism and type of injuries, limb ischemia time, type of vascular reconstruction, associated complications, limb salvage, and mortality.Results: 157 vascular reconstructions were performed for 103 patients with penetrating popliteal vascular injuries, the majority 94 (91.3%) were male. Mean age was 27.3 ± 12.3 years. Popliteal vascular injuries were the second most common accounting for 35% of lower extremity vascular injuries and 22.4% of the total vascular injuries. Nearly half 54 (52.4%) of patients sustained complex popliteal vascular injuries (arterial and venous injuries), 31 (30.1%) isolated arterial injuries, and 18 (17.5%) isolated venous injuries. Management of vascular injury was repaired by interposition graft in 68 (66%), end-to-end anastomosis in 16 (15.5%), and venous patch in 1(1%). Venous injury was repaired in 53 (51.4%) and ligated in 18 (17.5%). Less than 6 hours from injury to completed revascularization was achieved in 58 (56.3%) patients. The overall fasciotomy was 28 (27.2%) which significantly increased length of hospital stays (17 days vs 7 days, P= 0.0003). The overall limb-salvage rate in our study was 94.2%. During the study period, the most common complication was 14 (13.6%) wound infection, 14 (13.6%) graft thrombosis, 6 (5.8%) bleeding, 4 (3.9%) graft infection. Early limb loss occurred in 6 (5.8%) and the mortality rate was (1.9%).Conclusions: Wartime penetrating popliteal vascular injury is a real challenge. However, team approach and promptly vascular repair found to associate with a remarkable limb salvage rate of 94.2%. We advocate repair of arterial injury with vein graft as the treatment of choice whenever possible.

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IFT08. Comparative Study of Short-Term Clinical Outcomes of Single Versus Multiple Infrapopliteal Vessel Angioplasty in Critical Limb Ischemia in Tertiary Referral Center in India

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.04.067 ◽

2019 ◽

Vol 69 (6) ◽

pp. e79

Author(s):

Hemant Chaudhari ◽

C.P.S. Sravan ◽

Roshan Rodney ◽

Vaibhav Lende ◽

Nishan Bojja

Keyword(s):

Comparative Study ◽

Clinical Outcomes ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Tertiary Referral ◽

Short Term ◽

Tertiary Referral Center ◽

Referral Center ◽

Single Versus

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Limb salvage procedures for lower extremity ischemia

The American Journal of Surgery ◽

10.1016/0002-9610(76)90440-2 ◽

1976 ◽

Vol 132 (6) ◽

pp. 707-709 ◽

Cited By ~ 2

Author(s):

George J. Collins ◽

Norman M. Rich ◽

Charles A. Andersen

Keyword(s):

Lower Extremity ◽

Limb Salvage ◽

Lower Extremity Ischemia ◽

Extremity Ischemia

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Repetitive bypass and revisions with extensions for limb salvage after multiple previous failures

Vascular ◽

10.1177/1708538113477859 ◽

2013 ◽

Vol 21 (2) ◽

pp. 63-68 ◽

Cited By ~ 7

Author(s):

Evan C Lipsitz ◽

Frank J Veith ◽

Neal S Cayne ◽

John Harvey ◽

Soo J Rhee

Keyword(s):

Lower Extremity ◽

Limb Salvage ◽

Primary Patency ◽

Secondary Patency ◽

Group A ◽

Lower Extremity Ischemia ◽

One Year ◽

Group B ◽

Revascularization Procedures ◽

Salvage Rate

The optimal treatment of patients facing imminent amputation after multiple (≥2) failed prior ipsilateral bypasses is unclear. We analyzed a group of patients undergoing multiple lower extremity bypasses for limb salvage to assess the utility of attempting multiple revascularizations. From 1990 to 2005, 105 revascularization procedures were performed in 55 limbs of 54 patients with imminent limb-threatening lower extremity ischemia after failure of ≥2 prior infrainguinal bypasses in the same leg. Fifty-five operations were the third procedure (Group A) and 50 operations were the fourth or more (Group B). We compared primary/secondary patency and limb salvage rates by Society for Vascular Surgery criteria. Limb salvage rates did not differ between patients undergoing a third bypass and those undergoing four or more bypasses at one year (62 versus 65%, NS) or at three years (58 versus 61%, NS). Secondary patency was not different between groups (76 versus 76%, P = NS) at one and three years (71 versus 70%, NS). Primary patency also did not differ between the two groups, at one year (24 versus 35%, NS), or at three years (11 versus 15%, NS). No differences were observed in morbidity and mortality rates between the groups. In conclusion, the likelihood of success of repetitive limb revascularization was unrelated to the number of previous failures. The expected incremental failure rate with each successive bypass was not found. These results, coupled with the three-year limb salvage rate of over 50% in patients who otherwise would have required amputation, lend support to aggressive use of limb revascularization in selected patients even after two or more failed bypasses.

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