Surgical treatment of chronic critical leg ischaemia

Abstract

Objective:

To evaluate mobility and care level required after amputation and arterial reconstruction for chronic critical leg ischaemia.

Design:

A 5 year follow up study in three hospitals serving a defined population.

Setting:

One regional and two district hospitals, Finland.

Patients:

117 Consecutive patients.

Outcome measures:

Survival, amputations, mobility, and care level required.

Main results:

66 Primary reconstructions, 51 primary and 35 later major amputations were done. Preoperatively 27 (53%) of the patients who underwent a primary amputation were in permanent institutional care. Of 86 patients who were living outside an institution, 62 (72%) had a reconstruction. One and five year mortality were 43% and 84% after amputation, and 20% and 57% after reconstruction, respectively. Of the patients who had had an amputation 10% were able to walk and 25% could manage to live outside an institution. Mobility and treatment level after primary and secondary amputations were similar. Forty seven (71%) of the patients who had had a reconstruction did not have an amputation. All patients whose reconstructions were successful preserved their walking ability and independent living.

Conclusion:

To maintain mobility and an independent living in patients with chronic critical leg ischaemia it is necessary to do a reconstruction that can salvage the leg. In old, institutionalised patients chronic critical leg ischaemia is often the harbinger of approaching death and then amputation is the only possible solution. Copyright © 1998 Taylor and Francis Ltd.