[MP-7] Simultaneous endovascular revascularization and minor amputation for Rutherford 5/6
Critical limb ischemia
-Single center retrospective study-
BACKGROUND: Critical limb ischemia (CLI) is often difficult to treat, and the life and limb prognosis is poor. Bypass surgery is recommended as a means of revascularization to provide more blood flow than Endovascular treatment (EVT), but there are also many cases of inappropriate and/or incompetent bypass surgery. Although primary major amputation is considered as an initial treatment in some CLI patients, the functional prognosis of CLI patients after major amputation is poor. Furthermore, from the mental aspect of patients, it is significant to aim for minor amputation. Simultaneous EVT and minor amputation has several advantages, such as infection control, supply of blood flow after revascularization, reduction of patient burden, and so on.
PURPOSE&METHODS: The purpose of this study was to evaluate the clinical outcomes of simultaneous EVT and minor amputation. We analyzed consecutive 25 Patients and 27 limbs who underwent simultaneous EVT and minor amputation at our hospital from June 2017 to October 2018.
RESULTS: The mean age of the patients was 76.3±10.3 years, including 18 males (72%). 76% of the patients had diabetes，and 56% had end-stage renal disease. The endovascular-treated segment was 14% (4/27 limbs) in aortoiliac, 51% (14/27 limbs) in femoropopliteal, and 92% (25/27 limbs) in below-the-knee. The amputation level was 5 cases of metatarsophalangeal joint, 19 cases of metatarsal bone, 2 cases of Lisfranc joint, and 1 case of Chopart joint. Intravenous anesthesia was used in all cases, and sciatic nerve and/or saphenous nerve block was used in 16 cases. There were no serious procedure-related complications. During the mean follow-up period of 144.9±126.7 days, 14 patients underwent repeated revascularization. The incidence of all-cause death was 12%, and no patients underwent major amputation.
CONCLUSION:
Simultaneous catheter revascularization and minor amputation could be performed safely, and its short-term clinical outcome was acceptable.
PURPOSE&METHODS: The purpose of this study was to evaluate the clinical outcomes of simultaneous EVT and minor amputation. We analyzed consecutive 25 Patients and 27 limbs who underwent simultaneous EVT and minor amputation at our hospital from June 2017 to October 2018.
RESULTS: The mean age of the patients was 76.3±10.3 years, including 18 males (72%). 76% of the patients had diabetes，and 56% had end-stage renal disease. The endovascular-treated segment was 14% (4/27 limbs) in aortoiliac, 51% (14/27 limbs) in femoropopliteal, and 92% (25/27 limbs) in below-the-knee. The amputation level was 5 cases of metatarsophalangeal joint, 19 cases of metatarsal bone, 2 cases of Lisfranc joint, and 1 case of Chopart joint. Intravenous anesthesia was used in all cases, and sciatic nerve and/or saphenous nerve block was used in 16 cases. There were no serious procedure-related complications. During the mean follow-up period of 144.9±126.7 days, 14 patients underwent repeated revascularization. The incidence of all-cause death was 12%, and no patients underwent major amputation.
CONCLUSION:
Simultaneous catheter revascularization and minor amputation could be performed safely, and its short-term clinical outcome was acceptable.