Stanley C. Fell

Progress in limb salvage by reconstructive arterial surgery combined with new or improved adjunctive procedures.

In the past nine years, 1196 patients whose lower extremity was threatened because of infrainguinal arteriosclerosis have been treated at Montefiore Hospital. In the last six years, limb salvage was attempted in 679 or 90% of 755 patients. Femoro-popliteal (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 86% 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 five years. The cumulative LT limb salvage rate after all reconstructive arterial operations was 66% at five 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 five years. Cumulative LT patency and limb salvage rates of small vessel and axillopopliteal bypasses were more than 50% at two years. Of patients undergoing arterial reconstruction, 88% of those who died within five 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, useable extremity, and 54% lived over two 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

Expanded Polytetrafluoroethylene Grafts in Reconstructive Arterial Surgery: Preliminary Report of the First 110 Consecutive Cases for Limb Salvage

One hundred ten arterial reconstructions, including several new and extended bypasses, were performed with polytetrafluoroethylene (PTFE) grafts and were observed for three to 16 months. Patency rates were 100% with 15 bypasses to the femoral artery, 95% with 66 bypasses to the popliteal artery, and 76% with 29 bypasses to the arteries of the leg and foot. These encouraging preliminary results justify continued use and evaluation of PTFE as an arterial prosthesis.