Surgical treatment of the severely ischaemic leg: II. Salvage rates

The salvage rates in 437 severely ischaemic legs (384 patients) treated by arterial reconstuction or by lumbar sympathectomy were studied by the life table method. The results were analysed in the surviving patients. Following arterial reconstruction, the salvage rate was 70 per cent at 2 years and 60 per cent at 5 years. The results were similar for aortofemoral reconstruction and for femoropopliteal bypass grafting. Following aortofemoral reconstruction the outcome was better for endarterectomy procedures than for Dacron grafts. The salvage rate for femoropopliteal bypass grafts with patent tibial vessels was higher than for grafts to an isolated popliteal segment or for femorotibial grafts. Late occlusion of a reconstruction frequently did not necessitate major amputation, whereas several amputations were required in spite of a functioning reconstruction. Following sympathectomy the salvage rate was 60 per cent from 1 year onwards. The results were better for tibial artery disease than for femoropopliteal or aortoiliac disease. Failed sympathectomy frequently led to major amputation of the leg or death of the patient. The salvage rates after either reconstruction or sympathectomy were not influenced by age, sex or a prior history of clinical myocardial ischaemia, but the rates were worse in diabetics. The outcome of either operation was best when the procedure was performed for rest pain or ischaemic ulceration, satisfactory for limited gangrene but very poor for extensive gangrene.