Chronic critical ischaemia of the lower extremities

The aim of the present study was to establish the best way to treat chronic critical ischaemia of the lower extremities for limb salvage purposes. The paper presents data on 239 cases observed in elderly patients (over 70) between January 1989 and July 1998. Cases were selected essentially on the basis of the European consensus criteria with due account for the unique clinical features each case may present and which may demand an approach that differs from the guidelines. The patients were surgically treated where possible, the type of procedure being selected on the basis of the specific indications. Patients ineligible for surgery were given conservative treatment. The ultimate aim in all cases was limb salvage and follow-up lasted one year. At one-year follow-up limb salvage had been achieved in 51% of patients given conservative treatment. That figure rose to 71% in patients given femoropopliteal or femeroanterotibial bypasses and to 74% in eases where the bypass was combined with lumbar sympathectomy (L2-L3), whereas the figure among those given lumbar ganglionectomy feel to 59%. Meanwhile limb salvage was achieved in 52% of the profundoplasty cases and 61% of those given thromboendarterectomies. Out of the total surgically treated series, 5 patients had died one year later compared to 4 of those given conservative treatment alone. In these essentially Fontaine Stage III or IV eases, medical treatment alone appears unable to achieve lastingly satisfactory results and was only adopted in patients whose inadequate blood vessels precluded surgery. The results obtained indicate that in critical ischaemia cases direct and/or indirect surgery, where possible, is a valid surgical tactic that can achieve limb salvage.