Limb-threatening ischemia in the medically compromised patient: amputation or revascularization?

作者: K. Ouriel , J. E. Geary , W. M. Fiore

DOI:

关键词: AmbulatoryMortality rateSurvival rateMedicinePerioperativeIschemiaAnesthesiologyAmputationRevascularizationSurgery

摘要: The clinical courses of 362 patients with threatened limbs, seen over a 25-year period, were reviewed. Below-knee amputation was elected in 158 and infrainguinal revascularization 204 patients. Patients excluded from the study if chosen on basis arteriographic findings, diffuse infection, or extensive tissue loss. In an effort to compare two treatment modalities minimally biased fashion, stratified into three classes Goldman Multifactorial Index Cardiac Risk American Society Anesthesiology classification. Within each class, treated bypass comparable respect age, sex, severity ischemia, anesthetic technique. who underwent had lower perioperative mortality rate (p less than 0.05), shorter length hospital stay increased long-term survival 0.05) medically matched subgroup amputation. group more successful regaining ambulatory abilities 0.01). These differences most significant as degree medical compromise increased. Although compromised have frequently been denied presumed increases surgical risk decreased survival, data appear suggest that it is precisely this benefit attempts at limb salvage.

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