Limb salvage and selectivity
Van De Water, J.M.; Thompson, R.R.; Laska, E.D.; Trudell, L.A.; Broffman, T.K.; Harrower, H.W.
Surgery Gynecology and Obstetrics 148(3): 349-354
1979
ISSN/ISBN: 0039-6087 PMID: 419433 Document Number: 142663
In a group of properly prepared poor risk patients with advanced atherosclerosis of both the aortoiliac and femoropopliteal segments, a combined procedure, extra-anatomic bypass with an extended profundoplasty, was used for successful salvage of their ischemic--mean calf pressure=27 millimeters of mercury--limbs. Prediction of success versus failure could be determined on neither clinical nor angiographic-anatomic grounds but was possible using two simple measurements: a large aortoiliac differential pressure--deltaP--between inflow pressure obtained from a standard arm cuff and outflow pressure measured directly from the femoral artery, 89.3 millimeters of mercury versus 33.2 millimeters of mercury, p less than 0.001, and a potentially adequate outflow bed as determined by the percentage drop in outflow [(deltaPo/Po) per cent] upon papaverine injection, 36.3 versus 11.3 per cent, p less than 0.001. These values became an important part of the selection scheme developed in the approach to 24 ischemic limbs.