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 PS138. Impact of Tissue Loss on Limb Salvage After Revascularization

Monica O'Brien-Irr2, Linda M. Harris1, Hasan H. Dosluoglu3, Gregory Cherr1, Sonya Noor1, George R. Curl1, Maciej Dryjski1
1Dept of Surgery, Buffalo General Medical Center, Buffalo, NY; 2University at Buffalo, Buffalo, NY; 3VA Western New York Healthcare, Buffalo, NY.


OBJECTIVES: To evaluate the impact of tissue loss (TL) classification, location and presence of infection on limb salvage (LS) following revascularization for lower extremity peripheral arterial disease (PAD).
METHODS: A retrospective medical record review was completed of all patients revascularized for TL during 2009.

RESULTS: There were 110 revascularizations. Major early amputation (mean time 4 months) was required in 30% due to inadequate healing and was more likely in those with gangrene than ulcer (46% vs. 15%; p=0.005) or infection (42% vs. 21%; p=0.05) but did not differ by location (p=0.57). Amputation risk was identified by composite evaluation: low risk: ulcers and non-infected toe gangrene; high risk: infected foot ulcers and all other gangrene (Table 1). LS was higher in low risk (86% vs. 46%; p<0.001) as was favorable outcome (improved/healed TL): 62% vs. 33%: p=0.04. Co-morbidities, post-op complications and pre/post runoff, did not differ between low and high risk. LS was related to pre-runoff for high risk; increasing from 0-3 vessels (0%, 47%, 64%, 75%; p=0.028); but not for low risk; 80%with 0 runoff to 87%, 1-3 vessel runoff; p=0.28.

CONCLUSIONS: Composite evaluation of TL is valuable in identifying patients likely to benefit from revascularization. Infected toe gangrene/foot ulcers or any foot/leg gangrene carry high risk for amputation. Runoff plays a key role for LS in this group but may be less critical to those with lower risk TL.

AUTHOR DISCLOSURES: G. Cherr: Nothing to disclose; G. R. Curl: Nothing to disclose; H. H. Dosluoglu: Nothing to disclose; M. Dryjski: Nothing to disclose; L. M. Harris: Nothing to disclose; S. Noor: Nothing to disclose; M. O'Brien-Irr: Nothing to disclose.

 
 
% LS
Toes Only
Foot
Leg
(-) Infection (+)
(-) Infection (+)
(-) Infection (+)
Ulcer
88
79
89
57*
100
100
Gangrene
82
42*
57*
54*
0*
0*

*high risk

Posted April 2013

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