Predictors of limb loss despite a patent endovascular-treated arterial segment.

OBJECTIVE: The goal of this study was to assess the frequency and predictors of major amputation with patent endovascular-treated arterial segments (PETAS) in patients with critical limb ischemia.

METHODS: The study included 358 consecutive patients (412 limbs) who underwent endovascular (236 limbs) or open (176 limbs) revascularizations for critical limb ischemia from June 2001 through May 2007. Patients with limb loss despite PETAS were compared with the rest of the endovascular-treated group (EV-other, n = 212) and with those who underwent amputations with patent bypasses (APB).

RESULTS: The EV group underwent 30 amputations (24 in PETAS, 6 in EV-other), and 37 occurred in the open group (14 in APB, 23 in open-other). Amputations occurring despite a patent revascularized segment constituted 38% of limb loss in open and 80% in EV-treated patients (P = .001). Limb loss occurred earlier in the PETAS group (58% vs 30%
CONCLUSIONS: Amputation despite PETAS is the most common means of limb loss in patients undergoing endovascular revascularization for limb salvage. It is likely the result of aggressive attempts at limb salvage and usually occurs