LIMB SALVAGE - THROMBOLYSOAAGIOPLASTY AS AN ALTERNATIVE TO AMPUTATION

Objective. This 5-year retrospective study evaluates the results of th rombolysoangioplasty (TLA) used as an alternative to major amputation in patients with severely debilitating, lower extremity, peripheral va scular disease. All patients in this study were originally designated for major amputation to treat their ischemic symptoms after all other surgical options were exhausted. Materials and methods. Twenty-one lim bs in 20 patients with complete occlusions of the superficial femoral, popliteal and at least 2 of the 3 major branches below the popliteal trifurcation were attempted for thrombolysoangioplasty for limb salvag e. The majority of patients had previous bypass procedures, and all pa tients had either nonhealing ischemic ulcers, tissue loss, and/or rest ing pain. Results. There were no primary failures. 17/21 patients were saved from major amputation. 4/21 patients were changed from an AKA t o a BKA. 5/21 patients reoccluded within 1 year. 4/5 were successfully retreated via TLA. 1/5 required a major amputation. Life Table analys is demonstrated 63.6% (+/- 3.72)-12 months and 45.4% (+/- 3.78)-15 mon ths primary patency rates. Limb salvage rates, however, were significa ntly better. Twenty-four month and 31 month rates of 75.5% (+/- 5.57) and 75.5% (+/- 6.44) were seen for complete limb salvage, respectively , while 24 and 40 months partial limb salvage rates of 94.7% (+/- 3.67 ) and 94.7% (+/- 4.27) were demonstrated. There were 2 complications; they were both retroperitoneal hemorrhages. Both patients recovered wi thout sequelae. Discussion. In conclusion, these preliminary results i ndicate that TLA is an effective alternative to major amputation for p atients with severely debilitating peripheral vascular disease.