This retrospective study analyses the clinical presentation surgical manage
ment and early outcome of 174 patients (mean age +/- SEM:73 +/- 15 yrs) adm
itted for critical limb ischaemia. 145 (84%) had tissue loss at admission:
toe gangrene or ischaemic ulcer in 77 and gangrene extending beyond the for
efoot in 68. 87 primary limb amputations and 107 revascularisations were pe
rformed at iliofemoral (n = 20), suprapopliteal (n = 22) or infrapopliteal
level. The postoperative mortality rate was 14% in the "Amputation" group a
nd 9% in the "Revascularisation'' group but the difference was not statisti
cally significant. Infective complications were comparable in both groups,
although 5 of 14 deaths after amputation were directly related to infection
and all deaths after revascularisation resulted from cardiovascular compli
cations. The early limb salvage rate after revascularisation was 82%. 19 se
condary limb amputations were performed for bypass failure. Patients in who
m primary amputations were required were older (p < 0.03) and had significa
ntly higher rates of heart disease and nonambulatory status (respectively,
24 vs 17%, p < 0.05; and 37 vs 13%, p < 0001) than patients in whom revascu
larisation was performed Ischaemic rest pain and tissue loss confined to di
git gangrene or ischaemic ulcer occurred more frequently than extensive gan
grene in the "Revascularisation'' group (p < 0.0001), while extensive gangr
ene extending beyond the forefoot occurred more frequently than ischaemic r
est pain and tissue loss in the "Amputation" group (p < 0.0001). Late prese
ntation of patients and enhanced tissue loss are probably the reasons for t
he higher primary amputation rate in our patients compared to that observed
elsewhere. In patients amenable to revascularisation (56%), arterial recon
struction for critical limb ischaemia improves the chances of limb salvage.