Surgical management of critical limb ischaemia in the French West Indies

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.