Arterial lesions in severe lower limb ischaemia: A prospective study of 100 consecutive ischaemic limbs in a Hong Kong Chinese population

Background: The pattern and distribution of arterial lesions in a local Chi nese population were studied to assess the feasibility of reconstruction an d the possibility of avoiding major amputation of ischaemic limbs. Method: Between March 1995 and August 1997, 90 consecutive patients with 10 0 severely ischaemic lower limbs and their arteriograms were analysed. Ther e were 48 female and 42 male patients with a mean age of 72 years. All the patients were in fair general health, did not have foot pulses and were wil ling to undergo major arterial reconstruction. Ten patients had bilateral l imb ischaemia and 94 of the ischaemic limbs were affected by rest pain with or without ulcer and/or gangrene, The remaining six patients had debilitat ing claudication. These lesions were classified into low-grade (less than 5 0% stenosis), high-grade (50-90% stenosis) and critical (> 90% stenosis to occlusion). Results: Critically stenotic or occlusive lesions were present in 16% of ao rto-iliac segments: 76% of femoropopliteal arteries; and 82% of trifurcatio n and infrapopliteal segments. in at least 27 patients one of the two main foot arteries was also severely diseased. The present analysis suggested th at 79 of these ischaemic limbs had reconstructable lesions. Sixteen were no t suitable for intervention and in five patients the reconstructability was uncertain radiologically. Conclusion: Contrary to local belief, the majority of patients in the Chine se community with severe lower limb ischaemia without foot pulses would hav e technically reconstructable arterial lesions and could benefit from a rev ascularization procedure.