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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

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Giornale Italiano di Chirurgia Vascolare 2000 December;7(4):309-15

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: English, Italian

Chronic critical ischaemia of the lower extremities

Matarazzo A., Rosati Tarulli V., Florio A., Polichetti R., Crinisio A., Molino C.

From the Faculty of Vascular Surgery (Director: Prof. A. Marcialis) II University of Naples, Naples, Italy


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The aim of the ­present ­study was to estab­lish the ­best way to ­treat ­chronic crit­ical ­ischaemia of the ­lower extrem­ities for ­limb sal­vage pur­poses. The ­paper ­presents ­data on 239 ­cases ­observed in eld­erly ­patients (­over 70) ­between Jan­uary 1989 and ­July 1998. ­Cases ­were ­selected essen­tially on the ­basis of the Euro­pean con­sensus1 cri­teria ­with due ­account for the ­unique clin­ical fea­tures ­each ­case may ­present and ­which may ­demand an ­approach ­that dif­fers ­from the guide­lines. The ­patients ­were sur­gi­cally ­treated ­where pos­sible, the ­type of pro­ce­dure ­being ­selected on the ­basis of the spe­cific indi­ca­tions. ­Patients inel­i­gible for sur­gery ­were ­given con­ser­va­tive treat­ment. The ulti­mate aim in all ­cases was ­limb sal­vage and ­follow-up ­lasted one ­year. At one-­year ­follow-up ­limb sal­vage had ­been ­achieved in 51% of ­patients ­given con­ser­va­tive treat­ment. ­That ­figure ­rose to 71% in ­patients ­given femor­o­pop­li­teal or fem­e­roan­ter­o­ti­bial by­passes and to 74% in ­cases ­where the ­bypass was com­bined ­with ­lumbar sym­pa­thec­tomy (L2-L3), ­whereas the ­figure ­among ­those ­given ­lumbar gan­gli­o­nec­tomy ­fell to 59%. Mean­while ­limb sal­vage was ­achieved in 52% of the pro­fun­do­plasty ­cases and 61% of ­those ­given throm­boen­dar­ter­ec­to­mies. Out of the ­total sur­gi­cally ­treated ­series, 5 ­patients had ­died one ­year ­later com­pared to 4 of ­those ­given con­ser­va­tive treat­ment ­alone. In ­these essen­tially Fon­taine ­Stage III or IV ­cases, med­ical treat­ment ­alone ­appears ­unable to ­achieve last­ingly sat­is­fac­tory ­results and was ­only ­adopted in ­patients ­whose inad­e­quate ­blood ves­sels pre­cluded sur­gery. The ­results ­obtained indi­cate ­that in crit­ical ­ischaemia ­cases ­direct and/or indi­rect sur­gery, ­where pos­sible, is a ­valid sur­gical ­tactic ­that can ­achieve ­limb sal­vage.

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