Noninvasive hemodynamic evaluation in selection of amputation level.

Various noninvasive techniques of hemodynamic evaluation have been used to determine the optimal level of amputation. Noninvasively obtained measurements of pressure and blood flow in the lower extremity have been found to be reliable in predicting the probable healing of an amputation. In patients with severely calcified noncompressible arteries, noninvasive electromagnetic flowmeter measurements of peak pulsatile flow provide a more accurate indication of the vascular status of the patient than do blood pressure measurements which, in such patients, frequently exceed 300 millimeters of mercury. Skin thermistor thermometry does not appear to be applicable in patients with extensive severe ischemia of the leg. The need for a reliable method of determining the lowest possible level of amputation is well recognized. Such factors as wound edge bleeding and clinical judgment too often lead to above the knee amputation when, frequently, a more distal amputation could have been possible. Our experience has shown that noninvasive techniques for hemodynamic evaluation are a valuable aid to clinical judgment in determining accurately the lowest level for successful limb amputation.