Effect of arterial reconstruction on limb salvage: a ten-year appraisal.

Two hundred forty-four consecutive patients were reviewed who presented themselves over a ten-year period (1967 to 1977) with threatened limb loss secondary to arteriosclerosis involving the arteries supplying the lower extremities. Patients with claudication as the presenting complaint were not included. Primary amputation was performed in 14 patients (6%), with an operative mortality of 21%, whereas arterial reconstructive surgery was carried out in 230 patients (94%) with an operative mortality of 2.7% One hundred eleven femoral-popliteal vein grafts in 101 patients showed a cumulative five-year graft patency of 78% with a limb salvage rate of 73%. Twenty-eight femoral-femoral grafts and 21 axillary-bilateral femoral grafts yielded five-year graft patency rates of 91% and 77%, respectively: the limb salvage rates were 91% and 86%. Inclusive of the 14 patients undergoing primary amputation, the overall five-year cumulative limb salvage in the entire group was 76%.