Distal amputations: impact of the introduction of femorocrural and femoropedal arterial bypass.

The aim of the study was to assess the impact of the introduction of femorodistal arterial bypass grafting on the patterns of lower limb amputation and reconstructive surgery, in particular the success rates of distal, conservative, amputations. Two 2-year cohorts of patients 7 years apart were analysed by a retrospective analysis of departmental audit and patient records. Significantly more patients undergoing distal amputation were considered to have reconstructible arterial disease in the later cohort. This was paralleled by an increase in the rate of suprapopliteal/popliteal and distal arterial bypass and a fall in below-knee amputation rate in this group of patients. The overall healing rate and rate of conversion of distal amputations were not adversely affected by the introduction of femorodistal bypass grafting, despite the fact that more distal amputees were non-diabetic in this second group. There was a high rate of success for distal amputations combined with femorodistal bypass, but the subgroup was too small for statistical analysis. We conclude that the use of distal amputation, with or without distal arterial bypass, offers a promising, although unproven, prospect for lower limb conservation even in non-diabetics.