Sharp, Elizabeth Jean; (1995) Critical lower limb ischaemia. Is distal revascularisation worthwhile? Masters thesis (M.S), UCL (University College London).

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Abstract

Many patients with gangrene in this country are still offered amputation without any attempt at revascularisation. At Regional Vascular Services (RVS) all patients are investigated and a variety of surgical procedures performed. At many district general hospitals (DGH) the repertoire of surgical procedures is smaller. This study aims to evaluate whether it is worthwhile to apply the most sophisticated methods of revascularisation to patients with critical lower limb ischaemia. Differences in demography are noted between patients with critical lower limb ischaemia, intermittent claudication and abdominal aortic aneurysms. Diabetes mellitus is most prevalent in patients with critical limb ischaemia. Comparing the demographic data of patients with critical ischaemia presenting to the RVS and the DGH there were no significant differences in risk factors, but, the annual presentation rate at the RVS was two and a half times greater than at a DGH in the North West Thames Region. Moreover, the RVS had more patients with distal disease. There were no overall differences in the cumulative limb salvage and survival rates comparing the RVS and the DGH, but for patients with distal disease the cumulative limb salvage rates were 78% and 18% respectively at one year. At the RVS when revascularisation failed and major amputation was needed 72% were at the below knee level compared to 50% at the DGH. 31-Phosphorus magnetic resonance spectroscopy was used to study the small muscles of the foot at rest to see if the system could predict which limbs had potentially reversible ischaemia. Changes in the 31P spectra were seen at rest, but proved to be of limited clinical value. Quality of life studies demonstrated significant improvement in reduction in pain and mobility in the reconstruction group with time. Surprisingly, we were unable to demonstrate statistically significant differences between the reconstruction and amputation groups, presumably due to the small sample size.

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