The influence of subintimal angioplasty on level of amputation and limb salvage rates in lower limb critical ischaemia: A 15-year experience

Objectives. The aim of this study is to assess the influence of subintimal angioplasty (SIA) on lower limb amputation rate and level in critically ischaemic limbs. Methods. Between January 1989 and March 2004, 1268 patients were admitted for treatment of lower limb critical ischaemia. Eight hundred and twenty-nine patients underwent revascularisation (bypass 671 and angioplasty 158), while 439 patients had primary amputations. A retrospective analysis of a prospectively maintained vascular registry was performed. Patients were divided into two groups, those who were admitted prior to the availability of subintimal angioplasty and those treated post-introduction of angioplasty. The two groups were compared with regards to age, sex, diabetes mellitus, ASA grade, Rutherford classification and level of disease. Outcome was assessed by the limb salvage rate, 30-day morbidity and mortality, and length of hospital stay. Results. The average number of revascularisation increased with the introduction of subintimal angioplasty, from 53 to 96 per year (p < 0.001). The overall limb salvage rate increased significantly from 42 to 70% (p < 0.001). The cumulative limb salvage rate following revascularisation rose from 72 to 86% (p < 0.001). The level of amputation (AKA:BKA) did not vary significantly. Thirty-day morbidity, mortality and length of hospital stay were significantly lower in the post-angioplasty group. Conclusions. Technical advances have resulted in a steadying of amputation numbers despite an ageing population.