Successful conservative therapy of severe limb-threatening ischemia: the value of nonsympathectomy

Fourteen patients with severely ischemic extremities but relatively minor degrees of pedal gangrene or ulceration were managed without surgery. Contraindications to direct arterial reconstruction included significant intercurrent illness or generally poor surgical risk, the need for reoperative or d...

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Bibliographic Details
Published inSurgery Vol. 99; no. 6; p. 759
Main Authors Rivers, S P, Veith, F J, Ascer, E, Gupta, S K
Format Journal Article
LanguageEnglish
Published United States 01.06.1986
Subjects
Aged
Amputation
Anti-Bacterial Agents - therapeutic use
Bed Rest
Follow-Up Studies
Gangrene - therapy
Hospitalization
Humans
Ischemia - etiology
Ischemia - therapy
Leg - blood supply
Leg Ulcer - therapy
Length of Stay
Middle Aged
Sympathectomy
Vascular Surgical Procedures
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Summary:Fourteen patients with severely ischemic extremities but relatively minor degrees of pedal gangrene or ulceration were managed without surgery. Contraindications to direct arterial reconstruction included significant intercurrent illness or generally poor surgical risk, the need for reoperative or difficult distal reconstruction, or the favorable characteristics of the actual lesion. Management consisted of bed rest, simple saline soaks, occasional gentle debridement, and antibiotics when indicated. Seven patients had complete resolution of their lesions for 3 to 48 months, and seven had improvement or stabilization for 3 to 18 months. Only three of the 14 patients have eventually required surgery with limb salvage in one. Revascularization remains the method of choice for managing most severely ischemic extremities. However, the conservative approach described represents an alternative to early amputation, attempts at revascularization, or lumbar sympathectomy in some patients with advanced ischemia. Studies of sympathectomy and pharmacologic agents as effective treatment for ischemic ulcers or gangrene should include control groups treated with the conservative measures outlined herein.
ISSN:0039-6060