ABSTRACT
PURPOSE: To evaluate the role of repetitive vascular surgery in below-knee amputation for critical lower-limb ischemia. METHODS: The data of the 39 below-knee amputee despite receiving one more vascular surgery for critical limb ischemia from Jaunary 1990 through October 1995 were retrospectively reviewed. A total of 102 surgical operation was included. RESULTS: The mean age was 46 years old ranged from 21 through 78 and the forth decade was the most prevalent group by proportion of 33% (13 cases). The frequency of Buerger's disease is 20, and that of atherosclerotic occlusion (ASO), ASO with diabetes, and diabetic arteriopathy (DA) were 11, 4, 3, respectively. The number of operative procedures before amputation and the total mean duration (TMD: days) from initial operation to final amputation for femoral, popliteal and tibial occlusion were 45/485, 26/921 and 13/1725, respectively. Those for Buerger's disease, ASO, ASO with diabetes and DA were 42/960, 25/865, 9.1027, and 7/251 respectively. The proportions of duration between initial vascular procedure and second one in the TMD for the patients of tibial occlusion and ASO with diabetes revealed 95.0% and 98.4%. Smoking revealed shortened the duration until amputation in cases of popliteal artery involvement. CONCLUSION: The frequency of below-knee amputation due to critical limb ischemia is high in Buerger's disease and in the age of fourth decade. Patients of the tibial artery involvement and ASO with diabetes may not have benifits from repetitive operative procedures after initial vascular surgery in postponing the below-knee amputation. More study is needed with incresed number of cases.