Failure of below-knee amputation in peripheral arterial disease. Use of arteriography in determining site of election.

Abstract

Amputation is frequently necessary in patients with arteriosclerosis obliterans and other arterial occlusive diseases. It is important to preserve as much of the limb as possible; yet experience has shown that amputation below the knee in the patient with peripheral vascular disease may heal poorly. All of the below-knee amputations done at the Seattle Veterans Administration Hospital in an 8-year period were studied, and the results of this study are presented. The purpose of this report is to indicate the need for more accurate diagnostic studies in order to evaluate the status of the arterial vessels in the leg before the site of amputation of a lower extremity is attempted, particularly below the knee. In this way the complications of arterial insufficiency, such as sepsis, failure to heal, and trophic ulcers, and the possibility of reamputation may be minimized or avoided. Two cases are presented that illustrate the value of