TH4.3 Walk the extra mile!!

Abstract

Abstract Aim Limb salvage and mortality remain high in patients with critical limb ischaemia. The present study looks at outcomes of a multimodality 24x7 service at a major diabetic foot centre. Methods We retrospectively reviewed surgical outcomes of bypass procedures done to identify patients that needed to go have further procedures within the same admission for limb salvage. Electronic patient records were reviewed and data analysed to assess the outcomes of overall limb salvage rates and mortality. Results 68 patients underwent bypasses in the study period. 38 (55%) of patients who had procedures performed in the study period needed to have an additional intervention after the index procedure. 9 needed redo surgery (thromebctomy and further extension of graft with jump grafts), 27 needed angioplasties and 2 patients needed both. Majority of the intervention were done within 24–72 hours. Among those grafts which failed one of the causes identified was prolonged hypotensive episodes in perioperative period. All these additional interventions delayed discharge, prolonged hospital stay but were essential for limb salvage. 64 patients (94%) had intact limbs at discharge, 4 required a major amputation - 1 below knee and 3 above knee. At 1 year follow up 56 patients (82%) were alive. Conclusion If the patients have to retain the ability to walk we have to be prepared for some extra effort. Additional procedures planned or unplanned are sometimes necessary to save the limb. A multimodality 24x7 service willing to go the extra mile goes a long way in preventing major amputations.