Vascular reconstruction for limb salvage in the spinal cord injured patient

Abstract

Severe arterial insufficiency of the lower extremity secondary to atherosclerosis is manifested in the clinical setting by the development of gangrene and ulceration. Clinicians caring for the spinal cord injured (SCI) patient with a threatened ischaemic extremity have previously advocated primary amputation. At our institution, we have adopted an alternative approach to the clinical problem utilising vascular reconstruction for limb salvage. During the period October 1980 to February 1988, 6 spinal cord injured patients were identified who were treated for limb- threatening ischaemia by vascular reconstruction in lieu of primary amputation. A combined approach of local wound care (debridement) and improvement of the arterial inflow by percutaneous transluminal angioplasty and/or operative vascular reconstruction successfully avoided major amputation in 6 of 7 threatened extremities. Follow-up data was complete in all patients and ranged from 4 to 52 months with an average of 20 months. In the review period, there was no operative mortality with a cumulative limb salvage rate of 86%. The clinician caring for the spinal cord injury patient with an ischaemic limb should: (1) proscribe the patient’s use of tobacco products; (2) consider vascular reconstruction in lieu of primary amputation whenever feasible. Limb salvage may be of benefit to the SCI population with improvements in body image, sedentary stability and the activities of daily living. © 1990 International Medical Society of Paraplegia.