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(Circulation. 1966;33:I-189.)
© 1966 American Heart Association, Inc.

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Atherosclerotic Gangrene: Improved Results of Treatment

CHARLES W. PEARCE M.D.¹; ROBERT J. SCHRAMEL M.D.¹; ROBERT L. HEWITT M.D.¹; PRENTISS E. SMITH JR. M.D.¹; OSCAR CREECH JR. M.D.¹

¹ From the Department of Surgery, Tulane University School of Medicine, and the Surgical Service, Tulane Division, Charity Hospital of Louisiana at New Orleans, New Orleans, Louisiana.

Advanced atherosclerosis of the lower limb often necessitates major amputation unless arterial flow can be restored. To improve results of treatment on the Tulane Surgical Unit at Charity Hospital, we decided in 1964 to extend indications for restoration of arterial flow to all patients who faced possible loss of a lower limb and who had a patent distal segment of artery to which anastomosis could be made. The general condition of the patient was not held to be a deterrent if operation could be done with use of a local anesthetic.

From July 1, 1957 to July 1, 1964, an average of 21 operations was performed each year for restoration of arterial flow to the lower limb: two-thirds for femoropopliteal occlusive disease and one-third for aortoiliac occlusive disease. In contrast, 108 operations were performed from July 1, 1964 to July 1, 1965: three-fourths for femoropopliteal occlusive disease and one-fourth for aortoiliac occlusive disease. The fatality rate for operative restoration of arterial flow to the lower limb was 4.1% for the first seven years and 5.5% for the eighth year.

An average of 79 major amputations of the lower limb was done for atherosclerosis each year from 1957 to 1964, whereas only 53 amputations were done during the 1964-1965 period. The annual number of major amputations was thus reduced by 33%. The increased number of digital and transmetatarsal amputations from an average of 22 each year during the period 1957-1964 to 42 during 1964-1965 reflects our increased effort to avoid major amputation. Our recent experience suggests that the criteria for restorative operations in patients faced with loss of limbs may safely be extended and that a positive attitude toward operation for advanced atherosclerosis will result in preservation of more limbs.