Indications for distal arterial reconstruction in the presence of palpable pedal pulses

Steven P. Rivers, Larry Scher, Frank J. Veith

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Eight patients with severe pedal ischemia in the presence of palpable foot pulses are described. All had atherosclerosis, and seven patients also had diabetes. There were two anatomic patterns of disease, including supramalleolar obstruction with reconstitution of pulsatile flow in three patients and segmental occlusion of the pedal vessels in five. All patients underwent arterial reconstructive surgery. Patency was sustained in six patients, with limb salvage in five and below-knee amputation in one patient for persistent necrosis and infection of an open amputation. Of the two eventual bypass failures, a transmetatarsal amputation continued to heal in one patient, and the other required amputation below the knee. Palpable pedal pulses and satisfactory ankle/brachial indexes did not rule out the presence of surgically correctable distal arterial occlusive disease. Therefore arteriography is indicated in any patient with persistent forefoot ischemia that fails to respond to conservative measures. The safety and patency of the distal reconstructive procedures performed in this series suggest that salvage of weight-bearing tissue and rapid healing, as well as limb salvage, are legitimate indications for revascularization.

Original languageEnglish (US)
Pages (from-to)552-557
Number of pages6
JournalJournal of Vascular Surgery
Volume12
Issue number5
DOIs
StatePublished - Nov 1990

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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