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Endovascular Intervention Prior To Lower Extremity Free Tissue Transfer Provides Effective And Durable Limb Salvage: Analysis Of 338 Cases Over A 13-year Period
Rachel N. Rohrich, BS, Karen R. Li, BBA, Elonay Yehualashet, BS, Brian Truong, BS, Christian X. Lava, MS, John W. Rutland, MD, Nisha J. Gupta, MS, Christopher E. Attinger, MD, Richard C. Youn, MD, Cameron M. Akbari, MD, Karen K. Evans, MD.
Georgetown Medstar University Hospital, Washington, DC, USA.
PURPOSE: Previous studies have demonstrated the importance of preoperative arteriography for lower extremity (LE) free tissue transfer (FTT); however, the role of preoperative percutaneous endovascular intervention (PEI) has not been studied. This study evaluates the role of preoperative PEI in LE FTT for limb salvage.
METHODS: A retrospective review of LE FTT between July 2011 and July 2024 was conducted.
RESULTS: 338 LE FTT were performed in 329 patients: 61 (18.5%) underwent preoperative PEI. Prevalent comorbidities included diabetes mellitus (n=182, 55.3%), peripheral artery disease (n= 125, 38.0%), and chronic kidney disease (n=36, 10.9%). Median time from PEI to FTT was 8.5 days (IQR: 9). At a median follow-up of 12.2 months, rates of flap success (n=325, 96.4%), flap takeback (n=16, 4.7%), and ipsilateral amputation (n=41, 12.2%) were not statistically different between PEI and Non-PEI groups. The PEI group experienced a significantly higher incidence of any postoperative complication (46.03% vs. 25.3%, p = 0.001), including increased rates of partial flap necrosis (9.52% vs. 1.84%, p = 0.001) and flap hematoma (11.29% vs. 4.40%, p = 0.034). In the total cohort, 53 (15.7%) FTT presented with healing suspicion precipitating a post-FTT arteriogram. A significantly higher proportion of patients in the PEI group required post-FTT revascularization (33.3% vs. 2.9%, p<0.001). Mortality rates did not differ significantly between groups.
CONCLUSION: : In this very complex patient population, preoperative PEI and FTT achieves high rates of durable and successful limb salvage. Surveillance of these patients requires a vasculo-plastic approach.
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