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Invited Critique |

Limb Salvage Using High-Pressure Intermittent Compression Arterial Assist Device in Cases Unsuitable for Surgical Revascularization—Invited Critique

Julie Ann Freischlag, MD
Arch Surg. 2001;136(11):1286. doi:10.1001/archsurg.136.11.1286.
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This manuscript bravely describes an innovative treatment of 13 patients with 14 critically ischemic limbs who by their criteria were not candidates for routine arterial revascularization. Two thirds of these patients were diabetic and had either poor run-off, no suitable vein conduit, or were in generally poor medical condition that obviated a major operation. Surprisingly, 9 of these limbs demonstrated a significant increase in pulse volume amplitude after 3 months, giving some proof of numbers to this voodoo-type therapy. All of these limbs were salvaged. The other 4 limbs did not have such an increase in their pulse volume amplitude, and their limbs were not salvaged. Three of the 4 patients who had a flat-line pulse volume recording noted at the ankle prior to treatment unfortunately went on to undergo amputation. An element of patient compliance was noted as well. Those patients using their device for a mean of 2.38 hours a day—almost the recommended time of 4 hours per day—had their limbs salvaged, whereas those only using their device for a mean of 1.14 hours per day required an amputation. The follow-up was short—8.7 ± 6.9 months as 2 patients died during the study period. But in these patients, that follow-up period is rather long as their life expectancy is lower than in those patients who can undergo revascularization.

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