Improvement of amputation level by lower extremity revascularization.

Improvement of amputation level, with a resulting increase in the ambulatory rehabilitation potential, was achieved in ten patients requiring extirpation of the lower extremity because of gangrene. Arterial reconstruction, percutaneous transluminal dilation or chemical lumbar sympathectomy, or a combination of these modalities, was used to achieve primary healing at an amputation site at least one level below that initially suggested by clinical and noninvasive diagnostic means. Patients requiring amputation of the lower extremity who are good candidates for ambulatory rehabilitation should undergo an aggressive diagnostic and therapeutic search for treatable proximal arterial lesions, thereby preserving limb length and increasing the likelihood of independent prosthetic use.