Percutaneous Endovascular Intervention Prior to Lower Extremity Free Tissue Transfer Provides Effective and Durable Limb Salvage: Analysis of 338 Cases Over a 13-Year Period.

Abstract

Free tissue transfer (FTT) in patients with peripheral arterial disease (PAD) and lower extremity (LE) tissue loss is a complex option for reconstructive limb salvage. Previous studies have demonstrated the importance of preoperative arteriography for success; however, the role of preoperative percutaneous endovascular intervention (PEI) has not been comprehensively studied. Thus, this study evaluates the role of preoperative PEI in LE FTT for the management of chronic, non-healing wounds. A retrospective review of all LE FTT between July 2011 and July 2024 was conducted. Patients were classified into two groups based preoperative PEI treatment ("PEI" group vs. "Non-PEI" group). A total of 338 LE FTT were performed in 329 patients, of which 61 (18.5%) underwent preoperative PEI. The median age was 57 (IQR: 17) years. Prevalent comorbidities included diabetes (55.3%), PAD (38.0%), and chronic kidney disease (10.9%). At a median follow-up of 12.2 months, rates of ipsilateral amputation (12.2%) were not statistically different between PEI and Non-PEI groups. However, 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). Mortality rates did not differ significantly between groups. Despite significant differences in baseline comorbidities, patients requiring PEI achieved limb salvage and flap success rates comparable to those without the need for such intervention. Preoperative vascular optimization via PEI is an effective tool to expand reconstructive options for patients with advanced PAD.