A 65-year-old man with type 2 diabetes presents with a non-healing foot ulcer over the heel with gangrene of the 3rd toe. ABI is 0.4. CT angiography shows a short-segment occlusion of the superficial femoral artery (SFA) and tibial vessel disease. What is the most appropriate vascular intervention?
- A Primary below-knee amputation
- B Revascularization (angioplasty/bypass) before amputation ✓
- C Best medical therapy with wound care only
- D Hyperbaric oxygen therapy alone
Explanation
This patient has critical limb-threatening ischaemia (CLTI) defined by ABI <0.5, ischaemic ulceration, and gangrene. The fundamental principle in managing CLTI is 'revascularize first, amputate later.' Revascularization (either endovascular angioplasty/stenting or surgical bypass) to restore adequate perfusion should be attempted before deciding on the extent of amputation, as successful revascularization can convert a major amputation to a minor one (toe amputation) or allow wound healing. The BASIL trial established that both surgical and endovascular approaches have comparable outcomes, with surgery preferred for longer occlusions and angioplasty for short segment disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.