INTEGRATED VASCULAR AND SURGICAL APPROACH TO LIMB SALVAGE: MIDFOOT AMPUTATION PREVENTS BELOW-KNEE LOSS IN CRITICAL LIMB ISCHEMIA (4-YEAR FOLLOW-UP) dranupk@aiimspatna.org

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INTEGRATED VASCULAR AND SURGICAL APPROACH TO LIMB SALVAGE: MIDFOOT AMPUTATION PREVENTS BELOW-KNEE LOSS IN CRITICAL LIMB ISCHEMIA (4-YEAR FOLLOW-UP)

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India

Oral or Poster

COVID-19–associated hypercoagulability increases the risk of arterial thrombosis, including acute lower limb ischemia (ALLI). In patients with severe pulmonary compromise, open revascularization may be unfeasible, requiring minimally invasive alternatives. This case illustrates successful limb salvage through endovascular intervention and multidisciplinary trauma care.

A 75-year male with severe COVID-19 developed progressive ischemia of the right foot despite anticoagulation. Initially diagnosed as “COVID toes,” CT angiography revealed complete occlusion of the anterior tibial, posterior tibial, and peroneal arteries. Owing to significant respiratory compromise, endovascular thrombectomy and angioplasty were performed under local anaesthesia.

The three-hour procedure successfully recanalized major arteries, resulting in immediate pain relief and improved perfusion. However, distal gangrene progressed due to devascularization following non-recanalization of the arches, requiring a two-month conservative period until demarcation. A staged Lisfranc amputation was subsequently performed. Recovery was favourable, with full healing of surgical flaps and independent ambulation achieved by six months. At the four-year follow-up, the patient remains ambulatory without an orthosis or prosthesis and has healthy stump flaps.

COVID-19-related arterial thrombosis poses management challenges due to high clot burden and possible heparin resistance. In this high-risk surgical candidate, endovascular intervention offered a safe and effective limb salvage strategy. A coordinated approach: combining anticoagulation, minimally invasive revascularization, staged Lisfranc amputation, and rehabilitation helped preserve limb function and enabled independent ambulation at 4 years, avoiding the functional and psychosocial burden of below-knee amputation.