Today, I was asked by one of the residents what the criteria were for doing an bypass of a lower extremity.  I kinda froze (was too busy holding up the heavy leg of the patient who had just had below knee amputation).  I was not sure of exact criteria although I knew it had to be signs/symptoms indicating that the tissue was still viable (like how it looked? gangrene?  any tissue loss? how it felt -- cold? like are the blood vessels still intact?).  I couldnt spit it out though!!

Anyhow, i looked it up today in NMS.  An amputation (instead of revascularization) should be done when:

1) patient has nonambulatory status
2) the vessels are nonreconstructible (arteriography does not reveal a patent distal vessel -- poplitial, tibial, or dorsalis pedis).
3) there is extensive tissue loss (gangrene, widespread osteomyelitis)
4) the patient has other medical conditions that make revascularization too risk.

An amputation or revascularization is performed when a patient has:

1) incapacitating  claudication
2) rest pain
3) tissue loss