Background: Primary above-knee amputation (AKA) may at times be the only option for unsalvageable acute lower limb ischemia. However, occlusion of the femoral arteries may result in poor inflow and contribute to wound complications such as stump gangrene and sepsis. Previously attempted inflow revascularisation techniques include surgical bypass and percutaneous angioplasty and/or stenting.
Case presentation: We present a case of a 77-year-old lady with unsalvageable acute right lower limb ischemia secondary to cardioembolic occlusion of the common (CFA), superficial (SFA) and deep (PFA) femoral arteries. We performed a primary AKA with inflow revascularisation using a novel surgical technique involving endovascular retrograde embolectomy of the CFA, SFA and PFA via the SFA stump. The patient made an uneventful recovery without any wound complications. Detailed description of the procedure is followed by a discussion of the literature on inflow revascularisation in the treatment and prevention of stump ischemia.
Keywords: above-knee amputation; embolectomy; retrograde; stump ischemia; trans-amputation.