An alternative to amputation in patients with neoplasms, ischemia, fractures, and other limb-threatening conditions. Generally, sophisticated surgical procedures such as vascular surgery and reconstruction are used to salvage diseased limbs.

The removal of a limb or other appendage or outgrowth of the body. (Dorland, 28th ed)

A therapeutic approach, involving chemotherapy, radiation therapy, or surgery, after initial regimens have failed to lead to improvement in a patient's condition. Salvage therapy is most often used for neoplastic diseases.

A hypoperfusion of the BLOOD through an organ or tissue caused by a PATHOLOGIC CONSTRICTION or obstruction of its BLOOD VESSELS, or an absence of BLOOD CIRCULATION.

The inferior part of the lower extremity between the KNEE and the ANKLE.

The anterior and posterior arteries created at the bifurcation of the popliteal artery. The anterior tibial artery begins at the lower border of the popliteus muscle and lies along the tibia at the distal part of the leg to surface superficially anterior to the ankle joint. Its branches are distributed throughout the leg, ankle, and foot. The posterior tibial artery begins at the lower border of the popliteus muscle, lies behind the tibia in the lower part of its course, and is found situated between the medial malleolus and the medial process of the calcaneal tuberosity. Its branches are distributed throughout the leg and foot.

The degree to which BLOOD VESSELS are not blocked or obstructed.

The continuation of the femoral artery coursing through the popliteal fossa; it divides into the anterior and posterior tibial arteries.

The region of the lower limb in animals, extending from the gluteal region to the FOOT, and including the BUTTOCKS; HIP; and LEG.

The main artery of the thigh, a continuation of the external iliac artery.

Pathological processes which result in the partial or complete obstruction of ARTERIES. They are characterized by greatly reduced or absence of blood flow through these vessels. They are also known as arterial insufficiency.

The vessels carrying blood away from the capillary beds.

Operative procedures for the treatment of vascular disorders.

The farthest or outermost projections of the body, such as the HAND and FOOT.

The tunnel in the lower anterior ABDOMINAL WALL through which the SPERMATIC CORD, in the male; ROUND LIGAMENT, in the female; nerves; and vessels pass. Its internal end is at the deep inguinal ring and its external end is at the superficial inguinal ring.

Distinct regions of mesenchymal outgrowth at both flanks of an embryo during the SOMITE period. Limb buds, covered by ECTODERM, give rise to forelimb, hindlimb, and eventual functional limb structures. Limb bud cultures are used to study CELL DIFFERENTIATION; ORGANOGENESIS; and MORPHOGENESIS.

Homopolymer of tetrafluoroethylene. Nonflammable, tough, inert plastic tubing or sheeting; used to line vessels, insulate, protect or lubricate apparatus; also as filter, coating for surgical implants or as prosthetic material. Synonyms: Fluoroflex; Fluoroplast; Ftoroplast; Halon; Polyfene; PTFE; Tetron.

Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.

Summarizing techniques used to describe the pattern of mortality and survival in populations. These methods can be applied to the study not only of death, but also of any defined endpoint such as the onset of disease or the occurrence of disease complications.

A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery.

Death and putrefaction of tissue usually due to a loss of blood supply.

Pathological processes involving any one of the BLOOD VESSELS in the vasculature outside the HEART.

Device constructed of either synthetic or biological material that is used for the repair of injured or diseased blood vessels.

The vein which drains the foot and leg.

Procedures used to reconstruct, restore, or improve defective, damaged, or missing structures.

Endovascular procedure in which atheromatous plaque is excised by a cutting or rotating catheter. It differs from balloon and laser angioplasty procedures which enlarge vessels by dilation but frequently do not remove much plaque. If the plaque is removed by surgical excision under general anesthesia rather than by an endovascular procedure through a catheter, it is called ENDARTERECTOMY.

Tumors or cancer located in bone tissue or specific BONES.

Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.

Use of a balloon catheter for dilation of an occluded artery. It is used in treatment of arterial occlusive diseases, including renal artery stenosis and arterial occlusions in the leg. For the specific technique of BALLOON DILATION in coronary arteries, ANGIOPLASTY, BALLOON, CORONARY is available.

A sarcoma originating in bone-forming cells, affecting the ends of long bones. It is the most common and most malignant of sarcomas of the bones, and occurs chiefly among 10- to 25-year-old youths. (From Stedman, 25th ed)

Obstruction of flow in biological or prosthetic vascular grafts.

A symptom complex characterized by pain and weakness in SKELETAL MUSCLE group associated with exercise, such as leg pain and weakness brought on by walking. Such muscle limpness disappears after a brief rest and is often relates to arterial STENOSIS; muscle ISCHEMIA; and accumulation of LACTATE.

Surgical insertion of BLOOD VESSEL PROSTHESES to repair injured or diseased blood vessels.

Common occlusive arterial disease which is caused by ATHEROSCLEROSIS. It is characterized by lesions in the innermost layer (ARTERIAL INTIMA) of arteries including the AORTA and its branches to the extremities. Risk factors include smoking, HYPERLIPIDEMIA, and HYPERTENSION.

The distal extremity of the leg in vertebrates, consisting of the tarsus (ANKLE); METATARSUS; phalanges; and the soft tissues surrounding these bones.

Tongues of skin and subcutaneous tissue, sometimes including muscle, cut away from the underlying parts but often still attached at one end. They retain their own microvasculature which is also transferred to the new site. They are often used in plastic surgery for filling a defect in a neighboring region.

Surgical insertion of BLOOD VESSEL PROSTHESES, or transplanted BLOOD VESSELS, or other biological material to repair injured or diseased blood vessels.

Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.

Radiography of blood vessels after injection of a contrast medium.

Elements of limited time intervals, contributing to particular results or situations.

Common foot problems in persons with DIABETES MELLITUS, caused by any combination of factors such as DIABETIC NEUROPATHIES; PERIPHERAL VASCULAR DISEASES; and INFECTION. With the loss of sensation and poor circulation, injuries and infections often lead to severe foot ulceration, GANGRENE and AMPUTATION.

Femoral neoplasms refer to abnormal growths or tumors, benign or malignant, located in the femur bone or its surrounding soft tissues within the thigh region.

Lack of perfusion in the EXTREMITIES resulting from atherosclerosis. It is characterized by INTERMITTENT CLAUDICATION, and an ANKLE BRACHIAL INDEX of 0.9 or less.

A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant.

The superior part of the upper extremity between the SHOULDER and the ELBOW.

Either of two large arteries originating from the abdominal aorta; they supply blood to the pelvis, abdominal wall and legs.

Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy.

A slowly growing malignant neoplasm derived from cartilage cells, occurring most frequently in pelvic bones or near the ends of long bones, in middle-aged and old people. Most chondrosarcomas arise de novo, but some may develop in a preexisting benign cartilaginous lesion or in patients with ENCHONDROMATOSIS. (Stedman, 25th ed)

Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery.

Congenital structural deformities of the upper and lower extremities collectively or unspecified.

General or unspecified injuries involving the leg.

The external junctural region between the lower part of the abdomen and the thigh.

The noninvasive measurement or determination of the partial pressure (tension) of oxygen and/or carbon dioxide locally in the capillaries of a tissue by the application to the skin of a special set of electrodes. These electrodes contain photoelectric sensors capable of picking up the specific wavelengths of radiation emitted by oxygenated versus reduced hemoglobin.

The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones.

A disease or state in which death is possible or imminent.

The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the FIBULA laterally, the TALUS distally, and the FEMUR proximally.

The removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. (Dorland, 27th ed)

The bones of the free part of the lower extremity in humans and of any of the four extremities in animals. It includes the FEMUR; PATELLA; TIBIA; and FIBULA.

Neoplasm drug therapy involving an extracorporeal circuit with temporary exclusion of the tumor-bearing area from the general circulation during which high concentrations of the drug are perfused to the isolated part.

Surgical union or shunt between ducts, tubes or vessels. It may be end-to-end, end-to-side, side-to-end, or side-to-side.

Reconstruction or repair of a blood vessel, which includes the widening of a pathological narrowing of an artery or vein by the removal of atheromatous plaque material and/or the endothelial lining as well, or by dilatation (BALLOON ANGIOPLASTY) to compress an ATHEROMA. Except for ENDARTERECTOMY, usually these procedures are performed via catheterization as minimally invasive ENDOVASCULAR PROCEDURES.

Ultrasonography applying the Doppler effect combined with real-time imaging. The real-time image is created by rapid movement of the ultrasound beam. A powerful advantage of this technique is the ability to estimate the velocity of flow from the Doppler shift frequency.

Ulceration of the skin and underlying structures of the lower extremity. About 90% of the cases are due to venous insufficiency (VARICOSE ULCER), 5% to arterial disease, and the remaining 5% to other causes.

Transplantation of an individual's own tissue from one site to another site.

The forepart of the foot including the metatarsals and the TOES.

Bone in humans and primates extending from the SHOULDER JOINT to the ELBOW JOINT.

Surgical shunt allowing direct passage of blood from an artery to a vein. (From Dorland, 28th ed)

The vessels carrying blood away from the heart.

The continuation of the subclavian artery; it distributes over the upper limb, axilla, chest and shoulder.

A nonparametric method of compiling LIFE TABLES or survival tables. It combines calculated probabilities of survival and estimates to allow for observations occurring beyond a measurement threshold, which are assumed to occur randomly. Time intervals are defined as ending each time an event occurs and are therefore unequal. (From Last, A Dictionary of Epidemiology, 1995)

Pathological outpouching or sac-like dilatation in the wall of any blood vessel (ARTERIES or VEINS) or the heart (HEART ANEURYSM). It indicates a thin and weakened area in the wall which may later rupture. Aneurysms are classified by location, etiology, or other characteristics.

Perception of painful and nonpainful phantom sensations that occur following the complete or partial loss of a limb. The majority of individuals with an amputated extremity will experience the impression that the limb is still present, and in many cases, painful. (From Neurol Clin 1998 Nov;16(4):919-36; Brain 1998 Sep;121(Pt 9):1603-30)

Bones that constitute each half of the pelvic girdle in VERTEBRATES, formed by fusion of the ILIUM; ISCHIUM; and PUBIC BONE.

The condition of an anatomical structure's being constricted beyond normal dimensions.

Minimally invasive procedures, diagnostic or therapeutic, performed within the BLOOD VESSELS. They may be perfomed via ANGIOSCOPY; INTERVENTIONAL MAGNETIC RESONANCE IMAGING; INTERVENTIONAL RADIOGRAPHY; or INTERVENTIONAL ULTRASONOGRAPHY.

Restoration of integrity to traumatized tissue.

Recovery of blood lost from surgical procedures for reuse by the same patient in AUTOLOGOUS BLOOD TRANSFUSIONS. It is collected during (intraoperatively) or after completion of (postoperatively) the surgical procedures.

A tibial fracture is a medical term that describes a break or crack in the shinbone, one of the two bones in the lower leg, which can occur anywhere along its length due to various traumatic injuries or stresses.

General or unspecified injuries involving the arm.

A measure of the quality of health care by assessment of unsuccessful results of management and procedures used in combating disease, in individual cases or series.

The plan and delineation of prostheses in general or a specific prosthesis.

Instruments that generate intermittent forces, uniformed or graduated, to facilitate the emptying of VEINS. These devices are used to reduce limb EDEMA and prevent venous THROMBOEMBOLISM, such as deep vein thrombosis in the legs.

Artificial substitutes for body parts, and materials inserted into tissue for functional, cosmetic, or therapeutic purposes. Prostheses can be functional, as in the case of artificial arms and legs, or cosmetic, as in the case of an artificial eye. Implants, all surgically inserted or grafted into the body, tend to be used therapeutically. IMPLANTS, EXPERIMENTAL is available for those used experimentally.

The vein formed by the union of the anterior and posterior tibial veins; it courses through the popliteal space and becomes the femoral vein.

Surgical removal of an obstructing clot or foreign material which has been transported from a distant vessel by the bloodstream. Removal of a clot at its original site is called THROMBECTOMY.

Prosthetic replacements for arms, legs, and parts thereof.

Restoration of an organ or other structure to its original site.

Either of two extremities of four-footed non-primate land animals. It usually consists of a FEMUR; TIBIA; and FIBULA; tarsals; METATARSALS; and TOES. (From Storer et al., General Zoology, 6th ed, p73)

The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods.

The vein accompanying the femoral artery in the same sheath; it is a continuation of the popliteal vein and becomes the external iliac vein.

Fractures occurring as a result of disease of a bone or from some undiscoverable cause, and not due to trauma. (Dorland, 27th ed)

Infections resulting from the implantation of prosthetic devices. The infections may be acquired from intraoperative contamination (early) or hematogenously acquired from other sites (late).

The local recurrence of a neoplasm following treatment. It arises from microscopic cells of the original neoplasm that have escaped therapeutic intervention and later become clinically visible at the original site.

Polyester polymers formed from terephthalic acid or its esters and ethylene glycol. They can be formed into tapes, films or pulled into fibers that are pressed into meshes or woven into fabrics.

A mass of tissue that has been cut away from its surrounding areas to be used in TISSUE TRANSPLANTATION.

Surgical insertion of a prosthesis.

The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)

Human or animal tissue used as temporary wound coverings.

Neoplasms of whatever cell type or origin, occurring in the extraskeletal connective tissue framework of the body including the organs of locomotion and their various component structures, such as nerves, blood vessels, lymphatics, etc.

Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting.

A partial or complete return to the normal or proper physiologic activity of an organ or part following disease or trauma.

The back (or posterior) of the FOOT in PRIMATES, found behind the ANKLE and distal to the TOES.

Comparison of the BLOOD PRESSURE between the BRACHIAL ARTERY and the POSTERIOR TIBIAL ARTERY. It is a predictor of PERIPHERAL ARTERIAL DISEASE.

The treatment of a disease or condition by several different means simultaneously or sequentially. Chemoimmunotherapy, RADIOIMMUNOTHERAPY, chemoradiotherapy, cryochemotherapy, and SALVAGE THERAPY are seen most frequently, but their combinations with each other and surgery are also used.

Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.

Procedures used to treat and correct deformities, diseases, and injuries to the MUSCULOSKELETAL SYSTEM, its articulations, and associated structures.

A benign tumor composed, wholly or in part, of cells with the morphologic characteristics of HISTIOCYTES and with various fibroblastic components. Fibrous histiocytomas can occur anywhere in the body. When they occur in the skin, they are called dermatofibromas or sclerosing hemangiomas. (From DeVita Jr et al., Cancer: Principles & Practice of Oncology, 5th ed, p1747)

The return of a sign, symptom, or disease after a remission.

Statistical models used in survival analysis that assert that the effect of the study factors on the hazard rate in the study population is multiplicative and does not change over time.

A non-atherosclerotic, inflammatory thrombotic disease that commonly involves small and medium-sized arteries or veins in the extremities. It is characterized by occlusive THROMBOSIS and FIBROSIS in the vascular wall leading to digital and limb ISCHEMIA and ulcerations. Thromboangiitis obliterans is highly associated with tobacco smoking.

The grafting of bone from a donor site to a recipient site.

An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.

Endoscopic examination, therapy or surgery performed on the interior of blood vessels.

Devices to be inserted into veins or arteries for the purpose of carrying fluids into or from a peripheral or central vascular location. They may include component parts such as catheters, ports, reservoirs, and valves. They may be left in place temporarily for therapeutic or diagnostic purposes.

Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called ATHERECTOMY.

Surgical removal of an obstructing clot or foreign material from a blood vessel at the point of its formation. Removal of a clot arising from a distant site is called EMBOLECTOMY.

A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other covariates on the function.

The flow of BLOOD through or around an organ or region of the body.

A distribution in which a variable is distributed like the sum of the squares of any given independent random variable, each of which has a normal distribution with mean of zero and variance of one. The chi-square test is a statistical test based on comparison of a test statistic to a chi-square distribution. The oldest of these tests are used to detect whether two or more population distributions differ from one another.

Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder.

Injuries caused by impact with a blunt object where there is no penetration of the skin.

Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols.

External devices which hold wires or pins that are placed through one or both cortices of bone in order to hold the position of a fracture in proper alignment. These devices allow easy access to wounds, adjustment during the course of healing, and more functional use of the limbs involved.

The survival of a graft in a host, the factors responsible for the survival and the changes occurring within the graft during growth in the host.

A front limb of a quadruped. (The Random House College Dictionary, 1980)

A region of the lower extremity immediately surrounding and including the KNEE JOINT.

Malfunction of implantation shunts, valves, etc., and prosthesis loosening, migration, and breaking.

The longest and largest bone of the skeleton, it is situated between the hip and the knee.

The procedure of removing TISSUES, organs, or specimens from DONORS for reuse, such as TRANSPLANTATION.

Wounds caused by objects penetrating the skin.

Infection occurring at the site of a surgical incision.

A malignant tumor of the bone which always arises in the medullary tissue, occurring more often in cylindrical bones. The tumor occurs usually before the age of 20, about twice as frequently in males as in females.

Reinfusion of blood or blood products derived from the patient's own circulation. (Dorland, 27th ed)

Formation and development of a thrombus or blood clot in the blood vessel.

A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations.

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Period after successful treatment in which there is no appearance of the symptoms or effects of the disease.

A method of delineating blood vessels by subtracting a tissue background image from an image of tissue plus intravascular contrast material that attenuates the X-ray photons. The background image is determined from a digitized image taken a few moments before injection of the contrast material. The resulting angiogram is a high-contrast image of the vessel. This subtraction technique allows extraction of a high-intensity signal from the superimposed background information. The image is thus the result of the differential absorption of X-rays by different tissues.

Blocking of a blood vessel by an embolus which can be a blood clot or other undissolved material in the blood stream.

Conditions or pathological processes associated with the disease of diabetes mellitus. Due to the impaired control of BLOOD GLUCOSE level in diabetic patients, pathological processes develop in numerous tissues and organs including the EYE, the KIDNEY, the BLOOD VESSELS, and the NERVE TISSUE.

Pathological processes involving any part of the AORTA.

Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project.