54. Endovascular Intervention Prior to Lower Extremity Free Tissue Transfer Provides Effective and Durable Limb Salvage: Analysis of 338 Cases Over A 13-year Period

PURPOSE: Previous studies have demonstrated the importance of preoperative arteriography for lower extremity (LE) free tissue transfer (FTT); however, the role of preoperative percutaneous endovascular intervention (PEI) has not been studied. This study evaluates the role of preoperative PEI in LE FTT for limb salvage. METHODS: A retrospective review of LE FTT between July 2011 and July 2024 was conducted. RESULTS: 338 LE FTT were performed in 329 patients: 61 (18.5%) underwent preoperative PEI. Prevalent comorbidities included diabetes mellitus (n=182, 55.3%), peripheral artery disease (n= 125, 38.0%), and chronic kidney disease (n=36, 10.9%). Median time from PEI to FTT was 8.5 days (IQR: 9). At a median follow-up of 12.2 months, rates of flap success (n=325, 96.4%), flap takeback (n=16, 4.7%), and ipsilateral amputation (n=41, 12.2%) were not statistically different between PEI and Non-PEI groups. The PEI group experienced a significantly higher incidence of any postoperative complication (46.03% vs. 25.3%, p = 0.001), including increased rates of partial flap necrosis (9.52% vs. 1.84%, p = 0.001) and flap hematoma (11.29% vs. 4.40%, p = 0.034). In the total cohort, 53 (15.7%) FTT presented with healing suspicion precipitating a post-FTT arteriogram. A significantly higher proportion of patients in the PEI group required post-FTT revascularization (33.3% vs. 2.9%, p<0.001). Mortality rates did not differ significantly between groups. CONCLUSION: In this very complex patient population, preoperative PEI and FTT achieves high rates of durable and successful limb salvage. Surveillance of these patients requires a vasculo-plastic approach.