Prosthetic Gait Achievement in an Elderly Patient with Chronic Limb-threatening Ischemia and High Complications Using a Novel Lipoprotein Apheresis

Background: Chronic limb-threatening ischemia is a condition of the lower extremities that requires therapeutic intervention. It is characterized by ischemia, tissue loss, neuropathy, infection, and risk of amputation.

Case: An 82-year-old woman with a history of bilateral total knee arthroplasty and rheumatoid arthritis underwent a left ankle arthroplasty. Wound healing was delayed, and chronic limb-threatening ischemia was diagnosed. When endovascular therapy was found ineffective, novel low-density lipoprotein apheresis was initiated. Pedicle flap and split-thickness skin grafting were performed to save the affected limb. However, skin necrosis progressed, and the patient underwent left lower limb amputation 17 days after ankle arthroplasty. The stump included a skin graft area, and the decision to fabricate a prosthetic leg was difficult because of the patient's advanced age, rheumatoid arthritis, and poor upper limb function. However, her cognitive function, muscle strength, and joint range of motion were good. No sign of wound infection was observed, and the patient was able to walk before surgery. Therefore, we decided to fabricate a prosthetic leg. Seventy-five days after amputation, the patient achieved independent walking using a cane and a silver-wheel walker.

Discussion: The benefit of novel low-density lipoprotein apheresis helped our decision to fabricate a prosthesis when uncertainty existed about the maturity of a recent amputation in an elderly patient with chronic limb-threatening ischemia. The patient successfully achieved a prosthetic gait under challenging conditions.