Original title: Lower Extremity Amputation: Factors Associated With Mortality or Contralateral Amputation Reference: Samir K. Shah, et; al. Vascular and Endovascular Surgery 2013:47 (8):608-613.

Peripheral vascular disease is associated with trophic injuries with tissue lose, often leading to amputation, of which about 50 % were major amputations. 454 amputations in 391 patients were analyzed, 63 were contralateral. Most of the patients have received prior treatment before amputation, which generally was angioplasty procedure.

The amputation rate was 70% transtibial and 30% transfemoral. Mortality at 30 days after amputation was 9.2 %, and after 1, 2 and 5 years revealed 30%, 40% and 56 % respectively, with an average survival of 25.4 months. The variables associated with mortality were age, dialysis, high cardiac risk and transfemoral or transtibial amputation. The need of dialysis and high cardiac risk were associated with contralateral amputation. The only variable that produced protection against death was the contralateral limb intervention. Survival free of contralateral amputation – at 1, 2 and 5 years was 60 %, 49 % and 33 % respectively. The following factors with high risk were associated with contralateral amputation:  Age and moderate or high cardiac risk, having the intervention in that limb a protective effect.

Conclusion

Patients with advanced peripheral vascular disease requiring amputation of one lower limb have a decrease in survival and a high rate of amputation of the contralateral limb. Age and dialysis are factors that predispose to amputation. These data favor the strategies to improve limb preservation. 

Comment

Amputation is associated with poor short-term outcome and increases the risk of repeated in the contralateral limb. It is necessary to optimize medical treatment and education of patients and their relatives in order to prevent or avoid trophic lesions. It is very important before performing angiographic studies or try limb revascularization in the best possible way, once or several times before making the final decision. 

Courtesy of Carlos Fava MD
Interventional Cardiologist
Favaloro Foundation
Argentina

Dr. Carlos Fava para SOLACI.ORG