M. T. Cain1, M. Wohlauer1, P. Rossi1, B. Lewis1, K. Brown1, G. Seabrook1, C. J. Lee1 1Medical College Of Wisconsin,Division Of Vascular Surgery,Milwaukee, WI, USA
Introduction: Lower extremity amputation is a significant cause of morbidity for patients with peripheral vascular disease. Revision of an amputation to a more proximal level carries a heightened physiological, functional, and psychological stress for patients. Little data exists describing outcomes of non-traumatic amputations and risk factors associated with subsequent need for revisions. The objective of this study was to identify the determinants for revisions following lower extremity amputations:
Methods: Patient data was reviewed retrospectively from a prospectively collected database. Patients with underlying peripheral arterial disease who underwent non-traumatic lower extremity amputation between 2013 and 2016 were included in the study. A total of 260 patients met study criteria,. Patients who required revision were grouped and compared to those who did not require revision. Preoperative, intraoperative, and postoperative variables were collected and analyzed. Univariate and multivariate analysis was performed.
Results: Amputation revision was required in 70 patients (26.9%). Patients who underwent amputation revision to a higher level were significantly younger, taller, and heavier, and experienced higher degree of independence in mobility prior to revision (p value < 0.001, 0.035, 0.004, and 0.014, respectively). Preoperative and postoperative aspirin use, statin use, and P2Y12 use appeared to be protective against the need for revisions (p value 0.018, 0.026, and 0.007, respectively). Having undergone prior open or endovascular arterial intervention on the index limb was also protective against the need for amputation revision (p value 0.005). The indication at the index amputation of acute limb ischemia or severe infection was more common in those who underwent subsequent revision (p value < 0.001). Urgent or emergent amputations and active tobacco use were also associated with amputation revisions (p value < 0.001). Patients who experienced one or more postoperative complications after index amputation (arrhythmia, congestive heart failure, myocardial infarction, pneumonia, or respiratory failure) were also more commonly revised (p value < 0.001).
Conclusion: Preoperative patient comorbidities and limb acuity are significant determinants for amputation revision. Procedural urgency and postoperative complications correlate significantly with the need for amputation revision in patients with peripheral vascular disease. Factors protective against the need for revision included prior arterial interventions and optimal medical therapy to reduce