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[Amputation due to chronic peripheral vascular disease. Risks and prognosis]
D Kirsch1, T Böttger, T Junginger
1Klinik und Poliklinik für Allegmein- und Abdominalchirurgie, Johannes-Gutenberg-Universität Mainz.
Insights
This study reviewed 181 amputations for peripheral vascular disease, finding minor amputations and below-knee procedures offered better rehabilitation outcomes. Pre-amputation vascular reconstruction reduced complications and revision rates.
Area of Science:
- Vascular Surgery
- Amputation Outcomes
- Peripheral Vascular Disease Management
Context:
- Retrospective review of 181 amputations in 156 patients (1985-1996) with chronic peripheral vascular disease.
- High prevalence of prior vascular operations (81%) indicates complex patient population.
- Analysis encompasses major (above/below-knee) and minor (foot/forefoot) amputations.
Purpose:
- To analyze complications, revision rates, and mortality associated with major and minor amputations.
- To evaluate the impact of pre-amputation vessel reconstruction on surgical outcomes.
- To assess long-term survival and rehabilitation status in patients undergoing amputation.
Summary:
- Operative mortality rates were 20% for major amputations and 9% for minor amputations.
- Pre-amputation vessel reconstruction significantly reduced wound healing complications and revision rates.
- Minor amputations, below-knee amputations, and knee disarticulations demonstrated superior rehabilitation results.
Impact:
- Highlights the importance of limb salvage strategies and appropriate amputation level selection.
- Demonstrates the benefit of optimizing vascular status prior to amputation.
- Provides data on long-term outcomes, informing clinical decision-making for peripheral vascular disease patients.
Abstract:
A series of 181 amputations in 156 patients treated between 1985 and 1996 because of chronic peripheral vascular disease was reviewed. 107 major amputations (above- and below-knee) and 74 minor amputations (foot and forefoot) were performed. 81% of the patient population had previous vascular operations. Complications, revisions and mortality of all patients were retrospectively analyzed. The operative mortality rate of major amputations was 20% and the operative mortality rate of minor amputations was 9%. By a vessel-reconstruction before amputation the complication- (wound healing) and revision-rate could be reduced. By examination of the family-doctors, the survival times of the patients and the rehabilitation status of 69 living patients were recorded. Minor amputations, below-knee amputations and knee-disarticulations had the best results of rehabilitation.