Amputation for acute ischaemia is associated with increased comorbidity and higher amputation level

Area of Science:

• Vascular Surgery
• Limb Amputation Outcomes
• Ischemic Disease Management

Background:

• Limited data exists comparing risk factors and outcomes for major amputations due to acute versus chronic ischemia.
• Previous studies suggest poorer early outcomes for major amputations following failed thromboembolectomy.
• A comprehensive comparison of acute vs. chronic ischemia amputation outcomes in a large patient series is needed.

Purpose of the Study:

• To compare the risk factors and 30-day outcomes of major amputations performed for acute ischemia versus chronic ischemia.
• To identify specific patient characteristics and procedural differences between the two groups.
• To determine if acute ischemia amputation patients represent a higher-risk surgical group.

Main Methods:

• Retrospective review of 322 primary major amputations for arterial disease between 1992 and 1998.
• Analysis of 270 amputations for chronic ischemia and 52 amputations for acute ischemia.
• Comparison of patient demographics, comorbidities, amputation level, and 30-day outcomes.

Main Results:

• The acute ischemia group exhibited higher rates of cardiac disease (48% vs. 29%), pulmonary disease (27% vs. 13%), and severe comorbidities (ASA grades 4/5: 27% vs. 14%).
• Amputations below the knee were significantly less frequent in the acute ischemia group (31% vs. 60%).
• Trends indicated higher revision rates (19% vs. 11%) and mortality (25% vs. 19%) in the acute group, though not statistically significant.

Conclusions:

• Major amputations for acute ischemia are associated with greater pre-existing comorbidity compared to chronic ischemia.
• Patients undergoing amputation for acute ischemia are twice as likely to require above-knee amputation.
• These findings highlight the need to manage acute ischemia amputation patients as a distinct, high-risk surgical population.