The long-term mobility and mortality of patients with peripheral arterial disease following bilateral amputation

To study the postoperative course, mobility, housing conditions and the mortality following bilateral amputations in patients with peripheral arterial occlusive disease (PAD).

Part retrospective, part prospective open study.

Vascular unit of a university hospital.

Sixty-six consecutive patients with PAD undergoing bilateral trans-metatarsal (TM), below-knee, through-knee and above-knee amputations between 1980 and 1989 were studied. Their medium are at the time of an amputation in the second limb was 58 years (range 27-91 years).

Initial and subsequent amputation levels, co-morbidity, mobility, housing conditions and mortality were recorded from 1989 until 2001.

Follow-up was 98%. Hospital mortality after amputation of the second leg was 12%. The mortality after 2 years was 38% and after 5 years 69%. At the end of the observation period, truly three patients were still alive (15%). Coronary heart disease was the leading cause of death and accounted for 37%, cerebro-vascular incidents for 14%. During follow-up, 56% of the patients needed at least one stump revision or reamputation to a higher level. Reamputations occurred after TM in 63%, below-knee in 42% and/through-knee amputations in 69%, respectively. Of 58 patients who were discharged, 38% became able to walk, 52% were mobile with a wheelchair and 10% remained bedridden. Of the patients who were able to walk, 82% returned to individual homes as compared to 63% of those who were mobile with a wheelchair.

Amputation levels should be kept as distal as possible in the interest of mobility which is one of the primary keys to social reintegration. However reamputations to higher levels are frequent as PAD progresses. The well-known very high mortality is clearly related to generalised atherosclerosis.