Determination of amputation level in ischaemic lower limbs

Area of Science:

• Vascular Surgery
• Lower Extremity Amputation
• Ischemia Management

Background:

• Amputation is a life-saving procedure when vascular reconstruction is not feasible.
• Current criteria for determining amputation level in ischemic lower extremities are inconsistent.
• Predicting the optimal amputation level is crucial for patient outcomes.

Purpose of the Study:

• To develop a reliable method for determining the best amputation level in patients with lower extremity ischemia.
• To devise a scoring system based on preoperative angiograms to assess distal run-off vessel patency.

Main Methods:

• A retrospective review of 232 lower extremity amputations in 202 patients over 5 years.
• Development of a scoring system to quantify distal run-off vessel patency from preoperative angiograms.
• Statistical analysis (chi-squared testing) to correlate the score with amputation level.

Main Results:

• A significant correlation was found between the devised score and the required amputation level (chi2 = 289.23, P < 0.005).
• Lower scores predicted higher amputation levels: <12 for above-knee, 12-19 for below-knee, 20-25 for forefoot, and >25 for toe amputation.
• The scoring system demonstrated predictive value for determining appropriate amputation levels.

Conclusions:

• A scoring system based on preoperative angiogram assessment of run-off vessels offers a practical method for predicting amputation levels in ischemic lower extremities.
• While valuable, the scoring system is not entirely reliable and should be used in conjunction with other clinical factors.
• This tool aids in decision-making for amputation levels in vascular surgery.