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Amputation for occlusive arterial disease. A prospective multicentre study of 177 amputees
1Department of Orthopaedics, Helsingborg Hospital, Sweden.
Insights
Lower limb amputations due to arterial disease have high mortality rates. While stump healing was similar across groups, diabetics had more bilateral amputations, impacting prosthesis use.
Area of Science:
- Vascular Surgery
- Orthopedic Surgery
- Rehabilitation Medicine
Background:
- Occlusive arterial disease frequently necessitates lower limb amputation.
- High mortality and morbidity rates are associated with these amputations.
Purpose of the Study:
- To prospectively evaluate outcomes of lower limb amputations in Malmöhus county.
- To assess stump healing, prosthesis use, and mortality at 6 months and 4 years.
Main Methods:
- Prospective, consecutive study of all major lower limb amputations over one year.
- Inclusion of 177 patients across 5 hospitals, with follow-up for 6 months.
- Data collection on amputation level, patient demographics, stump healing, prosthesis use, and mortality.
Main Results:
- At 6 months, 38% mortality was observed. Of 109 survivors, 85 had healed stumps.
- No significant difference in stump healing based on sex, age, diabetes, or amputation level.
- Diabetic patients were more likely to be bilateral amputees; 72% mortality at 4 years.
Conclusions:
- Lower limb amputations for occlusive arterial disease carry a substantial mortality risk.
- While stump healing is generally favorable, diabetes is a risk factor for bilateral amputations.
- Rehabilitation and prosthesis use are critical for survivors, but long-term survival remains a significant concern.
Abstract:
All major amputations of the lower limb due to occlusive arterial disease were studied prospectively and consecutively during one year in the 5 hospitals in Malmöhus county, Sweden. The patients were followed for 6 months after the primary amputation of which 136 were through the tibia, 6 through the knee and 35 through the femur. One hundred and seventy-seven patients (92 men and 85 women) were included; 49% were 80 years or older and 40% were diabetic. At 6 months, 85 of the surviving 109 patients had healed stumps, 10 were not healed and 14 had been revised or reamputated. Half the survivors used a prosthesis daily. There was no significant difference in healing related to sex, age, diabetes or the level of amputation, but diabetics were more often bilateral amputees. The mortality at 6 months was 38% and at 4 years 72%.