Major lower extremity amputation after multiple revascularizations: was it worth it?

Area of Science:

• Vascular Surgery
• Patient-Reported Outcomes
• Limb Salvage

Background:

• Lower extremity revascularization often prioritizes lesion-specific interventions over patient-centered goals.
• Understanding patient perspectives is crucial for evaluating the success of limb salvage strategies.

Purpose of the Study:

• To investigate patient perspectives on multiple lower extremity revascularization procedures that ultimately resulted in major amputation.
• To assess patient satisfaction, decision-making involvement, functional status, and prosthesis use after failed limb salvage attempts.

Main Methods:

• A prospective vascular surgery database (2000-2005) identified patients undergoing amputation after failed revascularization.
• Telephone surveys collected data on patient experiences, functional status, and prosthesis use.
• The Social Security Death Index verified patient survival; amputations for infection were excluded.

Main Results:

• 142 revascularizations (median 4/patient) were performed on 78 patients before amputation.
• Of 33 surveyed amputees, 85% would undergo procedures again to save their leg.
• 54% used a prosthesis, and 91% lived at home, indicating achievable independence.

Conclusions:

• Patients are willing to endure multiple revascularization attempts for limb salvage, even if amputation is the final outcome.
• Patient-centered outcomes, including independence and functional status, are vital for guiding revascularization strategies.
• Both percutaneous and open revascularization techniques should consider patient-oriented goals.