Lower extremity amputation in peripheral artery disease: improving patient outcomes

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Public Health

Background:

• Peripheral artery disease (PAD) impacts millions, increasing risks of mortality, cardiovascular events, and limb loss.
• Critical limb ischemia (CLI), a severe PAD form, often necessitates lower extremity amputation (LEA), despite declining incidence.
• Major LEA rates exhibit significant geographic variation in the US, with high post-amputation mortality (48% at 1 year, 71% at 3 years).

Purpose of the Study:

• To review the significance of lower extremity amputation (LEA) in peripheral artery disease.
• To discuss current methods and propose strategies for reducing the occurrence of LEA.
• To emphasize the importance of diagnostic testing prior to LEA.

Main Methods:

• Review of existing literature on peripheral artery disease, critical limb ischemia, and lower extremity amputation.
• Analysis of trends and geographic variations in LEA rates.
• Discussion of diagnostic testing utilization and its impact on outcomes.
• Exploration of risk factor recognition, revascularization techniques, and novel therapies.

Main Results:

• Diagnostic testing (noninvasive and invasive) in the year preceding LEA is underutilized.
• Utilization of diagnostic testing varies based on patient, provider, and regional factors.
• Significant morbidity and mortality are associated with LEA.

Conclusions:

• Improved recognition of PAD risk factors by clinicians and patients is crucial.
• Strong advocacy for noninvasive and/or invasive imaging prior to LEA is needed.
• Advancements in endovascular revascularization techniques and novel therapies offer potential to reduce LEA rates.