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Predictors of Major Adverse Limb Events after Open Forefoot Amputation in Patients with Chronic Limb-Threatening

Louis L Zhang1, Nallely Saldana-Ruiz1, Ramsey S Elsayed1

  • 1Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of USC, Los Angeles, CA.

Annals of Vascular Surgery
|February 7, 2020
PubMed

Insights

Open transmetatarsal amputation (TMA) offers limb salvage for chronic limb-threatening ischemia (CLTI). However, end-stage renal disease (ESRD) independently predicts major adverse limb events (MALE) after TMA.

Area of Science:

  • Vascular Surgery
  • Limb Salvage Procedures
  • Diabetic Foot Complications

Background:

  • Chronic limb-threatening ischemia (CLTI) with extensive foot necrosis poses significant limb salvage challenges.
  • Open transmetatarsal amputation (TMA) is a surgical option for select CLTI patients.
  • Evaluating preoperative risk factors is crucial for optimizing TMA outcomes.

Purpose of the Study:

  • To assess the durability and efficacy of limb salvage following open TMA in CLTI patients.
  • To identify preoperative risk factors associated with major adverse limb events (MALE) after open TMA.
  • To investigate the impact of foot infections and renal failure on TMA outcomes.

Main Methods:

  • Retrospective analysis of 39 patients undergoing 43 open TMAs (2009-2018).
  • Multivariable logistic regression used to identify predictors of MALE.
  • Data adjusted for preoperative risk factors including diabetes, hypertension, and end-stage renal disease (ESRD).

Main Results:

  • The cohort (mean age 63) had high rates of diabetes (89%) and hypertension (95%).
  • End-stage renal disease (ESRD) was present in 54% of patients.
  • Major adverse limb events (MALE) occurred in 39% of patients; ESRD independently predicted MALE (OR 7.43, P=0.038).

Conclusions:

  • Open TMA demonstrates acceptable limb salvage rates in complex CLTI patients.
  • End-stage renal disease (ESRD) is a significant independent risk factor for MALE post-TMA.
  • Close follow-up is vital for this high-risk patient group due to potential for poorer outcomes.
Abstract

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