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Amputation for peripheral vascular disease: the case for level selection
P T McCollum1, V A Spence, W F Walker
1Department of Vascular Surgery, Ninewells Hospital, Dundee, UK.
Insights
This study on lower limb amputations found that below-knee amputations, guided by skin blood flow and thermography, led to a 3:1 ratio over above-knee procedures. Prioritizing below-knee amputations can enhance patient mobility and quality of life.
Area of Science:
- Vascular Surgery
- Amputation Techniques
- Patient Outcomes
Background:
- End-stage peripheral vascular disease (PVD) necessitates major lower limb amputations.
- Current practices in some UK centers favor above-knee amputations, despite potential drawbacks.
Purpose of the Study:
- To evaluate the effectiveness of laboratory criteria in selecting amputation levels.
- To assess the ratio of below-knee to above-knee amputations and its impact on patient outcomes.
Main Methods:
- One hundred major lower limb amputations were performed over 15 months for end-stage PVD.
- Amputation level selection was based on laboratory criteria, including skin blood flow and infrared thermography.
- Data analysis focused on amputation levels and success rates.
Main Results:
- Eighty-one (81%) amputations were performed at the below-knee level, with only six failures.
- This resulted in a below-knee to above-knee amputation ratio of 3:1.
- A high rate of successful below-knee amputations was achieved.
Conclusions:
- Laboratory criteria effectively guide the selection of below-knee amputation levels.
- Increasing below-knee amputation rates can improve amputee mobility and quality of life.
- A shift towards higher below-knee amputation rates is recommended in centers still favoring above-knee procedures.
Abstract:
One hundred major lower limb amputations were performed for end stage peripheral vascular disease over a 15-month period. Selection of amputation level was made on the basis of laboratory criteria using skin blood flow and infrared thermography data. Eighty-one amputations were performed at the below-knee level with six failures. This resulted in a final below-knee: above-knee amputation ratio of 3:1. It is clear that there are still many centres in the UK where above-knee amputation is the accepted operation, despite the inherent drawbacks to this procedure. We recommend that more attention is given to achieving higher below-knee amputation rates to improve the chances of amputee mobility and therefore quality of life.