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Risk factors for reamputations in patients amputated after revascularization for critical limb-threatening ischemia

Eva Torbjörnsson1, Ann-Mari Fagerdahl2, Lena Blomgren3

  • 1Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden.

Journal of Vascular Surgery
|May 4, 2020
PubMed

Insights

Patients needing major lower limb amputation due to critical limb-threatening ischemia (CLTI) face high reamputation risks. Ischemic pain as an amputation indication significantly increases this risk, suggesting a need for better preoperative circulation assessment.

Area of Science:

  • Vascular Surgery
  • Limb Salvage
  • Amputation Prevention

Background:

  • Critical limb-threatening ischemia (CLTI) poses significant amputation risks despite vascular interventions.
  • Patients undergoing major lower limb amputation for CLTI are susceptible to stump complications and reamputation.

Purpose of the Study:

  • To identify risk factors for reamputation after major lower limb amputation in CLTI patients.
  • To investigate mortality rates following major lower limb amputation in this cohort.

Main Methods:

  • Retrospective analysis of 288 patients undergoing major ipsilateral amputation for CLTI between 2007-2013 in Stockholm, Sweden.
  • Primary outcome measured was ipsilateral reamputation; secondary outcome was mortality.

Main Results:

  • Fifty patients (17.4%) experienced reamputation, and 222 (77.1%) died during follow-up.
  • Ischemic pain as an indication for primary amputation was associated with a nearly fourfold increased risk of reamputation (SHR 3.55; CI 1.55-8.17).
  • Advanced age correlated with increased mortality risk (HR 1.03; CI 1.02-1.04).

Conclusions:

  • Ischemic pain as an indication for amputation is a significant predictor of reamputation.
  • This finding suggests more extensive or proximal ischemia in patients with ischemic pain.
  • Enhanced preoperative circulation assessment may optimize amputation level selection and reduce reamputation rates.
Abstract

Keywords:
Critical limb-threatening ischemiaIschemic painMajor amputationReamputationRisk factors

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