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Risks and Risk Factors for Contralateral Amputation in Patients who have Undergone Amputation for Chronic Limb

Joseph M Czerniecki1, Alyson J Littman2, Greg Landry3

  • 1VA Puget Sound Health Care System, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; VA Centre for Limb Loss and Mobility (CLiMB), USA.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|April 17, 2022
PubMed

Insights

Patients with chronic limb-threatening ischemia (CLTI) undergoing amputation face a 7.7% risk of contralateral amputation. Risk factors include amputation level, dialysis, and race, highlighting the need for targeted risk identification.

Area of Science:

  • Vascular Surgery
  • Epidemiology
  • Amputation Prevention

Background:

  • Chronic limb-threatening ischemia (CLTI) is a severe condition often requiring amputation.
  • Contralateral limb loss significantly impacts patient morbidity and mortality.
  • Understanding risk factors for contralateral amputation is crucial for patient management.

Purpose of the Study:

  • To determine the cumulative incidence of contralateral amputation in patients with CLTI.
  • To identify pre-operative risk factors associated with contralateral amputation.

Main Methods:

  • Retrospective cohort study using the National Veterans Affairs Surgical Quality Improvement Program database (2004-2014).
  • Inclusion of patients with unilateral transmetatarsal (TM), transtibial (TT), or transfemoral (TF) amputation secondary to CLTI.
  • Competing risk analysis using a Fine-Gray subdistribution hazard model to estimate incidence and risk factors.

Main Results:

  • The overall risk of contralateral amputation was 7.7%, with higher rates following transfemoral (TF) amputations (9.7%).
  • Dialysis was the strongest risk factor (sub-HR, 2.3), while obesity was associated with lower risk (sub-HR, 0.67).
  • Increased risk was also observed for TF amputations, and in Black or Hispanic patients.

Conclusions:

  • The one-year risk of contralateral amputation is linked to the level of the initial amputation, comorbidities, race/ethnicity, and BMI.
  • Identified risk factors are predominantly non-modifiable but aid in identifying high-risk populations.
  • This research underscores the importance of comprehensive risk assessment in CLTI patients.
Abstract

Keywords:
Chronic limb threatening ischaemiaContralateral amputationDiabetesRisk factors

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