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Changing pattern of lower limb amputation for vascular disease
Insights
Lower limb amputation rates increased by 33% in six years. Injudicious arterial reconstruction before amputation may hinder rehabilitation outcomes.
Area of Science:
- Vascular Surgery
- Orthopedic Surgery
- Rehabilitation Medicine
Background:
- A previous review reported lower limb amputation data from 1974-1978.
- Recent data shows a 33% increase in lower limb amputations for peripheral vascular disease over six years.
- This rise exceeds that attributable to population aging alone.
Purpose of the Study:
- To analyze trends in lower limb amputation rates and types.
- To evaluate the impact of reconstructive vascular surgery on amputation levels and rehabilitation.
- To identify factors influencing re-amputation and successful prosthetic limb use.
Main Methods:
- Retrospective analysis of 193 lower limb amputations for peripheral vascular disease.
- Comparison of amputation types: below-knee amputation (BKA) versus Gritti-Strokes amputation (GSA).
- Assessment of re-amputation rates, reasons, and subsequent rehabilitation success.
Main Results:
- Amputation rate increased by 33% over six years.
- Fewer BKAs (33%) and more GSAs (32%) were performed.
- Overall re-amputation incidence was 13.5%. BKA stumps had a 28% re-amputation rate with 75% successful rehabilitation, while GSA stumps had an 8% re-amputation rate with 28% successful rehabilitation.
- 37% of patients had prior reconstructive vascular surgery.
- 58% of patients requiring re-amputation had undergone arterial reconstruction, often shortly before amputation (26.9%).
Conclusions:
- The increase in lower limb amputations is significant and not solely due to an aging population.
- Changes in amputation technique (fewer BKA, more GSA) and high re-amputation rates impact rehabilitation.
- Injudicious arterial reconstruction attempts prior to inevitable amputation may negatively affect outcomes and jeopardize rehabilitation.
Abstract:
In 1980 a review of lower limb amputation over a 3.5 year period between 1974 and 1978 was reported from our centre. More recently 193 amputations were performed for peripheral vascular disease over a similar 3.5 year period, representing an increase of 33 per cent in the amputation rate during the last 6 years. This cannot be explained by the increasing age of the population alone. Fewer below-knee amputations (BKA) (33.0 per cent) and more Gritti-Strokes amputations (GSA) (32.0 per cent) were performed and the overall incidence of re-amputation for stump breakdown was 13.5 per cent. Twenty-eight per cent of below-knee amputation stumps required re-amputation at higher levels, but when successful were associated with a 75 per cent incidence of rehabilitation with an artificial limb. Eight per cent of GSA stumps required re-amputation and were associated with a twenty-eight per cent incidence of successful rehabilitation. Thirty-seven per cent of patients had undergone reconstructive vascular surgery before amputation. Of the 26 patients requiring re-amputation 58 per cent had undergone arterial reconstruction in an attempt to salvage the limb (chi 2 = 5.65, P less than 0.02) and in 26.9 per cent of cases this was performed within the week before amputation. We feel that injudicious attempts at arterial reconstruction, when amputation appears inevitable, may adversely affect the subsequent level of amputation and jeopardize rehabilitation.