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Mortality Risk of Upper Extremity Amputation in Patients With Peripheral Artery Disease
Seong-Won Kim1, Nicholas C Bank, Stephen J Perle
1From the Department of Orthopaedics, The University of North Carolina School of Medicine, Chapel Hill, NC (Kim, Bank, Perle, Patterson, and Draeger), the Case Western Reserve University School of Medicine, Department of Orthopaedics, Cleveland, OH (Bank), and the Department of Vascular Surgery, University of North Carolina, Chapel Hill, NC (Brown).
Introduction:
The mortality risk of patients with peripheral artery disease (PAD) undergoing upper extremity amputation (UEA) remains poorly understood. The aim of this study was to clarify the mortality risk associated with upper extremity amputation in patients with PAD.
Methods:
The TriNetX database was retrospectively queried to identify patients with PAD who did or did not undergo UEA, using International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes. Patients were divided into two cohorts: PAD with UEA and PAD without UEA. Propensity score matching was conducted on a 1:1 ratio based on age, sex, body mass index, diabetes, and other comorbidities. Subgroup analyses were conducted based on level of amputation. Kaplan-Meier survival analyses, along with hazard ratios (HRs) and 95% confidence intervals (CIs), were used to assess mortality at 1, 5, and 10 years after UEA.
Results:
A total of 1,802,975 patients with PAD were identified (1,862 with UEA; 1,801,113 without UEA). Each cohort included 1,862 patients after propensity score matching. Patients who underwent UEA had higher mortality rates at 1 year (24.1% vs. 14.1%), 5 years (54.3% vs. 36.6%), and 10 years (72.5% vs. 54.8%). UEA was associated with increased mortality risk at all time points: 1 year (HR 1.767, 95% CI, 1.500 to 2.081), 5 years (HR 1.739, 95% CI, 1.544 to 1.958), and 10 years (HR 1.705, 95% CI, 1.524 to 1.908). Long-term survival was poor across both digit-level and forearm-level amputation groups, with no statistically significant differences in mortality risk over time.
Discussion:
These findings demonstrate an increased mortality risk among patients with PAD who undergo UEA compared with those who do not. Given the high prevalence of diabetes and vascular disease in the United States, these results underscore the importance of early recognition, patient education, and implementation of preventive strategies to reduce disease progression and the potential need for amputation.
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Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...