Outcomes in Patients With Peripheral Arterial Disease With and Without Prior Minor Amputation: A Comparative Analysis

Peripheral arterial disease (PAD) is a major global health concern, as critical limb-threatening ischemia leads to higher rates of amputation and mortality. The prognostic impact of prior minor amputation (PMA) is unclear. This study compares major amputation and all-cause mortality rates in patients with PAD with and without PMA and examines key demographic and clinical differences between these groups.

This retrospective cohort study included 430 consecutive patients with PAD at a tertiary vascular center. Patients were stratified according to PMA status into a PMA group (n = 72, 16.7%) and a non-PMA group (n = 358, 83.3%). Demographic data, comorbidities, and treatments were analyzed. Primary outcomes were major amputation and all-cause mortality. Statistical analysis included unpaired t-tests, chi-square tests, Cox proportional hazards regression, and Kaplan-Meier analysis.

Among 430 patients, 72 (16.7%) had PMA, whereas 358 (83.3%) did not. The PMA group had higher rates of smoking (n = 45, 62.5%, vs. n = 175, 48.9%; P = 0.039), chronic kidney disease (n = 29, 40.3%, vs. n = 98, 27.4%; P = 0.034), and revascularization (n = 16, 22.2%, vs. n = 14, 3.9%; P < 0.001), but lower utilization of antiplatelet therapy (n = 34, 47.2%, vs. n = 229, 64.0%; P = 0.006) and statin therapy (n = 38, 52.8%, vs. n = 258, 72.1%; P = 0.001). Although unadjusted Kaplan-Meier analysis demonstrated lower survival in the PMA group, multivariable Cox regression showed that PMA was associated with a lower adjusted risk of major amputation (hazard ratio (HR), 0.05; 95% confidence interval (CI), 0.02-0.18; P = 0.001) and all-cause mortality (HR, 0.44; 95% CI, 0.22-0.87; P = 0.017). Statin therapy (HR, 0.21; 95% CI, 0.10-0.43; P < 0.001) and anticoagulation (HR, 0.39; 95% CI, 0.21-0.72; P = 0.003) were associated with reduced mortality risk, whereas revascularization was associated with increased mortality risk (HR, 2.02; 95% CI, 1.05-3.83; P = 0.033).

PMA was associated with lower adjusted risks of major amputation and mortality in this retrospective cohort of patients with PAD. These results represent observational associations and require prospective validation. Aggressive medical management should be prioritized in all patients with PAD.