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Updated: Oct 16, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
"Not so minor" - Digital Amputation as a precursor to Major Amputation and Mortality in an Irish tertiary vascular
Ubaid Ullah1, Megan Power Foley1, Shahla AlBalushi2
1Department of Vascular Surgery, Beaumont Hospital, Dublin 9, Ireland, D09V2N0.
Background:
Minor (toe) amputations are a common consequence of peripheral arterial disease (PAD) and/or diabetes. They can herald further forefoot and major amputations and are a poor prognostic indicator for five-year survival. This study aimed to identify prognostic indicators for progression from minor amputation to major amputation and all-cause mortality.
Methods:
Index digital amputations performed by vascular surgeons in a tertiary referral hospital between 2017-2022 were identified from Hospital In-Patient Enquiry (HIPE) data. Electronic records for each limb were followed up to October 2025 for further ipsilateral minor and major amputations and mortality.
Results:
224 limbs in 209 patients underwent at least one minor amputation. The cohort was predominantly male (86%) with a mean age of 66.3 years (± 12.7). 70% had PAD and 80% had diabetes. In total, 34% (n=73/215) required further ipsilateral amputation, 78.3% of which occurred within 12 months of index surgery. Minor and major re-amputation rates were 25.6% and 11%, respectively. Predictors of further amputation at any level included ischaemic heart disease (IHD) (OR 2.796, 95% CI 1.54-5.06), diabetes (OR 2.31, 95% CI 1.04-5.136) and dialysis (OR 2.20, 95% CI 1.021-4.915). Index hallux amputation, IHD, and revascularisation at index admission were risk factors for further major ipsilateral amputation. All-cause mortality was 11.4%, 24.8% and 48% at one, three and five years, respectively.
Conclusion:
Consistent with international data, minor amputations are poor prognostic factor for limb loss and death. In this cohort, patients with IHD and dialysis were most at risk for further amputation.
