Late outcomes of limb loss after failed infrainguinal bypass

Most reports regarding infrainguinal bypass surgical procedures demonstrate benefits well but pay less attention to adverse outcomes and consequences of failure for the patient. For a wider scope of infrainguinal bypass surgical procedures, we evaluated patient-oriented outcomes of limb loss occurring after failed infrainguinal bypass operations.

Eighty-one patients with vascular amputations were identified in a retrospective study. Follow-up was complete with a mean of 3.6 years. Life-table and multivariate analyses were used to assess factors influencing the desired outcome goals of rehabilitation. Mortality rates, social function, risk of contralateral amputation, and the ability to walk were used to measure the late outcome.

The long-term survival rate was poor (72% at 1 year; 53% at 3 years) and was not related to traditional risk factors for atherosclerosis. Moreover the risk for contralateral amputation was 10% per year. One year after amputation 81% (47 of 58) of the surviving amputees were walking independently, and 73% (42 of 58) were living at home, 32 with their spouse. At 3 years these results were 73% (27 of 37) and 78% (29 of 37), respectively. In addition, the level of self-care changed significantly (p < 0.001) after amputation. Advanced age (older than 65 years), self-care performance, and living with someone were important predictors of late outcome.

It is possible for a high percentage of patients with vascular amputations to return home successfully, either walking or in a wheelchair. Moreover this result can be predicted based on preoperative clinical variables. These data may be helpful to guide fitting of prosthetic devices, planning of discharge home, and use of health care resources.