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Limb loss in association with vascular surgery--a five-year series of major lower-limb amputation
E Wahlberg1, U Lepner, P Olofsson
1Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
Objective:
To evaluate the type, timing and number of vascular reconstructions that preceded amputation; to compare the characteristics of amputees who had had reconstructions with those of amputees who had not, and to compare the results of amputation.
Design:
Retrospective study of case notes.
Setting:
University hospital, Sweden.
Subjects:
All 219 patients who underwent amputation between 1987 and 1992.
Main Outcome Measures:
Incidence of amputations; presenting features, and type and results of vascular reconstructions.
Results:
The number of amputations decreased after 1988, and that of vascular reconstructions increased. 56 of the 99 who had amputations after reconstruction (57%) had had their last procedure within a month. This group had had a mean of three operations, had worse run-off as assessed by angiography, and 2 of them (5%) had amputations after failed suprainguinal reconstruction for claudication alone. 68 of the total (31%) had amputations without first being assessed by a vascular surgeon. 52 (24%) required reamputation.
Conclusion:
Better objective methods are needed for the assessment of patients before primary as well as secondary vascular reconstructions. All patients should be seen by a vascular surgeon before amputation is recommended.