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Relative risks of limb revascularization and amputation in the modern era
M J Schina1, R G Atnip, D A Healy
1Section of Vascular Surgery, Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey 17033.
Cardiovascular Surgery (London, England)
|December 1, 1994
Summary
Infrainguinal revascularization for limb salvage has similar mortality to amputation. This study found revascularization and major amputation have comparable 30-day mortality rates, with cardiac issues being a primary concern.
Area of Science:
- Vascular Surgery
- Surgical Outcomes
- Limb Salvage Procedures
Background:
- Advanced limb ischemia often necessitates surgical intervention, including infrainguinal revascularization or major amputation.
- Previous literature suggests higher mortality rates associated with amputation compared to revascularization.
Purpose of the Study:
- To determine procedure-specific 30-day operative morbidity and mortality rates for infrainguinal revascularization and major amputation.
- To compare the outcomes of limb salvage revascularization versus amputation in patients with advanced limb ischemia.
Main Methods:
- Retrospective review of 266 patients undergoing infrainguinal revascularization or major amputation between 1984 and 1990.
- Analysis of procedure-specific morbidity and mortality, including primary and secondary revascularizations, and transmetatarsal, below-knee, and above-knee amputations.
Main Results:
- Morbidity and mortality rates were 48% and 2% for primary revascularization, 35% and 2% for secondary revascularization, and 37% and 4% for amputation.
- Cardiac, graft, and wound complications were the leading causes of morbidity; cardiac etiology accounted for most deaths.
- Mortality rates for revascularization and amputation were statistically similar, with revascularization approaching potentially lower rates.
Conclusions:
- Infrainguinal revascularization can be safely performed in most patients with advanced limb ischemia.
- The mortality rate for revascularization is comparable to, and potentially lower than, that of major amputation.
- Major amputation can be performed with a lower mortality rate than previously reported in older literature.