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Halving the number of leg amputations: the influence of infrapopliteal bypass
A E Pedersen1, B Bornefeldt Olsen, M Krasnik
1Department of Thoracic and Vascular Surgery L, University of Copenhagen, Bispebjerg Hospital, Denmark.
Insights
Vascular disease amputations decreased significantly due to increased vascular reconstructions and bypass surgeries. However, amputations in long-stay institution patients remained constant.
Area of Science:
- Vascular Surgery
- Limb Amputation Trends
- Patient Outcomes
Background:
- Vascular disease necessitates limb amputations, impacting patient mobility and quality of life.
- Historical trends in amputation rates provide a benchmark for evaluating surgical interventions.
- Understanding factors influencing amputation rates is crucial for optimizing patient care.
Purpose of the Study:
- To analyze trends in lower extremity amputations for vascular disease patients over a decade.
- To investigate the correlation between amputation rates and advancements in vascular reconstructive surgery.
- To compare amputation patterns in previously independent patients versus those from long-stay institutions.
Main Methods:
- Retrospective review of 1383 amputations performed over 10 years at Bispebjerg Hospital.
- Analysis of final amputation levels, including below-knee (BKA) and above-knee (AKA) amputations.
- Comparison of amputation data with trends in vascular reconstructions, bypass surgeries, and angioplasties.
Main Results:
- Total final level amputations in independent patients halved from 122 (1981) to 58 (1990).
- Reamputations and total amputations also showed a significant reduction during the study period.
- Amputations in long-stay institution patients remained stable, averaging 17 per year.
- The decrease in amputations coincided with a >100% increase in bypass surgeries and vascular reconstructions.
- The below-knee amputation to above-knee amputation (BKA/AKA) ratio decreased significantly from 1.12 to 0.67.
Conclusions:
- Advancements in vascular surgery, including bypass and angioplasty, have effectively reduced amputation rates in vascular disease patients.
- The disparity in amputation trends between independent patients and those from institutions warrants further investigation.
- The shift towards a lower BKA/AKA ratio suggests a trend towards more distal revascularization or conservative amputation levels.
Abstract:
A retrospective review of amputations in patients with vascular disease during 10 years in Bispebjerg Hospital was undertaken. There were 1383 amputations leading to 1167 final level amputations. In previously independent patients there were 482 below knee amputations (BKA), 476 above knee amputations (AKA) and 43 had disarticulations in the ankle, knee or hip. During the period studied the number of final level amputations in independent patients were halved from 122 in 1981 to 58 in 1990. A similar reduction was also found in the total number of amputations: from 171 to 90, and in the number of reamputations: from 35 to 21. However, amputations in patients from long stay institutions remained at a constant level by on average 17 per year. The decrease in amputation rate took place synchronously with an increasing use of bypass to crural and pedal arteries as well as an overall increase in vascular reconstructions and angioplasties of more than 100%. However, the BKA/AKA ratio decreased from 1.12 to 0.67 (p < 0.005).