Late outcome of amputees with premature atherosclerosis

Peripheral atherosclerosis in young adults has been associated with a high amputation rate. Our purpose was to examine the natural history of amputees with premature atherosclerosis.

We compared 50 consecutive young patients undergoing dysvascular amputation who were 49 years of age or younger (mean age +/- SEM, 43 +/- .7 years) with 75 consecutive men and women ranging in age from 60 to 75 years (mean age, 67 +/- .6 years) who were undergoing major amputations for atherosclerosis during the same period.

Before undergoing amputation 46 (92%) patients in the study group underwent a mean of 3 +/- 0.3 vascular operations, and 49 (65%) older patients in the control group underwent a mean of 2 +/- 0.2 vascular operations (p = 0.003). The mean time from onset of symptoms to first amputation was not different in the study group versus the control group. Of those patients surviving until discharge, 20 (45%) patients in the study group and 21 (31%) patients in the control group became community or household ambulators, whereas 24 (55%) patients in the study group and 47 (69%) patients in the control group were confined to wheelchairs or were bedridden (p = 0.17). Seventeen (74%) patients in the study group who did not require contralateral amputations became community ambulators, as did 18 (38%) members of the control group (p = 0.01). Twenty (40%) patients in the study group and 39 (52%) patients in the control group died during the study period. The mean age at death was 48 +/- 1 years for the study group and 69 +/- .8 years for the control group (p < 0.001). Cumulative 5-year survival (62% patients in study group, 47% patients in control group) was not different between the two groups (p = 0.41, Kaplan-Meier).

Compared with older counterparts, amputees with premature atherosclerosis have a higher number of failed bypasses before undergoing amputation and die at a younger age. However, both groups have a similar cumulative survival after amputation. Fewer than one half of young patients undergoing dysvascular amputation ultimately achieve ambulation, suggesting that major amputations are a harbinger of long-term disability and dependency in these patients. Because young patients had a higher potential for rehabilitation after unilateral amputation, these patients should be monitored closely for development of ischemia in the contralateral limb.