A Randomised Controlled Trial of the Use of a Tourniquet to Reduce Blood Loss During Transtibial Amputation for Peripheral Arterial Disease

Abstract

Objectives To examine the effects of an exsanguination tourniquet on blood loss during transtibial amputation in patients with peripheral arterial disease (PAD). Design Prospective randomised blinded controlled trial. Materials and methods Sixty-four patients undergoing transtibial amputation for non-reconstructible PAD were randomised to either tourniquet or no tourniquet (control). Blood loss (primary outcome), fall in haemoglobin, transfusion requirements, wound healing, breakdown and revision (secondary outcomes) were also recorded. Results Twenty-five patients in the tourniquet and 29 in the control group conformed to the trial protocol and completed the follow up. Intra-operative blood loss (median and IQR) was significantly greater in the control group compared to the tourniquet group (550 ml (255–1050) vs 255 ml (150–572.5), respectively, p=0.014, Mann–Whitney). There was a significantly greater drop in haemoglobin concentration (median and IQR) in the control compared to the tourniquet group (1.8 g/dl (0–1.2) vs1.0 g/dl (0.6–2.4), p=0.035, t-test). Transfusion requirements were lower in the tourniquet group (p=0.05, Mann–Whitney). The rate of wound healing, breakdown and revision were similar in the tourniquet and control groups, respectively (59 vs 57%, 0 vs 9%, 14 vs 9%, p=NS). Conclusions The use of a tourniquet during transtibial amputation for severe PAD reduces blood loss and need for blood transfusion.