Factors Affecting Lower Limb Amputation following Arterial Bypass Surgery

Chumpon Wilasrusmee

doi:10.4172/2155-6156.1000208

Abstract

Study background: To identify important risk factors for subsequent amputation within one year after surgery in patients with acute lower limb ischemia undergoing distal arterial bypass. Methods: A chart review of patients undergoing distal vascular bypass for lower limb ischemia within the 5-year period between 2006 and 2011 was done. All patients were followed for at least one year. The outcome of interest was the need for amputation of the treated limb within one year after bypass surgery. Potential risk factors associated with the need to perform amputations were abstracted from the medical charts. Logistic regression and chi-square tests were used to identify significant associations between risk factors and amputation. Results: Of 128 patients reviewed, only 18 (14%) had amputations within one year. Although there was a trend for increased risk of amputation for patients with a history of smoking, DM, renal dysfunction, presenting with rest pain, lower ABI, multilevel disease, circumferential thickening of the stenosis, and lower risk for patients taking postoperative antiplatelets (but not anticoagulants), the only significant risk factor at the 5% level were poorly controlled diabetes mellitus after operation and cerebrovascular disease. Conclusion: A few well-known risk factors were associated with increased risk of early amputation after arterial bypass surgery.

Highlights

Limb salvage is the primary goal in management of peripheral arterial occlusive disease (PAOD), especially in patient with critical limb ischemia [1,2,3]
This study was undertaken to determine the outcome of revascularization procedures of PAOD on a hospital basis by reviewed data in Ramathibodi hospital between 2006 and 2011
For many parameters in these 128 patients reviewed in Ramathibodi Hospital in between 1994-2004, there was a trend for increase risk of amputation for patients with history of smoking, diabetes mellitus, renal dysfunction, presenting with rest pain, lower ABI, multilevel disease, circumferential thickening of the stenosis, and lower risk for patients taking postoperative antiplatelets, the only significant factors were poorly controlled diabetes mellitus and cerebrovascular diseases

Summary

Introduction

Limb salvage is the primary goal in management of peripheral arterial occlusive disease (PAOD), especially in patient with critical limb ischemia [1,2,3]. Evaluation of therapeutic effectiveness of interventional procedures used to treat peripheral arterial occlusive disease (PAOD) requires use of several outcome measures that assess factors that affect patients directly (e.g., survival, amputation-free survival, quality of life, and pain relief), and clinical measures (e.g., laboratory test measurement) [5,6,7]. On the other hand some studies showed no changes in lower extremities amputation rates [9,10,11]. The assumption in these studies is that if revascularization procedures avert the need for amputation in some patients, a negative correlation should exist between rates of amputation and revascularization procedures

Methods

Results

Conclusion