Internal Iliac Artery Patency as a Predictor of Above-Knee Amputation Stump Healing

Abstract

PurposeThe primary aim of this study is to assess role of internal iliac patency in predicting outcome of AKA stump healing. The secondary objectives were assess accuracy of Wound, Ischemia, and foot Infection (WIfI) classification system in predicting AKA stump healing and association of delayed mortality. Materials and MethodThis is a retrospective study performed in Vascular Surgery Unit, in a tertiary hospital, on patients who underwent above-knee amputations over one year, from July 2021 until June 2022. Patient demographic data, WIfI scoring, outcome of above-knee amputations and patency of profunda femoris and internal iliac artery were collected. To minimize confounding, a single vascular surgeon performed all CT imaging reviews and arterial measurements. Approval for this study was obtained from the National Research Registry NMRR ID-23-01865-KQ4 (IIR). ResultNinety patients underwent AKA over one year, from July 2021 until June 2022. Occluded internal iliac artery in the presence of patent profunda femoris did not affect the wound healing of AKA stump. There was significant association between WIfI scoring with mortality. Patients with WIfI scoring 3 to 4 was observed to have higher mortality rate compared to patients with normal healing 47 (72.0%) vs 4 (80.0%); p= 0.021. ConclusionIn this study, the internal iliac artery patency shows no statistically significant effect on AKA stump healing; however, the small number of patients is a study drawback. This study also demonstrates that the WIfI score can be a prognostic factor for mortality in patients undergoing above-knee amputation.