The Majority of Patients Have Diagnostic Evaluation Prior to Major Lower Extremity Amputation.

BACKGROUND: Critical limb ischemia (CLI) patients who do not undergo revascularization are at great risk for major lower extremity (LE) amputation. It has been reported that less than half (49%) of a reference Medicare amputation population had any diagnostic vascular evaluation prior to a major LE amputation. We were surprised by these data so we reviewed the preoperative evaluation in all patients who had a major LE amputation. We propose that significantly more patients will have a vascular evaluation prior to major LE amputation at a tertiary care referral center when a vascular surgeon does the amputation.

METHODS: A retrospective analysis of major LE amputations was performed. Patient demographics, comorbidities, type of amputation, reason for amputation, Rutherford classification, and type of preoperative vascular examination were evaluated.

RESULTS: Over 4 years, 281 patients required major LE amputation. Above-knee amputation was performed in 39.1% of patients, whereas below-knee amputation was performed in 60.9%. Amputation was performed due to CLI in 92.9% of patients, whereas 7.1% of amputations were performed due to diabetes or other reasons. Preoperative vascular evaluation was performed in 100% of patients undergoing major LE amputation. Vascular surgeon pulse examination was most common (99.3%) followed by pulse volume recordings/ankle-brachial index (78.8%), angiography (54.8%), computed tomography angiography (29.3%), duplex ultrasonography (41.3%), and magnetic resonance angiography (0.4%). Amputations most commonly occurred due to Rutherford classification VI (63.3%) with 97.2% of patients having Rutherford IV-VI classification.

CONCLUSIONS: Preoperative vascular evaluation prior to major LE amputation is achievable in the majority of patients, reported here in 100% of patients undergoing a major LE amputation. This allows us to evaluate the patient for revascularization options prior to amputation for possible limb salvage.