Clinical Experiences of Lower Limb Amputation in Ischemic Arterial Disease

Park, Chi Min; Huh, Seo Ho; Kim, Dong Ik; Lee, Byung Boong

Abstract

PURPOSE
Despite the decrease in the number of lower limb amputation in ischemic limb patients as a result of advances in vascular reconstruction surgery, amputation still plays an important role in the management of end-stage peripheral vascular disease. Owing to the importance of the amputation level in postoperative rehabilitation and prevention of reamputation, there have been many reports defining theses level. Clinical characteristics were determined by retrospectively reviewing medical records of patients who underwent lower limb amputation for peripheral vascular disease. METHOD: Between June 1997 and September 2002, lower limb amputation was performed in 73 patients with peripheral vascular disease. RESULT: Mean follow-up period was 15 months; male to female ratio was 7.1 to 1; and mean age was 62.6 years. Associated diseases included DM (39 patients), hypertension (15 patients), ischemic heart disease (13 patients), and cerebrovascular disease (6 patients). Etiologies were atherosclerosis in 47.9%, Buerger's disease in 15.1%, DM foot in 13.7%, acute arterial embolization in 2.7%, ruptured abdominal aortic aneurysm in 1.4%, and combined atherosclerosis with DM foot in 19.2%. Bypass surgery was performed in 24 cases and only 4 cases underwent radiologic vascular intervention. The frequency of amputation was one surgery in 50 cases and more than two surgeries in 23 cases. Amputation level was digit amputation in 49 cases (67.1%), transmetatarsal in 10 cases (13.7%), below-knee in 11 cases (15.1%) and above-knee in 3 cases (4.1%). In 73 cases, reamputation was performed in 19 cases (26%) for poor stump wound healing. The cause of reamputation was atherosclerosis in 17.1%, Buerger's disease in 27.3%, DM foot in 60.0% and combined atherosclerosis with DM foot in 28.6%; the reamputation rate was the highest in DM foot patients. Bypass surgery for improved blood flow in the stump was performed in 24 cases, among these cases, reamputation was performed in 2 cases (8.3%).
CONCLUSION
Amputation in ischemic limb patients was most commonly performed in artherosclerosis patients and the most common amputation level was digit. The reamputation rate was the highest in DM foot patients; a more careful selection of the amputation level in DM foot patients may be needed.