Patients should be counseled that <50% of patients receiving MLEAs are ambulatory after amputation. Educating patients about the deleterious effects of obesity on ambulatory status after MLEA may motivate patients to improve their level of fitness to achieve successful ambulation. Patients with an elevated mFI, patients with dementia, and those on dialysis should be considered for AKAs.

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Without controlling for the effects of other treatments, selecting a random drug to determine a particular effect in a relatively small subpopulation of patients has statistical challenges (type 2 errors) that are hard to ignore. The findings of this surveillance study can only suggest a potential association between metformin and AAA growth inhibition, which would require a randomized, controlled trial to answer definitively. Many other drugs toting similar effects have failed under intense investigation.

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