Mortality rates and walking ability transition after lower limb major amputation in hemodialysis patients

Serizawa, Fukashi; Sasaki, Shigeru; Fujishima, Shinobu; Akamatsu, Daijirou; Gotō, Hitoshi; Amada, Noritoshi

doi:10.1016/j.jvs.2016.03.452

Cited by 28 publications

(34 citation statements)

References 12 publications

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“…Investigations have shown that diabetes is a primary risk factor for mortality following lower extremity amputation 6,46 and that mortality is typically secondary to cardiovascular disease. 47 Overall, lack of ability to ambulate is also a primary risk factor for mortality 8 and those who are able to ambulate have half the mortality risk as those that are not post major amputation. 48 Every effort therefore should be taken to decrease pain, increase ambulation, and potentially improve survival.…”

Section: Treatment Recommendationsmentioning

confidence: 99%

Targeted Muscle Reinnervation: Outcomes in Treating Chronic Pain Secondary to Extremity Amputation and Phantom Limb Syndrome

McNamara

Iorio

2019

J Reconstr Microsurg

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Background Secondary to vascular disease, oncological resection, or devastating trauma, lower extremity amputations are performed globally at a yearly rate exceeding 1 million patients. Three-quarters of these patients will develop chronic pain or phantom pain, which presents a functional limitation for prosthetic use and contributes to deconditioning and increased mortality. Targeted muscle reinnervation (TMR) presents a surgical solution to this problem as either a primary or secondary intervention. Methods A review of the existing literature was conducted using a combination of the terms “phantom pain” “chronic pain,” “neuroma,” and “targeted muscle reinnervation” in Medline and PubMed. Results Five articles were found which addressed TMR for pain syndromes, four of which involved lower extremity amputation. Four of the articles were retrospective reviews, and one was a randomized control trial. A total of 149 patients were included, of which 82 underwent lower extremity amputation. Ninety-two of the patients underwent prophylactic TMR, of which 57 were secondary procedures.In patients who underwent TMR at the time of amputation, all studies reported a minimal development of symptomatic neuromas (27%). For secondary TMR, near-complete resolution of previous pain was found (90%). Phantom pain was noted to be similar to other studies in the literature but noted to improve over time with both primary (average drop of 3.5 out of 10 points on the numerical rating scale) and secondary (diminishing from 72% of patients to 13% over 6 months) operations. Conclusion Although much of the current literature is limited to retrospective studies with few patients, these data point toward near-complete resolution of neuroma pain after treatment as well as complete prevention of chronic pain if TMR is used as a prophylactic measure during the index amputation. This study was a level of evidence IV.

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Section: Treatment Recommendationsmentioning

confidence: 99%

Targeted Muscle Reinnervation: Outcomes in Treating Chronic Pain Secondary to Extremity Amputation and Phantom Limb Syndrome

McNamara

Iorio

2019

J Reconstr Microsurg

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“…14 Nonambulation has been found to be associated with poor survival 14,35 and AFS rates in HD and NHD patients. 19,35,37 Simons et al 31 reported a 1-year AFS rate of 74% after lower limb bypass, and poor ambulatory status and HD were the most relevant factors associated with it, whereas retrieval of ambulation was associated with improved survival rates. 35 Likewise, the results of this study demonstrated that ambulation after bypass and CHF significantly influenced survival rates in HD patients, and approximately half of the deaths occurring between 30 days and 5 years after LS were caused by cardiac events.…”

Section: Discussionmentioning

confidence: 99%

“…The life expectancy in HD patients was 15% at 5 years, 35 and main causes of death were CHF, CAD, and limb infection, which accounted for approximately half of the observed mortality. 35,36 Survival rates in HD patients after arterial reconstruction remained poor, amounting to 26% at 5 years. 14 Nonambulation has been found to be associated with poor survival 14,35 and AFS rates in HD and NHD patients.…”

Section: Discussionmentioning

confidence: 99%

“…35,36 Survival rates in HD patients after arterial reconstruction remained poor, amounting to 26% at 5 years. 14 Nonambulation has been found to be associated with poor survival 14,35 and AFS rates in HD and NHD patients. 19,35,37 Simons et al 31 reported a 1-year AFS rate of 74% after lower limb bypass, and poor ambulatory status and HD were the most relevant factors associated with it, whereas retrieval of ambulation was associated with improved survival rates.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of paramalleolar and inframalleolar bypasses in dialysis- and nondialysis-dependent patients with critical limb ischemia

Kikuchi

Sasajima

Inaba

et al. 2018

Journal of Vascular Surgery

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“…Based on their data, the authors of the previous study concluded that every increase of 0.1 in CV BP was associated with a 150% increase in the risk of death. The prevalence of peripheral artery disease in patients on chronic HD is substantially high [8], and mortality rates after lower leg amputation for critical limb ischemia in HD patients are reportedly as high as 17% at 30 days and 44% at 1 year, with cardiac disease being the leading cause of death [9].…”

Section: Discussionmentioning

confidence: 99%

Peripheral nerve block combined with general anesthesia for lower extremity amputation in hemodialysis patients: case series

Takemura¹,

Fujita

Matsuda

et al. 2018

JA Clin Rep

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Background: Anesthetic management of lower extremity amputation in chronic hemodialysis (HD) patients can be challenging because of their poor cardiovascular status. As previously reported, peripheral nerve block (PNB) may be beneficial in these complicated cases. We report the effects of PNB combined with general anesthesia on hemodynamic stability in HD patients undergoing elective lower extremity amputation. Methods: We retrospectively analyzed 13 HD patients who underwent lower extremity amputation. Patients received general anesthesia (GA group, n = 7) or general anesthesia combined with PNB (GA with PNB group, n = 6), as decided by the anesthesiologists. Mean blood pressure (MBP), systolic blood pressure (SBP), lowest BP, heart rate (HR), blood loss, fluid and blood infusion volumes, and doses of vasopressors required were compared for hemodynamic assessment. The coefficient of variation (CV ¼ σ= X) of MBP (CV MBP) and SBP (CV SBP) was calculated to compare hemodynamic stability. Intraoperative opioid use and postoperative pain scores at rest using a numerical rating scale (NRS) on postoperative days 0 and 1 were compared for pain assessment. We also assessed 30-day mortality. Results: CV MBP in the GA group was significantly higher than that in the GA with PNB group (0.15 ± 0.05 and 0.08 ± 0.04, respectively, p = 0.03). The CV SBP in the GA group was also significantly higher than that in the GA with PNB group (0.16 ± 0.02 and 0.09 ± 0.01, respectively, p = 0.03). No significant differences in other hemodynamic parameters were observed. Intraoperative fentanyl doses were significantly lower in the GA with PNB group (GA 210.7 ± 99.9 μg vs. GA with PNB 113.0 ± 75.6 μg, p = 0.04). There were no significant differences in other pain parameters and 30-day mortality between the groups. Conclusion: Our results suggest that PNB combined with general anesthesia contributes to intraoperative hemodynamic stability through better pain control in HD patients undergoing lower extremity amputation.

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Mortality rates and walking ability transition after lower limb major amputation in hemodialysis patients

Abstract: The mortality rate after major amputation in hemodialysis patients was high, and major amputation had a huge negative effect on patients' walking ability.

Cited by 28 publications

References 12 publications

Targeted Muscle Reinnervation: Outcomes in Treating Chronic Pain Secondary to Extremity Amputation and Phantom Limb Syndrome

Targeted Muscle Reinnervation: Outcomes in Treating Chronic Pain Secondary to Extremity Amputation and Phantom Limb Syndrome

Evaluation of paramalleolar and inframalleolar bypasses in dialysis- and nondialysis-dependent patients with critical limb ischemia

Peripheral nerve block combined with general anesthesia for lower extremity amputation in hemodialysis patients: case series

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