Utilization Rates of Diagnostic and Therapeutic Vascular Procedures Among Patients Undergoing Lower Extremity Amputations in a Rural Community Hospital: A Clinicopathological Correlation

Abstract

Background: Significant geographical variations exist in amputation rates and utilization of diagnostic and therapeutic vascular procedures before lower extremity amputations in the United States. The purpose of this study was to evaluate the rates of diagnostic and therapeutic vascular procedures in the year prior to amputation in a contemporary population and correlate with pathological findings of the amputation specimens. Methods: A retrospective analysis was conducted of non-traumatic amputations from 2011 to 2017 at a rural community hospital. We reviewed the proportion of patients undergoing diagnostic (ankle brachial index with duplex ultrasound, computerized tomography angiogram and invasive angiogram) and therapeutic (endovascular and surgical revascularization) vascular procedures in the year prior to amputation. Prevalence of tissue viability and osteomyelitis were evaluated in all amputated specimens and atherosclerotic vascular disease (ASVD) was evaluated in major amputations. We also analyzed primary amputation rates among different subgroups. Results: 698 patients were included with 248 (36%) major amputations and 450 (64%) minor amputations. Any diagnostic procedure was performed in 59% of the major amputations and 49% of the minor amputations (P = 0.01). Any therapeutic revascularization procedure was performed in 34% of the major amputations and 28% of the minor amputations (P = 0.08). The pathology of major amputation specimens revealed severe ASVD in 57% and mild-moderate ASVD in 27% of specimens. Tissue viability was significantly higher in major amputations (90% vs 30%, P = 0.04) and osteomyelitis was significantly higher in minor amputations (50% vs 14%, P = 0.03). Primary amputations were performed in 66% of major amputations, 72% of minor amputations, 81% with mild to moderate ASVD and 54% with severe ASVD. Conclusion: Diagnostic and therapeutic vascular procedures appear under-utilized for patients undergoing lower extremity amputations at a rural community hospital. ASVD rates and tissue viability imply that revascularization could be of significant benefit to avoid major amputation.

Percutaneous Deep Venous Arterialization: Treatment of Patients with End-Stage Plantar Disease

“…Unfortunately, major amputation remains Q11 a first line of therapy in up to 20% of cases. 15,16 Patients who undergo major amputation experience high rates of perioperative morbidity and mortality and range from 14% to 35% with BKA and AKA, respectively. 17 Less than one third of patients with AKA are able to ambulate because of patient frailty and comorbidities.…”

Demographic Profile and Surgical Outcome of Various Types of Lower Limb Amputations'

“…9, stump infection 26, phantom limb in 22.The overall complication rate is 59%.In comparison to other studies such by Gandala et al in Mangalore India(Kumar et al, 2018), the complication rate is much lower that is 23%, and DC Oblam et al(Obalum & Okeke, 2009) in Nigeria is 33%.The higher rate of complications can be attributed to the late presentation to hospital, increased number of people were in sepsis during…”

“…The lower rate of revascularization procedures tried may be due to the advanced grade of gangrene at presentation which could not give any scope for salvage of the limb. In the present study, 11 % of the subjects with PVD had underwent revascularization procedure.In a study by Joji et al (Varghese et al, 2021) and others the , after revascularization procedure, 38%had underwent major amputations and 28% had minor amputation. According to observations done by Louise S Londero et al (Londero et al, 2019)in Danish,the strongest predictor for major amputations was ulcers/gangrene at the time of revascularization.…”