Below-the-Knee Amputation for Arteriosclerosis Obliterans

Cranley, John J.; Krause, Raymond J.; Strasser, Edward S.; Hafner, Charles D.

doi:10.1001/archsurg.1969.01340070095018

Cited by 22 publications

(5 citation statements)

References 9 publications

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“…Palpable pulsations in the popliteal artery are the most valuable clinical sign. They indicate that a BK amputation will heal in about 90 per cent of the cases (Lempke et al 1963, Lim et al 1969, Cranley et al 1969. However, there is substantial evidence of successful BK amputation also in the absence of popliteal pulsations (Warren & Kihn 1968, and not even the lack of pulsations in the femoral artery rule out healing at BK level, accomplished in this situation in about one-third of the cases (Lempke et al 1963, Holstein, Sager & Lassen IV, Holstein VIII).…”

Section: Discussion On Level Selection By Clinical Examinationmentioning

confidence: 98%

“…Diabetes mellitus. Diabetic patients are often better candidates for BK amputations than non-diabetic patients (Cranley et al 1969, Condon & Jordan 1970, Persson & Sunden 1971, Termansen 1977, Holstein, Sager & Lassen IV, Holstein VIII, Ebskov 1983, and early advocates of BK amputation were dealing primarily with diabetic patients (Maes 1930, Silbert & Haimovici 1950, 1954, Smith 1956, Hoar & Torres 1962. This may be due to the fact that diabetics are younger when they come to amputation than non-diabetics (Lempke et al 1963, but a better circulation on the calf must also be taken into account.…”

Section: Discussion On Infection and Diabetes Mellitusmentioning

confidence: 99%

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Skin perfusion pressure measured by radioisotope washout for predicting wound healing in lower limb amputation for arterial occlusive disease

Holstein

1985

Acta Orthopaedica Scandinavica

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T. (1977). Skin perfusion pressure measured as the external pressure required to stop isotope washout. Methodological considerations and normal values on the legs. Scand. J. clin. Lab. Invest. 37,649-659. 11. Bolund, S. & Holstein, P. (1976). Blood flow cessation at external pressure in rat skin flaps. Isotope washout compared to vital capillary microscopy. Microvasc. Res. 11, 381-390. 111. Holstein, P., Nielsen, P. E. & Barras, J.-P. (1979). Blood flow cessation at external pressure in the skin of normal human limbs. Photoelectric recordings compared to isotope washout and to local intra-arterial blood pressure. Microvasc. Res. 17, 71-79.

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Section: Discussion On Level Selection By Clinical Examinationmentioning

confidence: 98%

Section: Discussion On Infection and Diabetes Mellitusmentioning

confidence: 99%

Skin perfusion pressure measured by radioisotope washout for predicting wound healing in lower limb amputation for arterial occlusive disease

Holstein

1985

Acta Orthopaedica Scandinavica

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“…In total, eleven studies with 23,597 patients with DM and 19,453 patients without DM reported STM after amputation [9, 12, 15, 16, 23, 24, 29, 30, 32–34]. Sjödin et al reported 1 week mortality, Cranley et al reported 14 days mortality, and the other studies reported 30 days mortality.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 6308 articles were identified through the online database search and manual retrieval. Based on the inclusion and exclusion criteria, 23 cohort studies [9, 10, 12, 15–34] with 58,219 patients were included in this study. Among the patients, 31,750 (54.5%) had DM, and 26,469 (45.5%) were non‐diabetic mellitus (NDM) patients.…”

Section: Resultsmentioning

confidence: 99%

The Influence of Diabetes Mellitus on Mortality of Patients After Lower Extremity Amputation: A Systematic Review and Meta‐analysis

et al. 2023

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Objective The influence of diabetes mellitus (DM) on mortality following lower extremity amputation (LEA) remains controversial. This systematic review and meta-analysis aimed to determine the influence of DM on longterm mortality (LTM) and short-term mortality (STM) after amputation. Materials and methods The Medline, the Cochrane library, and Embase databases were searched. The primary and secondary outcomes were LTM and STM following amputation. One-year and 30-day all-cause mortality after amputation were considered as LTM and STM, respectively. A random-effects model was utilized to pool results. To evaluate the stability of results, subgroup analyses and sensitivity analyses were conducted. Results Twenty-three cohort studies with a total of 58,219 patients were included, among which 31,750 (54.5%) patients had DM. The mean score of included studies evaluated by Newcastle-Ottawa Scale was 7.65, indicating moderate to high quality. The pooled results showed no significant difference in 1-year LTM (risk ratio [RR], 0.96; 95% CI 0.86-1.07) after amputation. However, 3-year (RR, 1.22; 95% CI 1.01-1.47) and 5-year (RR, 1.18; 95% CI 1.07-1.31) LTMs of DM patients were obviously higher than that of NDM (non-diabetes mellitus) patients. The STM of the DM group was significantly lower than the NDM group (RR, 0.80; 95% CI 0.64-0.98). Conclusions The current study revealed that DM patients had an obvious lower STM following LEA, but the risk of DM on LTM after amputation was gradually increased with time. More attention should be paid to the long-term survival of DM patients after LEA.

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“…To date this anomaly has not been adequately explained. Although data on vascular morphology obtained from leg amputation specimen have been published [ 24 , 25 ] to our knowledge data on mechanical properties of the individual layers of arterial walls in patients with MS are not available. Using mathematical modeling and computer simulation we were able to show that this clinically relevant inconsistency can be explained by media sclerosis interfering with arterial remodeling.…”

Section: Discussionmentioning

confidence: 99%

Media sclerosis drives and localizes atherosclerosis in peripheral arteries

Fok

Lanzer

2018

PLoS ONE

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Media sclerosis (MS) and peripheral artery disease (PAD) may coincide, particularly in type 2 diabetics (T2D) and in patients with chronic kidney disease (CKD). In contrast to non-diabetics, in T2D PAD is more severe and more distal. Although MS is suspected to play a role, the underlying pathophysiological reasons for the differences still remain elusive today. We tested the hypothesis that MS is a promoter of atherosclerosis as it occurs in T2D with PAD by interfering with arterial remodeling using an in-silico simulation. We confirmed that MS aggravates PAD by promoting negative remodeling. We found that the effect is more pronounced in smaller distal arteries compared to larger proximal ones. Our results suggest that the degree of this divergence depends on the ratio between the thickness of the intima relative to the thickness of the media/adventitia of the individually affected arteries.

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Below-the-Knee Amputation for Arteriosclerosis Obliterans

Cited by 22 publications

References 9 publications

Skin perfusion pressure measured by radioisotope washout for predicting wound healing in lower limb amputation for arterial occlusive disease

Skin perfusion pressure measured by radioisotope washout for predicting wound healing in lower limb amputation for arterial occlusive disease

The Influence of Diabetes Mellitus on Mortality of Patients After Lower Extremity Amputation: A Systematic Review and Meta‐analysis

Media sclerosis drives and localizes atherosclerosis in peripheral arteries

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