Mortality after major amputation in elderly patients with critical limb ischemia

Klaphake, Sanne; Leur, Kevin de; Mulder, Paul; Ho, Gwan H.; Groot, H.G. de; Veen, Eelco J.; Verhagen, Hence J.M.; Laan, Lijckle van der

doi:10.2147/cia.s137570

Cited by 80 publications

(66 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…9 Our results endorse these findings in patients with CLI. Because of high amputation rates (35%e67%) 3,8,30 in CLI, a valid QoL outcome and HS is important in vascular amputees. In our study, vascular amputees (with a one-year mortality of 35%) showed statistically significant improvement in the physical QoL domain at one-year follow-up (survey response 67%, n ¼ 20).…”

Section: Discussionmentioning

confidence: 99%

“…1 CLI, the end stage of peripheral arterial disease, is also the most common cause of major limb amputation in elderly patients. 2,3 Because major limb amputation is usually associated with poor physical function, high mortality, and assumed high revalidation costs, it is an outcome that health care providers fear. 3e6 However, in the elderly CLI patients, revascularization is not always possible and major limb amputation is often necessary, due to infection or severe pain in selected patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Quality of Life and not Health Status Improves After Major Amputation in the Elderly Critical Limb Ischaemia Patient

Peters

Vries

Lodder

et al. 2019

European Journal of Vascular and Endovascular Surgery

Self Cite

View full text Add to dashboard Cite

WHAT DOES THIS STUDY/REVIEW ADD TO THE EXISTING LITERATURE AND HOW WILL IT INFLUENCE FUTURE CLINICAL PRACTICEIn elderly patients with critical limb ischaemia (CLI), guidelines about the definition of quality of life and the instruments that measure quality of life are sparse. Often quality of life is confused with health status. This study provides evidence that there is a discrepancy between quality of life and health status in elderly CLI patients undergoing major amputation. This raises the question, which outcome measurement is the most relevant for elderly CLI patients. We advocate the use of distinctive and subjective QoL questionnaires, like the WHOQOL-BREF, in future research.Objectives: A patient-oriented appraisal of treatment has become extremely important, particularly in elderly patients with critical limb ischaemia (CLI). Quality of life (QoL) is an important patient-reported outcome in vascular surgery. Frequently, the physical domain of QoL questionnaires represents an 'objective' evaluation of performing activities, which is expected to be impaired after major limb amputation. However, an objective appraisal of physical function is an assessment of health status (HS) and not of QoL. Little is known about the subjective appraisal of physical health (QoL). The goal of this study was to evaluate, prospectively, QoL in relation to HS in elderly CLI patients undergoing major limb amputation. Methods: Patients suffering from CLI aged 70 years or older were included in a prospective observational cohort study with a follow-up period of 1 year. Patients were divided according to having had an amputation or not.The World Health Organization Quality Of Life-BREF (WHOQOL-BREF) was used to asses QoL.The 12-Item Short Form Health Survey (SF-12) was used to measure HS. These self-reported questionnaires were completed five times during follow-up. Results: Two-hundred patients were included of whom 46 underwent a major limb amputation within one year. Amputees had a statistically significant improvement of their physical QoL after six months (14.0 vs. 9.0 (95% CI -7.84;-1.45),p ¼ 0.005) and after a one-year follow-up (14.0 vs. 9.0 (95% CI -9.58;-1.46),p ¼ 0.008). They did not however show any statistically significant difference in HS. For non-amputees, both physical QoL and HS improved. An instant statistically significant improvement of the physical QoL appeared 1 week after inclusion (12.0 vs. 10.9 (95% CI -1.57;-0.63),p<0.001). Similarly, statistically significant improvement in the physical HS first occurred at 1 week follow-up (29.0 vs. 28.9 (95% CI -5.78; À2.23),p ¼ 0.003). Conclusions: There is a clear difference between patients' functioning (HS) and the patients' appraisal of functioning (QoL). In elderly CLI patients, this study clearly suggests a discrepancy between the physical QoL (WHOQOL-BREF) and HS (SF-12) measurements in vascular amputees. This raises the question, which outcome measurement is the most relevant for elderly CLI patients. Individual treatment goals should be kept in mind when as...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quality of Life and not Health Status Improves After Major Amputation in the Elderly Critical Limb Ischaemia Patient

Peters

Vries

Lodder

et al. 2019

European Journal of Vascular and Endovascular Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Therefore, despite the available treatments, it is difficult to achieve wound healing, and unhealed wounds persist in many patients. The prognosis and risk factors for death after EVT and those after major amputation of a lower limb have been investigated in advanced treatment centres. At these sites, satisfactory revascularisation using repeat EVT or bypass surgery cannot be performed in some cases with poor general conditions, and amputation of the lower limb is not always applicable, although it may be necessary in certain cases.…”

Section: Discussionmentioning

confidence: 99%

Poor survival of dialysis patients with unhealed wounds because of critical limb ischemia: Limb salvage and survival requires wound healing

Yoshikawa

Kujime

Iwasaki

et al. 2019

International Wound Journal

View full text Add to dashboard Cite

Maintenance of blood flow in the wound area is required to heal wounds of critical limb ischemia (CLI) in dialysis patients. However, many dialysis patients have both a stenotic lesion in below‐knee blood vessels and a cardiovascular event as complications, and thus, it may be difficult to ensure sufficient blood flow. Therefore, many deaths occur because of problems with wound healing. The aim of this study is to identify the optimal treatment, including revascularisation and amputation, from the perspective of wound healing by analysing the survival of hemodialysis patients with CLI who had healed or unhealed wounds in a lower extremity. The subjects were 52 patients who received maintenance dialysis at our clinic, including 27 with healed CLI wounds and 25 with unhealed CLI wounds. The Kaplan‐Meier method was used to compare survival between the two groups. Multivariate analysis was conducted to examine the effect of an unhealed wound on mortality. The mean follow‐up period was 1.7 ± 1.1 years. In the unhealed wound group, the 1‐, 2‐, and 3‐year survival rates were 48%, 20%, and 12%, respectively. The overall survival rate was significantly lower in the unhealed wound group compared with the healed wound group (12% vs 63%, P = .0002 by log‐rank test). In multivariate analysis, unhealed CLI wounds had a significant independent association with mortality (hazard ratio 3.32; 95% confidence interval [CI]: 1.41‐8.77, P = .0054). In this study, the 3‐year survival rate suggested a significantly poorer prognosis of hemodialysis patients with unhealed CLI wounds compared with those with healed wounds. An unhealed wound is an independent risk factor for mortality in hemodialysis patients with CLI.

show abstract

“…53 Studies comparing primary amputation versus amputation following revascularization among the elderly are mixed, with some finding higher rates of mortality following failed bypass. 54,55 The decision regarding revascularization versus amputation is a difficult and personal choice. This should involve a thoughtful discussion with the patient regarding appropriate expectations and outcomes.…”

Section: Patient Selection For Major Amputation In Cltimentioning

confidence: 99%

“…Long-term outcomes following major amputation remain poor, with relatively high rates of perioperative and longterm mortality. 54,68 Mustapha et al demonstrated that patients with CLTI treated with primary amputation had significantly lower rates of survival and a higher risk of subsequent amputation over 4 years compared with revascularization. 69 Even after propensity matching, those who underwent primary major amputation had a mean survival of 1.3 years compared with 2.7 and 2.9 years with endovascular and open revascularization, respectively.…”

Section: The Impact and Outcomes Of Major Amputationmentioning

confidence: 99%

The Role of Lower Extremity Amputation in Chronic Limb-Threatening Ischemia

2020

View full text Add to dashboard Cite

Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease associated with high rates of limb loss. The primary goal of treatment in CLTI is limb salvage via revascularization. Multidisciplinary teams provide improved care for those with CLTI and lead to improved limb salvage rates. Not all patients are candidates for revascularization, and a subset will require major amputation. This article highlights the role of amputations in the management of CLTI, and describes the patients who should be offered primary amputation.

show abstract

Mortality after major amputation in elderly patients with critical limb ischemia

Cited by 80 publications

References 15 publications

Quality of Life and not Health Status Improves After Major Amputation in the Elderly Critical Limb Ischaemia Patient

Quality of Life and not Health Status Improves After Major Amputation in the Elderly Critical Limb Ischaemia Patient

Poor survival of dialysis patients with unhealed wounds because of critical limb ischemia: Limb salvage and survival requires wound healing

The Role of Lower Extremity Amputation in Chronic Limb-Threatening Ischemia

Contact Info

Product

Resources

About