Vascular surgery reduces the frequency of lower limb major amputations

Lindholt, Jes Sanddal; Bøvling, Søren; Fasting, H; Henneberg, E W

doi:10.1016/s0950-821x(05)80116-1

Cited by 46 publications

(22 citation statements)

References 6 publications

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“…Although the studies document variable rates of LER since the mid-1990s, most confirm our finding of a generalized decline in major amputation rates during the past decade. 3,5,[8][9][10] Recently, Rowe et al 10 published similar findings to our own. They examined trends from 1996 to 2005 and reported an increase in endovascular procedures and a decrease in the rates of major amputations for patients admitted with acute PAD.…”

Section: Discussionsupporting

confidence: 89%

“…Previous reports analyzing data primarily for the 1990s suggested that endovascular therapies could reduce morbidity, mortality, lengths of stay (LOS), and limb loss. [3][4][5] In this study, we examine the more recent effect of this practice evolution, using large national and corroborative regional data sets on limb salvage, mortality, complications, and resource utilizations. Has the safety of vascular procedures improved?…”

mentioning

confidence: 99%

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An analysis of the outcomes of a decade of experience with lower extremity revascularization including limb salvage, lengths of stay, and safety

Egorova

Guillerme

Gelijns

et al. 2010

Journal of Vascular Surgery

143

115

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Although patients today, whether treated for claudication or CLI, have more comorbidities, the rates of amputation, the procedural morbidity and mortality, and LOS have all significantly decreased. Other variables, including changes in medical management and wound care, undoubtedly are important, but this change appears to be largely due to the widespread and successful use of endovascular LER or to earlier intervention, or both, driven by the safety of these techniques.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

An analysis of the outcomes of a decade of experience with lower extremity revascularization including limb salvage, lengths of stay, and safety

Egorova

Guillerme

Gelijns

et al. 2010

Journal of Vascular Surgery

143

115

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“…During recent decades the treatment of chronic critical limb ischaemia became more active. The rate of vascular September 2007;31(3): 277 -286 reconstructions has increased (Lindholt et al 1994;Ebskov et al 1994;Luther 1994) and the proportion of patients who had undergone a vascular surgical procedure before amputation increased (Luther 1994). Patients with amputations are usually elderly with several comorbidities and survival after amputation is thus often short (Lepäntalo and Mätzke 1996;Feinglass et al 2000).…”

Section: Introductionmentioning

confidence: 99%

Lower limb amputations

Heikkinen

Saarinen

Suominen

et al. 2007

Prosthetics &Amp; Orthotics International

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The purpose of the study was to evaluate possible differences between genders in amputation incidence, revascularization activity before and survival after amputation. This population-based study was carried out in a well-defined geographical area, where all vascular surgical consultations and reconstructions are performed in one university hospital. All amputations performed in the region during 1990 -1999 were identified from the hospital central registers. According to patient's identity codes, the Cause of Death Registry of Statistics Finland provided death data. Amputation data were cross-linked with the local vascular registry using identity codes. Women were found to be 8 years older than men (p 5 0.0001). Major amputations comprised 73.4% in males and 77.7% in females. The age-standardized amputation incidence among males was 338 and among females 226 (per 10 6 inhabitants/year) (p 5 0.001). The most prominent difference was seen in amputations due to trauma, where the age-adjusted major amputation incidence was over three-fold among males compared to females. The proportion of patients who had undergone vascular procedure before amputation was 23% in both genders. Median survival after amputation was 943 days in men and 716 in women (p ¼ 0.01). When the higher age of women was considered, there was no significant difference between the genders. Survival was poorer among diabetics in both genders and the difference was significant in males. The amputation incidence was found to be higher in men compared to women in all etiologic subgroups except malignant tumour. Almost one in 4 patients had undergone vascular surgical reconstruction before amputation in both genders. There was no significant difference between the genders in survival after amputation. Subjects with diabetes had a poorer survival after major amputation than those without diabetes.

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“…Immediate application of well-vascularized tissue allows us to spare even marginally vascularized tissues. For this purpose it seems essential to revascularize even small and isolated distal segments of the native artery [6,20,42]. Until now we have not observed one single case of ongoing necrosis postoperatively, which we attribute to our aggressive revascularization attempts [40].…”

Section: Casementioning

confidence: 87%

Single-stage revascularization and free flap coverage in the treatment of ischemic lower limb lesions

et al. 1996

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Old age, diabetes and atherosclerotic disease all have been considered to be relative contraindications for microsurgery. As such, gangrenous lesions of the lower limb traditionally resulted in staged amputations. A more aggressive approach, combining revascularization and free tissue transfer, allowed us to limit the level of amputation and to start early ambulation and rehabilitation, without the need for major orthotic help. Performing the vascular procedure, debridement, and free tissue transfer in one single intervention greatly reduces the number of operative procedures without substantial increase in operative time. Twenty consecutive patients underwent a combined free flap and revascularization procedure, two patients died perioperatively. One free flap was lost and needed replacement. All surviving patients were ambulating postoperatively.

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Vascular surgery reduces the frequency of lower limb major amputations

Cited by 46 publications

References 6 publications

An analysis of the outcomes of a decade of experience with lower extremity revascularization including limb salvage, lengths of stay, and safety

An analysis of the outcomes of a decade of experience with lower extremity revascularization including limb salvage, lengths of stay, and safety

Lower limb amputations

Single-stage revascularization and free flap coverage in the treatment of ischemic lower limb lesions

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