Vascular Evaluations May have Impact on Major Amputation Rates

Background
Prior studies have demonstrated that a majority of patients undergoing lower extremity amputations do not receive adequate vascular evaluations. Failure to have prior evaluation to assess for adequate vascular flow may result in poor wound healing, surgical debridement, revisions, and recurrent amputation. We hypothesize that patients who did not receive a vascular evaluation or revascularization prior to amputation had a greater likelihood of receiving recurrent amputations.

Methods
A retrospective analysis was preformed of all non-traumatic amputations between 2011-2017 at a community hospital. Patients were divided into four groups based on the number of amputations they received. The groups consisted of; Group I. single amputation on a unilateral limb (UL), Group II. single amputation on bilateral limbs (BL), Group III. multiple amputations on a UL, and Group IV. multiple amputations on BL. Patient demographics and vascular assessment (non-invasive studies, angiograms, and revascularization) analysis was preformed on these four groups

Results
The groups were similar in terms of baseline demographics, except, Group IV had the highest prevalence of peripheral artery disease and the highest rate of prior endovascular treatment. There were significantly more major amputations in Group I and II. Groups III and IV had significantly more vascular assessments attempts. Though not statistically significant, there was a numerical trend toward Group IV patients discharged home rather than rehab or skilled nursing and all in-hospital moralities occurred within Group I.

Conclusions
Contrary to our hypothesis, this study demonstrates that vascular evaluation and revascularization rates were higher in patients who receive recurrent amputations. However, the recurrent amputation group demonstrated mostly minor amputations suggesting that multiple evaluations and revascularizations may effectively decrease the rate of major amputations and allow patients to retain their functional status with minor amputations. Further, detailed analyses are necessary to differentiate the incidence of multiple amputations despite revascularization attempts for adequacy and relation to the level of the amputation.