Scarcity of Vascular Studies and Actual Prevalence of Peripheral Arterial Disease upon Histopathology Analysis Among Amputation Population

Background
Peripheral arterial disease (PAD) is the leading cause of lower extremity amputations in the United States. A series of studies has revealed that 31-73% of patients are not receiving vascular studies prior to amputation. The purpose of this study was to evaluate the degree of vascular evaluation utilization within the year prior to amputation. We also assessed the prevalence of atherosclerotic vascular disease (ASD) in the major amputation specimens through histopathology analysis.

Methods
A retrospective analysis was conducted of all non-traumatic amputations from 2011-2017 at a community hospital. Minor amputations were considered: toes, transmetatarsal, lisfranc, and chopart. Major amputations were considered: transtibial, below-the-knee, and above-the-knee. The presence of ASD from histopathology analysis in major amputations was classified as: none, mild-moderate, and severe.

Results
Six-hundred and ninety-eight (698) patients had a total of 1,009 amputations during the seven year period. There were 248 (35.5%) index major amputations and 450 (64.5%) index minor amputations. Prior to amputation, non-invasive studies were performed in 361 (51.7%), angiograms in 198 (28.4%), endovascular revascularization in 179 (25.6%), and surgical revascularization in 41 (5.9%). ASD exhibited in histopathology analysis of major amputations was 56.5% severe, 27.4% mild-moderate and 13.3% none.

Conclusions
This study demonstrates that a majority of amputated specimens have severe PAD as proven by histopathology. Despite recent improvement in endovascular techniques, standard vascular evaluation is still vastly under utilized.