Back to Karmody Posters

Objectives:
Peripheral arterial disease (PAD) affects more than 5 million American adults. Critical limb ischemia (CLI) is a major consequence of PAD and affects 250,000 Americans per year. For CLI patients who do not undergo revascularization, the risk of amputation within 1 year is 73% for Rutherford class IV and 95% for patients in class V or VI.
Allie reported that less than half (49%) of amputation patients had any diagnostic vascular evaluation prior to a major lower extremity amputation. They suggested that every patient with CLI should have a vascular imaging study to evaluate for revascularization to avoid amputation.
We evaluated all patients who underwent a major amputation and looked at whether or not these patients had a diagnostic vascular examination or testing prior to their amputation. We propose that all patients have a vascular evaluation exam prior to major LE amputation and some only need a physical exam.
Methods:
A retrospective analysis of major LE amputations was performed. Patient demographics, comorbidities, type of amputation, reason for amputation, Rutherford classification, type of preoperative vascular examination, and time since the last vascular examination were evaluated.
Results:
During 2010 to 2013, 281 patients (64.1% male) required major LE amputation. The average age was 65 years (range, 25-96 years). AKA was performed in 39.1% of patients whereas BKA was performed in 60.9%. Amputation was performed due to CLI in 92.9% of patients whereas 7.1% of amputations were performed due to diabetes (ulcer, wet gangrene/sepsis) or other reasons. Preop vascular evaluation was performed in 100% of patients undergoing major amputation. Pulse and wound physical examination was most common(99.3%) followed by PVR/ABI (78.8%), Angio (54.8%), and CTA (29.3%), duplex ultrasonography (41.3%), and MRA (0.4%). Amputations most commonly occurred due to Rutherford classification VI (63.3%) with 97.2% of patients having Rutherford IV-VI classification. Patients with nonsalveagable limbs and non ambulatory patients did not have additional imaging.
Conclusions:
We demonstrate that 100% of patients undergo preop vascular evaluation prior to major LE amputation at a tertiary referral hospital. Up to 50% of patients already have non salvageable limbs or are not revascularization candidates and do not need further diagnostic imaging. Recommending imaging in all individuals with CLI prior to major amputation is a waste of health care resources and money.