The Impact Of Endovascular And Open Revascularization On Level Of Amputation And Subsequent Rates Of Primary Healing Of Above And Below Knee Amputations
Jonathan Murdock, DO, Graham Long, MD, Diane Studzinski, BS, Matthew Major, MD, Samuel Osei, MD, Rocelious Goodson, III, PA-C, O. William Brown, MD, JD.
William Beaumont Hospital, Royal Oak, MI, USA.
Objective:The purpose of this study is to examine the impact of open and endovascular attempts at limb revascularization for critical limb ischemia or diabetic foot infection, on the level of amputation and subsequent primary healing.
Methods:This is a retrospective study of all patients undergoing major amputation at a single institution for critical limb ischemia or diabetic foot infection, between January 2008 and July 2019. Data collected included demographics, comorbidities, laboratory data, outcomes, complications, and mortality.
Results:Major lower extremity amputation was performed in 338 patients on a total of 348 limbs, 266 below the knee (BKA) and 82 above the knee (AKA). The median age was 65 years, 73% had diabetes and 53% had renal disease, with 57% of those on dialysis. All patients (189) who were candidates for reconstruction underwent angiography; 74% (140) underwent attempts at revascularization. Of those with a subsequent AKA, 35 (53%) underwent prior revascularization: 22 (62.8%) open and 13 (37.2%) endovascular. Of those with a subsequent BKA, 105 (48.6%) underwent prior revascularization: 43 (41%) open and 62 (59%) endovascular. Of all BKAs, 24 required conversion to AKA; 14 had prior revascularization, 6 endovascular and 8 open (p=0.245). In those with no prior revascularization 7 converted to AKA (p=0.1076). In patients with prior revascularization, 128 (91%) healed over all time; those without prior revascularization, 182 (92%) healed over all time (p>0.9999). In patients with prior revascularization, 52 (37%) healed at 30 days, compared with 98 (50%); without prior revascularization (p =0.027).
Conclusion:There was no statistical difference in the rates of conversion from BKA to AKA in those patients who underwent prior open or endovascular revascularization. Healing over all was not significantly different between patients with and without prior revascularization. Prior attempt at revascularization did not appear to affect the level of amputation. However, patients who underwent prior revascularization were less likely to heal at 30 days.
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