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Retrograde Transamputation Revascularization As An Adjunctive Therapy To Promote Amputation Healing
Roberto S. Loanzon, MD1, Christina L. Cui, MD MAS
1, Hana Shafique, BS BA
1, Kevin W. Southerland, MD
1, Chandler Long, MD
1, Leila Mureebe, MD MPH
1, Mitchell W. Cox, MD
2, Zachary F. Williams, MD
1.
1Duke University Health System, Durham, NC, USA,
2The University of Texas Medical Branch, Galveston, TX, USA.
OBJECTIVES: Failure to heal a below-knee amputation (BKA) can lead to significant patient morbidity and may consequently require additional surgical debridement or conversion to an above-knee amputation. We describe a novel hybrid technique of retrograde transamputation revascularization (RTAR) and its utility as an adjunctive therapy to optimize wound healing in patients with peripheral arterial disease (PAD) undergoing BKA.
METHODS: A single-center retrospective study of patients with PAD who underwent a BKA with a simultaneous RTAR procedure, utilizing transtibial access in the open amputation stump (
Figure 1), between January 2017 and June 2023 was performed. Data collected included patient demographics, medical comorbidities, surgical indication, and postoperative outcomes. Primary outcomes were technical success and wound healing. Secondary outcomes included 30-day complications, length of stay, reintervention rate, and amputation conversion rate.
RESULTS: Eight patients underwent BKA with simultaneous RTAR. Most of the procedures were performed in men (n=6, 75%). The mean age was 63 (standard deviation (SD) 9 years). Four patients (50%) urgently required a below-knee amputation for diabetic foot infection while the other four patients underwent amputation for unsalvageable tissue loss (50%). Technical success was 87.5%. Vascular access was not able to be performed in one patient due to chronically occluded tibial vessels. Among the remaining seven patients who underwent retrograde transamputation lower extremity angiography, four patients (50%) underwent balloon angioplasty, two patients (25%) underwent balloon angioplasty with stenting, and one patient (12.5%) was deemed to have adequate flow, not requiring any intervention. All patients (100%) achieved complete wound healing. Within 30 days, one patient (12.5%) had a surgical site infection. Average length of stay was 14 days. There were no reinterventions or amputation conversions within the follow-up period, which ranged from 1-53 months.
CONCLUSIONS: Retrograde transamputation revascularization appears to facilitate wound healing of patients undergoing below-knee amputation. Our case series demonstrates the feasibility and safety of performing below-knee amputation with simultaneous RTAR to optimize amputation healing in patients with PAD. Further investigation is warranted to delineate which patients would most benefit from this technique and whether BKA healing rates are improved.
Figure 1. Transtibial access in the open below-knee amputation stump.
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