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Review
. 2014 Jul 16:10:417-24.
doi: 10.2147/VHRM.S50588. eCollection 2014.

Lower extremity amputation in peripheral artery disease: improving patient outcomes

Aparna Swaminathan  1 , Sreekanth Vemulapalli  2 , Manesh R Patel  2 , W Schuyler Jones  2
Affiliations
Review

Lower extremity amputation in peripheral artery disease: improving patient outcomes

Aparna Swaminathan et al. Vasc Health Risk Manag. .

Abstract

Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE) amputation (LEA), although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing) in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies.

Keywords: lower extremity amputation; mortality; peripheral artery disease.

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Figures

Figure 1
Figure 1
Conceptual framework of treatment of patients with peripheral artery disease (PAD).
Figure 2
Figure 2
Clinical outcomes after lower extremity (LE) amputation. The occurrence of death, myocardial infarction, and stroke in patients hospitalized for peripheral artery disease (PAD) with and without major LE amputation: cumulative incidence rates of all-cause mortality (top panel), myocardial infarction (middle panel), and stroke (bottom panel) after major LE amputation. Note: Reprinted from Am Heart J. Vol. 165(5). Jones WS, Patel MR, Dai D, et al. High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease. Pages 809–815. © 2013, with permission from Elsevier. Abbreviations: w/o, without; w, with.
Figure 3
Figure 3
Geographic variation of major amputation of the lower extremity. Note: The rates of major amputation of the lower extremity per hospital referral region (when normalized to the US) from inpatient Medicare data from 2000 to 2008.
See this image and copyright information in PMC

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