Major Lower Extremity Amputation After Multiple Revascularizations: Was It Worth It?

Introduction and Objectives:
Lower extremity revascularization is often described as excessively lesion-centric with insufficient focus on the patient. We investigated patients’ perspective of multiple procedures for limb salvage that culminated in major lower extremity amputation.
Methods:
A prospective vascular surgery database was queried from January 2000 to December 2005 for patients who had undergone below knee (BKA) or above knee (AKA) amputation after failed lower extremity revascularization. Patients were surveyed via telephone by a vascular nurse regarding thoughts on undergoing multiple procedures for limb salvage, involvement in decision-making, functional status (work, meal preparation, shopping, driving), use of prosthesis and independence. The Social Security Death Index (SSDI) was utilized to verify patient survival. Amputations for infection were excluded.
Results:
Seventy-eight patients underwent AKA or BKA after failed revascularization from January 2000 to December 2005. A total of 142 lower extremity revascularizations (median= 4/patient) were performed on these patients including 94 surgical bypass (median=3/patient) and 48 percutaneous interventions (median=1/patient).Forty-six patients (59%) were alive at 5 years. Thirteen patients were lost to follow-up, leaving 33 available for survey. Eighty-five percent (28 of 33 patients) of amputees surveyed would do everything to save the leg if faced with a similar scenario, regardless of the number of procedures. Fifty-four percent (18/33) of patients actively used a prosthesis and 91% (30/33) resided at home.
Conclusions:
In retrospect, patients are willing to undergo multiple revascularizations - percutaneous or open -to attempt limb salvage even if the eventual result is major amputation. Independence and functional status appear to be obtainable in a majority of patients. Patient-oriented outcomes are necessary to guide revascularization, whether it is by percutaneous or open technique.