Document Detail

Major lower extremity amputation after multiple revascularizations: was it worth it?
MedLine Citation:
PMID:  18466814     Owner:  NLM     Status:  MEDLINE    
Lower extremity revascularization is often described as excessively lesion-centric, with insufficient focus on the patient. We investigated patients' perspectives of multiple procedures for limb salvage that culminated in major lower extremity amputation. 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 was utilized to verify patient survival. Amputations for infection were excluded. Seventy-eight patients underwent AKA or BKA after failed revascularization. Forty-six patients (59%) were alive at 5 years. Thirteen patients were lost to follow-up, leaving 33 available for survey. A total of 142 lower extremity revascularizations (median = 4/patient) were performed on these patients including 94 surgical bypasses (median = 3/patient) and 48 percutaneous interventions (median = 1/patient). 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. 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 a percutaneous or open technique.
Amy B Reed; Cindy Delvecchio; Joseph S Giglia
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of vascular surgery     Volume:  22     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:    2008 May-Jun
Date Detail:
Created Date:  2008-05-09     Completed Date:  2008-06-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  335-40     Citation Subset:  IM    
Division of Vascular Surgery, University of Cincinnati, Cincinnati, OH 45267, USA.
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MeSH Terms
Activities of Daily Living
Aged, 80 and over
Amputation* / psychology
Amputees* / psychology
Choice Behavior*
Health Knowledge, Attitudes, Practice
Limb Salvage* / psychology
Lower Extremity / blood supply*
Middle Aged
Patient Participation
Patient Satisfaction*
Peripheral Vascular Diseases / mortality,  physiopathology,  psychology,  surgery*
Prospective Studies
Recovery of Function
Risk Assessment
Time Factors
Treatment Failure
Vascular Surgical Procedures* / psychology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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