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Home > Vascular Annual Meeting > PP46. The Impact of Limb Amputation During Follow-Up...

PP46. The Impact of Limb Amputation During Follow-Up on Long-Term Survival in Patients Undergoing Peripheral Arterial Revascularization

Gijs M.J. Welten1, Olaf Schouten1, Tamara A. Winkel1, Hence J.M. Verhagen1, Ron T. van Domburg1, Jeroen J. Bax2, Don Poldermans1
1Erasmus Medical Center, Rotterdam, Netherlands; 2Leiden University Medical Center, Leiden, Netherlands

OBJECTIVES: The prognosis of patients with peripheral arterial disease is related to the presence and extent of underlying cardiovascular disease. Limb amputation after failed bypass surgery is a feared complication and might affect prognosis negatively. We aimed to identify and assess the prognosis of patients requiring an amputation after previous arterial revascularization.

METHODS: For 834 patients who underwent peripheral arterial revascularization for limb ischemia, cardiovascular risk factors, medication use and postoperative complications were noted. During a median follow-up of 6.8 years limb and survival status were noted. Major amputation was defined as amputations above the ankle. Survival status was assessed by contacting the civil service registry. The primary end-point was all-cause mortality.

RESULTS: A total of 834 patients were analyzed of which 194 (23%) underwent a reoperation. During follow-up major amputations were necessary in 161 (19%) patients. Patients who required amputation were more likely to be smokers, had more cardiac risk factors and had more perioperative complications during the index procedure. Statin use was associated with a 35% relative risk reduction for major amputation. In univariate analysis patients who required an amputation had a 1.6 fold increased risk for mortality (figure). After adjusting for underlying cardiac risk factors and medication use, amputation was still associated with a 1.3-fold increased risk for mortality (95% CI 1.0-1.6, p=0.02).

CONCLUSIONS: Patients who require a limb amputation during follow-up after peripheral arterial revascularization have a worse prognosis compared to patients who remain amputation-free.

AUTHOR DISCLOSURES: G.M.J. Welten, None; O. Schouten, None; T.A. Winkel, None; H.J.M. Verhagen, None; R.T. van Domburg, None; J.J. Bax, None; D. Poldermans, None.

Figure 1.