AIM: We aimed to determine whether revascularisation modality affected risk of an above knee amputation (AKA) in patients with peripheral arterial disease.
METHOD: We used English hospital data and began by determining the number of major amputations and revascularisation procedures performed between 1st April 2003- 31st March 2009. We then extracted demographic (age, sex, level of deprivation, treatment location), comorbidity (diabetes, hypertension, hypercholesterolaemia, coronary heart disease, ischaemic cerebrovascular disease and smoking) and revascularisation modality (endovascular/surgical) data. Multi-variate analysis determined the odds ratios of an AKA in relation to previous revascularisation attempts (if any).
RESULTS: Over the six year period, there were 25 312 major amputations of which 7544 (29.4%) were linked to a revascularisation attempt. Level of amputation was significantly influenced by previous revascularisation. Compared to patients not linked to revascularisation, those requiring endovascular treatment were less likely to undergo an AKA (OR .82; 95% CI .75-.90). Surgical (OR 1.16; 1.07-1.25) and combined endovascular/surgical treatment (OR 1.24;1.09-1.40) had the opposite effect. Men (.64; .55-.74) and diabetics (.44; .550.74) were less likely to undergo an AKA whereas patients with coronary (1.28; 1.10-1.47) or cerebrovascular (1.90; 1.33-2.71) disease were more likely to have the procedure. Age, deprivation, hypertension, hypercholesterolaemia, smoking and geographical location did not influence the level of amputation.
CONCLUSION: When a major leg amputation is necessary, the risk of this being carried out above the knee may be lowest after endovascular revascularisation attempts and highest after combined endovascular and surgical treatment.
|Publication status||E-pub ahead of print - 29 Jul 2015|