DETERMINATION OF THE LEVEL OF AMPUTATION IN PATIENTS WITH PERIPHERAL VASCULAR DISEASE

Abstract

Introduction: There is currently absolute increase in number of amputation being performed for peripheral vascular disease. The reasons are aging of population, high incidence of diabetes, physical inactivity, air, water and food contamination and smoking. Surgeon is required to perform amputation at lowest possible level and to ensure primary wound healing because dehiscence very often lead to reamputation on more proximal level. Beside clinical judgment as a method for determination of level of amputation, there are bunch of different methods that are currently used as objective predictors of primary amputation stump healing. We use different angiographies (DSA, CTA, and MRA). Objective of this study is to determine wheatear aforementioned angiographies are superior to clinical judgment in determination of level of amputation. Patients and methods: There were 135 patients in the study from our clinic, amputated below knee in period May 2004 – June 2007. They were separated in two groups; group of patients where clinical judgment was used in determination of the level of amputation; and group where different methods of angiography were used for determination of the level of amputation. Since we originally assumed that diabetic patients would fare a lot worse, we decided to monitor diabetics separately, also divided to groups with «clinical judgment» and angiography. All patients in the groups were matched according to age, gender and comorbidities. Results: We measured following parameters: Operative mortality, secondary wound healing, and reamputations. As shown from the study, operative mortality was the greatest in group - diabetics «clinical judgment» - 10%, and overall operative mortality was greater in groups with clinical judgment – 3.7-10%: 2-26%. Failure of primary wound healing was also more frequent in groups with clinical judgment – 30-33%: 12-13%, as well as incidence of reamputation – 18-20%: 4-5%. Discussion: Statistically significant difference in measured parameters between groups clearly indicates that angiography is reliable method for determination of the level of amputation and that it is superior to clinical judgment. Also, based on results of world studies, that were estimating reliability of other methods of determination of amputation level, we could conclude that angiography is the most reliable.