Factors affecting contralateral extremity following lower-extremity major amputation

Abstract

Objective: Lower-extremity amputation is performed in patients who are at risk due to acute limb ischemia (ALI), chronic limb-threatening ischemia (CLTI), and diabetic foot infections, yet the proportion of patients who progress to amputation of their contralateral extremity following major amputation is not well defined. This study determines the rate of subsequent minor or major amputation of a contralateral extremity. Methods: We conducted a retrospective review of patients undergoing lower-extremity major amputation at JIVAS from 2011 to 2015. Outcomes included the proportion of patients who underwent minor or major amputation of contralateral extremity for a follow-up of 3 years. Results: From 2011 to 2015 period, 113 patients underwent major lower-extremity amputation. The mean age of patients was 59.5 years. Seventy-five percent were male, 88% were diabetic, 69% were hypertensive, 19% had renal insufficiency, 35% had coronary artery disease, 15% were smokers, 31% presented with diabetic foot infections, 20% presented with ALI (four patients underwent contralateral major amputation within the same admission), and 48% presented with CLTI who underwent an initial major amputation. After ipsilateral major amputation, 54% had normal contralateral extremity (four patients had ALI and six patients had CLTI and underwent revascularization), 14% underwent contralateral minor amputation (toe/transmetatarsal), 4% underwent contralateral major amputation (below/above the knee), 6% lost to follow-up, and 19% were dead at follow-up for 3 years. In this study, there is no significant difference between factors (gender and comorbidities) affecting contralateral limb amputation in patients who underwent major amputation. Conclusions: Preexisting comorbidities and gender might not affect contralateral limb amputations in patients with major amputation. Good control of comorbidities in the follow-up and diligent foot care probably play a role in predicting contralateral limb amputations. Vascular surgeons should be alert, and close surveillance and counseling of patients should be followed to prevent subsequent amputation in their contralateral lower extremity.

Keywords

• acute limb ischemia
• chronic limb-threatening ischemia
• diabetic foot infections
• lower-extremity amputation