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The Effects of Endovascular Timing and In-line Flow on the Success of Pedal Amputations
- Source :
- The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 59(5)
- Publication Year :
- 2020
-
Abstract
- There has been a growing trend toward endovascular intervention to improve peripheral flow in patients with peripheral arterial disease. To date, there is no clear consensus regarding timing of lower-extremity amputations after revascularization. The purpose of this study was to evaluate the effects of timing between endovascular intervention and minor lower-extremity amputations and its influence on wound healing and limb loss within 1 year. A secondary purpose was to evaluate the impact of restoring in-line flow on healing rates. A total of 310 patients who underwent endovascular intervention and a minor lower-extremity amputation within 90 days were included in the study. Healing rates were defined as optimal, delayed, or failure. There was a statistically significant difference between patients with optimal healing to delayed healing and amputation ≥30 days after endovascular intervention (p = .037). We found no difference in healing rates in regard to amputation timing when examining patients who ultimately healed versus patients who failed to heal (p = .6717). Absence of in-line flow (p = .0177), male sex (p = .0090) and diabetes mellitus (p = .0076) were statistically significant factors for failing to heal. Presence of infection (p ≤ .0001) and wound dehiscence (p ≤ .001) were also associated with a failure to heal. End-stage renal disease trended toward significance for failing to heal (p = .065). Amputation-free survival at 1 year after endovascular intervention and pedal amputation was 76.8% (n = 238). Our findings suggest that in the absence of infection, performing minor lower-extremity amputations 15 to 60 days after endovascular intervention may allow for improved healing. Absence of in-line flow, male sex, diabetes mellitus, postoperative infection, and wound dehiscence are significant factors for failure.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Disease
030204 cardiovascular system & hematology
Revascularization
Amputation, Surgical
03 medical and health sciences
0302 clinical medicine
Ischemia
Risk Factors
Diabetes mellitus
medicine
Humans
Orthopedics and Sports Medicine
In patient
030212 general & internal medicine
Retrospective Studies
Line flow
Wound dehiscence
business.industry
Significant difference
Endovascular Procedures
medicine.disease
Limb Salvage
Surgery
Treatment Outcome
Amputation
business
Subjects
Details
- ISSN :
- 15422224
- Volume :
- 59
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
- Accession number :
- edsair.doi.dedup.....5ef4ab2c8d9e7221411d57dd7c3ea54f