Mortality after major amputation in elderly patients with critical limb ischemia

Sanne Klaphake, Kevin de Leur, Paul Gh Mulder, Gwan H Ho, Hans G de Groot, Eelco J Veen, Hence Jm Verhagen, Lijckle van der Laan, Sanne Klaphake, Kevin de Leur, Paul Gh Mulder, Gwan H Ho, Hans G de Groot, Eelco J Veen, Hence Jm Verhagen, Lijckle van der Laan

Abstract

Background: Owing to the aging population, the number of elderly patients with critical limb ischemia (CLI) has increased. The consequence of amputation is immense. However, at the moment, information about the mortality after amputation in the elderly vascular patients is unknown. For this reason, this study evaluated mortality rates and patient-related factors associated with mortality after a major amputation in elderly patients with CLI.

Methods: From 2006 to 2013, we included patients aged >70 years who were treated for chronic CLI by primary or secondary major amputation within or after 3 months of initial therapy (revascularization or conservative management). Outcome measurements were mortality after major amputation and factors associated with mortality (age, comorbidity and timing of amputation).

Results: In total, 168/651 patients (178 legs; 26%) underwent a major amputation. Patients were stratified by age: 70-80 years (n=86) and >80 years (n=82). Overall mortality after major amputation was 44%, 66% and 85% after 1, 3 and 5 years, respectively. The 6-month and 1-year mortality in patients aged 80 years or older was, respectively, 59% or 63% after a secondary amputation <3 months versus 34% and 44% after a secondary amputation >3 months. Per year of age, the mortality rate increased by 4% (P=0.005). No significant difference in mortality after major amputation was found in the presence of comorbidity or according to Rutherford classification.

Conclusion: Despite developments in the treatment of CLI by revascularization, amputation rates remain high and are associated with tremendous mortality rates. Secondary amputation after a failed attempt of revascularization causes a higher mortality. Further research concerning timing of amputation and patient-related outcome is needed to evaluate if selected patients might benefit from primary amputation.

Keywords: aged; limb ischemia; octogenarians; patient selection; peripheral arterial disease; primary amputation.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Patient selection. Notes: Numbers presented are the number of treated legs. *Primary amputation: no attempt of revascularization. **Secondary amputation: amputation after revascularization/conservative management/minor amputation. ***Conservative management includes analgesia, antibiotics, wound care and minor amputation.
Figure 2
Figure 2
Kaplan–Meier curve. Note: Mortality after primary treatment in patients who underwent a major amputation (primary and secondary; n=168) versus patients treated without amputation (n=505).
Figure 3
Figure 3
Kaplan–Meier curve. Note: Mortality after primary amputation and secondary amputation (n=168).

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