Abstract
The effect of failed vascular bypass surgery on final amputation level and stump complications is the subject of debate. The aim of this prospective cohort study was to assess the influence of previous infrainguinal bypass surgery on amputees in the authors’ centre.
Over a three-year period, 234 amputations (219 patients) were performed for critical ischemia. The cause of ischemia was either peripheral obstructive arterial disease (POAD) or diabetes mellitus (DM). Forty-eight percent (48%) (113 amputations) had ipsilateral vascular bypass surgery prior to amputation and 52% (121 amputations) had not. Final amputation level and the post-operative complications of infection, significant stump pain and delayed wound healing were used as the outcome measures for this study. At the end of the study period these outcome measures were used to compare the influence of previous bypass surgery on the two groups of amputees.
There was a significantly higher rate of trans-femoral amputations (TFA) (32.7% vs. 16.5%; p<0.05) and stump infection rate (42% vs. 23%; p<0.05) in the bypass group. Significant stump pain (p=0.23) and delayed wound healing (p=0.24) was more prevalent in the bypass group although statistical significance could not be demonstrated.
Bypass surgery prejudices the amputation level and stump infection rate. Further studies are required to identify the group of patients who would benefit from primary amputation for critical ischemia.