LIMB LOSS IN ASSOCIATION WITH VASCULAR-SURGERY - A 5-YEAR SERIES OF MAJOR LOWER-LIMB AMPUTATION

Objective: To evaluate the type, timing and number of vascular reconstructions that preceded amputation; to compare the characteristics of amputees who had had reconstructions with those of amputees who had not, and to compare the results of amputation. Design: Retrospective study of case notes. Setting: University hospital, Sweden. Subjects: All 219 patients who underwent amputation between 1987 and 1992. Main outcome measures: Incidence of amputations; presenting features, and type and results of vascular reconstructions. Results: The number of amputations decreased after 1988, and that of vascular reconstructions increased. 56 of the 99 who had amputations after reconstruction (57%) had had their last procedure within a month. This group had had a mean of three operations, had worse run-off as assessed by angiography, and 2 of them (5%) had amputations after failed suprainguinal reconstruction for claudication alone. 68 of the total (31%) had amputations without first being assessed by a vascular surgeon. 52 (24%) required reamputation. Conclusion: Better objective methods are needed for the assessment of patients before primary as well as secondary vascular reconstructions. All patients should be seen by a vascular surgeon before amputation is recommended.