Lower extremity amputations in chronically dialysed patients: a 10 year study.
BACKGROUND
Lower limb critical ischemia is a major problem in dialysed patients.


OBJECTIVE
To evaluate the results of revascularization procedures, amputations and prosthetic rehabilitation in dialysed amputees.


METHODS
In this retrospective study we examined the charts of selected dialysis patients. Forty-eight patients had undergone major amputation (4.5% of the dialysis population), and 24 patients entered the rehabilitation program. Widespread arterial calcification was common and led to falsely elevated ankle-brachial pressure indices in 9 of 14 limbs. Eight patients underwent revascularization. Subsequent major amputation was carried out 4 +/- 4.5 months after the revascularization (above knee in 5 patients and below knee in 3). Of the 16 patients who underwent primary amputation, only 2 were above-knee amputees. Seven patients with toe or metatarsal amputation went on to a major amputation 1.8 +/- 1.2 months after the distal amputation.


RESULTS
No differences were found between diabetic and non-diabetic patients regarding the number of revascularization operations performed, the level of major amputation, or overall survival. Prosthetic rehabilitation was considered successful in 12 patients, partially successful in 8, and failed in 4 patients. Patient survival time was shortest in those patients with failed rehabilitation. A younger age confirmed favorable rehabilitation results, while long-standing diabetics and bilateral amputees were poor rehabilitation candidates. Patients who underwent primary amputation had more successful rehabilitation. A comparison between 24 dialysed amputees and 138 non-uremic amputees revealed similar rehabilitation results, although hospitalization time was longer in the dialysed patients.


CONCLUSIONS
Early definitive therapy is essential when dealing with critical ischemia. After diagnostic angiography, proximal revascularization should be performed where feasible. Primary amputation is indicated in patients with extensive foot infection or gangrene. Prosthetic rehabilitation is warranted in most dialysed amputees.
Korzets
Asher
A
Institute of Nephrology and Hypertension, Rabin Medical Center (Golda Campus), Petah Tiqva, Israel.
Ori
Yaacov
Y
Rathaus
Mauro
M
Plotnik
Nora
N
Baytner
Shlomo
S
Gafter
Uzi
U
Isakov
Eli
E
D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D001186:Artificial Limbs; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016491:Peripheral Vascular Diseases / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011300:Preoperative Care; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors