Major lower extremity amputation in elderly patients with peripheral arterial disease: incidence and survival rates.
OBJECTIVE
The methods of treating peripheral arterial disease (PAD) have changed and become more prophylactic. This study describes and analyzes 1) the incidence rates of major lower extremity amputation (LEA) due to PAD, 2) occurrence of re-amputation, and 3) the survival of amputees and factors predicting survival.


METHODS
The series consisted of 210 patients (mean age 76.6, SD 10.7 yrs, 45.2% men) who underwent their first, i.e. index, major leg amputation because of PAD, in 1998-2002, in the city of Turku, Finland, population 175,000.


RESULTS
The age-and gender-standardized incidence rate of combined above-knee and below-knee amputations was 24.1/100,000 person-years during 1998-2002. Thirty-four per cent of amputees underwent repetitive amputation. One-month mortality was 21% (n=45), one-year mortality 52% (n=109) and overall mortality 80% (n=168). Cardiovascular diseases predicted equally well 31-day, one-year, and overall mortality in age- and gender- adjusted analysis. Multiple co-morbidities (p=0.023) and unilateral above-knee amputations (p=0.047) were significant predictors for overall mortality in age- and gender-adjusted analysis. Cardiovascular diseases remained a significant predictor for 31-day and overall mortality in multivariate analysis (p=0.008 and p=0.015, respectively). Amputated patients' previous vascular procedures did not have any effect on mortality in the Cox model. Most revascularizations were performed less than six months before the index/first major LEA.


CONCLUSIONS
Major LEAs seem to have been done late, and mainly for pain relief in the end-stage of patients with peripheral arterial disease.
Remes
Leena
L
Institute of Clinical Medicine, Department of Public Health, University of Turku, Turku, FI-20014, Finland. leena.remes@utu.fi
Isoaho
Raimo
R
Vahlberg
Tero
T
Hiekkanen
Heikki
H
Korhonen
Kimmo
K
Viitanen
Matti
M
Rautava
Päivi
P
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000401:mortality*; D005260:Female; D005387:Finland; D006801:Humans; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate