title: Lower extremity amputation in peripheral artery disease: improving patient outcomes.
abstract: Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE) amputation (LEA), although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing) in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies.
authors: Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors: Aparna
authors: A
authors: Swaminathan
authors: Department of Medicine, Duke University Medical Center, Durham, NC, USA ; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors: Sreekanth
authors: S
authors: Vemulapalli
authors: Department of Medicine, Duke University Medical Center, Durham, NC, USA ; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors: Manesh R
authors: MR
authors: Patel
authors: Department of Medicine, Duke University Medical Center, Durham, NC, USA ; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors: W Schuyler
authors: WS
authors: Jones
mesh_terms: D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003952:Diagnostic Imaging / Q000379:methods; D042241:Early Diagnosis; D057510:Endovascular Procedures; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: lower extremity amputation; mortality; peripheral artery disease