Level of Amputation Following Failed Arterial Reconstruction Compared to Primary Amputation – a Meta-analysis

Abstract 

Objectives:to determine if the level of amputation after failed vascular reconstruction was comparable to the level of amputation after primary amputation.Design and methods:medline literature search (1975–1996), meta-analysis.Results:the odds ratio of transtibial to transfemoral (TT/TF) amputations was 927/657=1.41 (95% confidence limits: 1.278–1.561) in postrevascularisation amputation (PRVA) and 1590/1162=1.37 (95% confidence limits: 1.269–1.477) in primary amputation (PA) (p=0.65). The pooled data show that the number of conversions from transtibial (TT) to transfemoral (TF) amputations due to amputation stump complications were 85/369 (23%) in PRVA against 93/752 (12.4%) in PA (p<0.01).Conclusions:we could not detect any difference in TT/TF ratio between PRVA and PA. However, the risk of conversion i.e. reamputation to a higher level is higher after PRVA compared to PA. The chance of having a successful transtibial amputation is approximately 58% for postrevacularisation amputation as well as for primary amputations. An aggressive approach towards vascular reconstruction seems justified.

Keywords: Failed arterial reconstruction, Amputation, Level of amputation.

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• f1 Please address all correspondence to: L. Bo Ebskov, Anyvej 10, 3500 Værløse, Denmark.