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• W3195520303 abstract "We sought to identify the anatomic factors and demographic factors associated with healing of transtibial amputations. Patients with available cross-sectional imaging studies who had undergone lower extremity amputations between 2010 and 2019 were retrospectively reviewed. The demographics, comorbidities, and anatomic findings were recorded. The outcomes of the final amputation level and survival were calculated. Multivariate logistic regression analysis of the significant predictors was performed for the outcome of the final level of amputation and regression analysis using Cox proportional hazards was performed for the outcome of survival. A total of 97 patients who had undergone lower extremity amputation during the study period had data for all predictor variables available. The mean age was 61.45 ± 12.87 years, and 53 were men. The mean follow-up period was 10.31 ± 14.59 months (range, 0.03-60.45 months). Of the amputations, 50 (including 6 guillotine) were transtibial and 46 (including 1 guillotine) were transfemoral. Eleven of the patients with a transtibial amputation had required revision to above-the-knee amputations. The median survival was 34.40 ± 12.98 months. Univariate analysis showed that a higher body mass index, dialysis dependence, and diabetes were associated with better chances of salvage of a below-the-knee amputation. Prior ipsilateral vascular interventions and external iliac and superficial femoral stenosis were associated with a greater risk of amputation. Multivariate logistic regression showed that external iliac artery stenosis/occlusion (odds ratio, 1.59; P = .046) remained a significant predictor for a final level of amputation above the knee (Table I). Univariate analysis showed age, stenosis/occlusion of the iliac vessels, smoking, and dialysis dependence were associated with decreased median survival. Age (hazard ratio, 1.042; P = .008) and dialysis dependence (odds ratio, 4.33; P = .002) remained significant predictors on Cox regression analysis, with patients with external iliac stenosis or occlusion showing a strong trend toward diminished survival (hazard ratio, 1.41; P = .054; Fig). External iliac disease is associated with higher final levels of amputation and might also predict for lower long-term survival. For patients who are undergoing transtibial amputations, inflow lesions should be addressed concomitantly or before the procedure.TableMultivariate analysis of factors leading to suprageniculate level of amputationPredictor variableOR Exp(B)P value95% CI for Exp(B)BMI0.95.0920.89-1.01Diabetes0.48.1600.17-1.34Dialysis0.34.1280.09-1.36Prior vascular intervention (ipsilateral)0.95.2790.85-1.05External Iliac artery stenosis >50%1.59.0461.01-2.52Superficial femoral artery stenosis >50%1.32.2050.86-2.06BMI, Body mass index; CI, confidence interval; OR, odds ratio.aC-statistic/area under the receiver operating characteristic curve: 0.77. Open table in a new tab" @default.
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• W3195520303 date "2021-09-01" @default.
• W3195520303 modified "2023-09-23" @default.
• W3195520303 title "External Iliac Artery Disease Adversely Affects Healing of Transtibial Amputations" @default.
• W3195520303 doi "https://doi.org/10.1016/j.jvs.2021.06.234" @default.
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