Outcomes and prosthesis procedure of major amputations in patients with peripheral arterial disease in our center

Abstract

Introduction: a decrease in rate of mayor amputation has been reported over the last years; approximately 7 % of patients with chronic peripheral arterial disease (PAD). Implant a prosthesis is a complex and important procedure for the patients´ quality of life. The journals shown different data between them. Objective: to describe the evolution of patients undergoing a major amputation due to PAD in our center and their prosthesis procedure in relation to their baseline status. Materials and methods: descriptive, retrospective and single center study. We collected all major amputations performed by our department between 2013 to 2019. We searched the registry of patients with prosthesis. Sociodemographic, clinical, intervention, postoperative and rehabilitation variables were collected. We analyzed the qualitative variables in the form of absolute frequencies and percentages, the quantitative data through the mean, the statistical inference with the chi2 and the survival with actuarial analysis. Results: we performed 282 major amputations, 65.95 % in men, with a mean age of 71.23 years. 82.68 % were above the knee and 17.32 % below the knee. 30.85 % had a previous minor amputation. 51.06 % had been previously revascularized. Only 37.9 % had an adequate social support. Median survival was 24 months. Mortality at one year was 35 %. 29.32 % of the patients had a previous independent walk, 21.22 % did not walk and the rest required assistance for walking. 28 % (79) of the patients received a prosthesis, with an average use of the prosthesis of 15.34 hours per day. Previous gait status was significantly related to wearing prosthesis, achieved by 49.9 % of those who walked independently versus 1.69 % of those who did not walk (p < 0.001). Of the rest of the factors analyzed, the following had a statistically significant relationship with prosthetic fitting: male gender (p < 0.028), younger than 70 years (p < 0.001), adequate social support (p < 0.001), history of previous revascularization (p < 0.001) and level of amputation (below the knee) (p < 0.001). Conclusions: the percentage of prosthetics of patients undergoing a major amputation is low and is related to the state of previous ambulation, gender, age, social support and level of amputation.