دورية أكاديمية
أعرض في EDS

Fate of the contralateral limb after lower extremity amputation.

التفاصيل البيبلوغرافية
العنوان: Fate of the contralateral limb after lower extremity amputation.
المؤلفون: Glaser JD; Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass., Bensley RP, Hurks R, Dahlberg S, Hamdan AD, Wyers MC, Chaikof EL, Schermerhorn ML
المصدر: Journal of vascular surgery [J Vasc Surg] 2013 Dec; Vol. 58 (6), pp. 1571-1577.e1. Date of Electronic Publication: 2013 Aug 03.
نوع المنشور: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 8407742 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6809 (Electronic) Linking ISSN: 07415214 NLM ISO Abbreviation: J Vasc Surg Subsets: MEDLINE
أسماء مطبوعة: Publication: <2008-> : New York, NY : Elsevier
Original Publication: St. Louis, Mo. : Mosby, [c1984-
مواضيع طبية MeSH: Risk Assessment*, Amputation, Surgical/*statistics & numerical data , Leg/*surgery , Peripheral Arterial Disease/*surgery, Aged ; Disease Progression ; Female ; Follow-Up Studies ; Humans ; Incidence ; Leg/blood supply ; Male ; Massachusetts/epidemiology ; Peripheral Arterial Disease/mortality ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Survival Rate/trends ; Treatment Outcome
مستخلص: Objective: Lower extremity amputation is often performed in patients where both lower extremities are at risk due to peripheral arterial disease or diabetes, yet the proportion of patients who progress to amputation of their contralateral limb is not well defined. We sought to determine the rate of subsequent amputation on both the ipsilateral and contralateral lower extremities following initial amputation.
Methods: We conducted a retrospective review of all patients undergoing lower extremity amputation (exclusive of trauma or tumor) at our institution from 1998 to 2010. We used International Classification of Diseases-Ninth Revision codes to identify patients and procedures as well as comorbidities. Outcomes included the proportion of patients at 1 and 5 years undergoing contralateral and ipsilateral major and minor amputation stratified by initial major vs minor amputation. Cox proportional hazards regression analysis was performed to determine predictors of major contralateral amputation.
Results: We identified 1715 patients. Mean age was 67.2 years, 63% were male, 77% were diabetic, and 34% underwent an initial major amputation. After major amputation, 5.7% and 11.5% have a contralateral major amputation at 1 and 5 years, respectively. After minor amputation, 3.2% and 8.4% have a contralateral major amputation at 1 and 5 years while 10.5% and 14.2% have an ipsilateral major amputation at 1 and 5 years, respectively. Cox proportional hazards regression analysis revealed end-stage renal disease (hazard ratio [HR], 3.9; 95% confidence interval [CI], 2.3-6.5), chronic renal insufficiency (HR, 2.2; 95% CI, 1.5-3.3), atherosclerosis without diabetic neuropathy (HR, 2.9; 95% CI, 1.5-5.7), atherosclerosis with diabetic neuropathy (HR, 9.1; 95% CI, 3.7-22.5), and initial major amputation (HR, 1.8; 95% CI, 1.3-2.6) were independently predictive of subsequent contralateral major amputation.
Conclusions: Rates of contralateral limb amputation are high and predicted by renal disease, atherosclerosis, and atherosclerosis with diabetic neuropathy. Physicians and patients should be alert to the high risk of subsequent amputation in the contralateral leg. All patients, but particularly those at increased risk, should undergo close surveillance and counseling to help prevent subsequent amputations in their contralateral lower extremity.
(Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
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معلومات مُعتمدة: T32 HL007734 United States HL NHLBI NIH HHS; HL007734 United States HL NHLBI NIH HHS
تواريخ الأحداث: Date Created: 20130808 Date Completed: 20140123 Latest Revision: 20221207
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC3844063
DOI: 10.1016/j.jvs.2013.06.055
PMID: 23921246
قاعدة البيانات: MEDLINE
الوصف
تدمد:1097-6809
DOI:10.1016/j.jvs.2013.06.055