Cath Lab Digest

Patients with advanced peripheral vascular disease (PVD) may have severe lower extremity atherosclerosis that cannot be revascularized by percutaneous or surgical techniques. Such patients, if they develop wound, ulcer, gangrene, or rest pain will need amputation, which carries serious cardiovascular morbidity and mortality. At our center, a retrospective analysis showed below knee amputation 30-day mortality was 8.5% and above knee amputation mortality was 16%. Hip disarticulation carried 100% mortality. The 6-month mortality of above knee amputations was 50%.

There is an interesting paradox in amputation patients. Rarely will a surgeon explain the mortality rates of above knee amputation to the patient or family. These patients do not undergo cardiovascular evaluation for pre-op clearance prior to amputation. Post-amputation, these patients are usually placed in a non-telemetry bed. The morbidity and mortality of CVA and myocardial infarctions are also high in patients after amputation.

We suggest that patients with advanced PVD undergo risk factor reduction in an aggressive manner. Patients with tissue loss will need aggressive percutaneous or surgical revascularization. Patients scheduled for amputation should be advised on natural history and outcomes, along with cardiovascular evaluation for pre-op clearance. Post amputation, they should be monitored in a telemetry floor with repeat emphasis on risk-factor reduction.