A Survey of Amputations for Degenerative Vascular Disease

A group of 116 amputees, coming to operation between January, 1967, and June, 1971, has been examined in a retrospective study. Men outnumbered women by almost 3 to 1. The mean age of all patients was just over 66 years. Over two-thirds had ECG evidence of myocardial ischæmia, and one-third had suffered frank myocardial infarction at some time. Forty-three per cent presented clinical evidence of cerebrovascular disease, and 13% had suffered a stroke. Arterial hypertension requiring treatment was relatively uncommon, occurring in only 6%. Chronic obstructive airways disease with emphysema was noted In 15%, diabetes requiring treatment in 23%. Approximately two-thirds of the patients smoked more than 10 cigarettes or the equivalent amount of tobacco each day. Diabetes was found more frequently among those smoking less than 10 cigarettes each day than among the heavier smokers. About half the patients had undergone some form of vascular surgery in an attempt to protect or save the limb. About 40% of patients presented a history of Intermittent claudication as the initial manifestation of vascular insufficiency; claudication was present for a median time of 48 months before amputation. The remaining patients presented with rest pain of relatively rapid onset, and these came to amputation at a median time of 2 months after presentation. Forty per cent of patients were dead by the time of the survey. Fifty per cent of patients were dead by 3-4 years from the date of the first amputation. The 5-year survival rate was 39%. The operative mortality rate was 13%. Between 10% and 20% of survivors at a given time died within the ensuing 12 months. About one-quarter of the patients had lost the second leg by the time of death or closure of the survey. The median time between the first and second amputation was 8.5 months. The chance of losing the second leg increased with time, and 45% of those surviving 5 years had undergone a second amputation. During the period of the survey, a marked change in amputation practice was observed, the proportion of below-knee amputations rising from 1 in 6 to 2 in 3.