Risk factors for reamputation in chronic limb-threatening ischemia: a scoping review
DOI:
https://doi.org/10.48750/acv.686Keywords:
Reamputation, Risk factors, Chronic limb-threatening ischemia, Predictive modelsAbstract
INTRODUCTION: After an initial amputation, up to 47% of patients with chronic limb-threatening ischemia (CLTI) experience reimputation, with debilitating consequences for patients and high healthcare costs. Identifying reimputation rates and risk factors is crucial to optimizing initial amputation-level decision-making. This review updates current evidence on reimputation rates and identifies key risk factors in patients with CLTI.
METHODS: A comprehensive review of the PubMed database was conducted to identify studies reporting reimputation rates and predictors in patients with CLTI. Keywords included: "reimputation", "risk factors", "CLTI", "Critical limb ischemia - CLI", and "dysvascular". We included seven retrospective cohort studies.
RESULTS: Reimputation rates ranged from 10% to 41%. Reimputation incidence varied widely by study population, follow-up duration, and initial amputation level. This review identified key predictors of reimputation, including diabetes mellitus, renal insufficiency (especially end-stage renal disease and hemodialysis), prior revascularization, severe atherosclerotic disease, and more distal initial amputation levels. Additional risk factors identified in specific cohorts included older age, male sex, abnormal ankle-brachial index, ischemic pain, non-ambulatory status, and systemic inflammatory markers. Mortality after initial lower-extremity amputation remained high, though it was not consistently associated with reimputation.
CONCLUSION: Reimputation remains prevalent among CLTI patients. Early identification of high-risk individuals may support more appropriate surgical decision-making. Significant heterogeneity across studied populations underscores the need for future research using local data and developing context-specific predictive models.
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References
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