Presence of a patent pedal arch is the primary predictor of transmetatarsal amputation healing and limb salvage.
Citation: Journal of Vascular Surgery. 77(5):1487-1494, 2023 05.Journal of Vascular Surgery. 77(5):1487-1494, 2023 May.PMID: 36717038Institution: MedStar Health Research Institute | MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Surgery/Podiatric Surgery | Vascular Surgery Integrated ResidencyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Foot | *Limb Salvage | Amputation, Surgical | Foot/bs [Blood Supply] | Humans | Ischemia | Lower Extremity/su [Surgery] | Retrospective Studies | Risk Factors | Treatment Outcome | Vascular Patency | Year: 2023ISSN:- 0741-5214
CONCLUSION: In this series of patients undergoing TMA and arteriography, with appropriate GLASS staging, we have demonstrated that patency of the pedal arch is a significant predictor of healing and limb salvage. GLASS femoral-popliteal and infra-popliteal did not predict TMA healing. Copyright � 2023. Published by Elsevier Inc.
METHODS: Consecutive patients within our institution who underwent a TMA and a lower extremity arteriogram between 2012 to 2020 were included. Patients who healed their TMA were compared against those who did not. Using pre-operative and peri-operative patient factors in addition to the Global Limb Anatomical Staging System (GLASS) and evaluation of the tibial runoff vessels, a multivariate analysis was used to define predictors of TMA healing (at 30 days and one year). In those patients who underwent intervention including those with repeat interventions, their post-intervention GLASS stage was calculated. All patients were followed by the vascular surgeon using standard ultrasound surveillance and clinical follow up. Once the predictors were identified, subsequent analysis was performed to correlate 30-day and 1-year limb salvage rates.
OBJECTIVE: The transmetatarsal amputation (TMA) is a durable and important functional limb salvage option. We herein present our results in identifying angiographic predictors of TMA healing using single-institution retrospective data.
RESULTS: 89 patients met inclusion criteria for the study period. There was no difference in GLASS femoral-popliteal and infra-popliteal stages in those that healed a TMA vs. those that did not. After multivariate regression analysis, the presence of a patent pedal arch vs. a non-intact arch had 5.5 greater odds of TMA healing at 30-days but not at 1-year. Additionally, the presence of patent arch was strongly associated with limb salvage at both 30-days (86% vs. 49%, p <0.01) and 1-year (79% vs. 49%, p <0.01).
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