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Presence of a patent pedal arch is the primary predictor of transmetatarsal amputation healing and limb salvage.

Authors :
Glousman BN
Cragon R
Steinberg JS
Evans KK
Attinger CE
Kiguchi MM
Tefera E
Akbari CM
Source :
Journal of vascular surgery [J Vasc Surg] 2023 May; Vol. 77 (5), pp. 1487-1494. Date of Electronic Publication: 2023 Jan 28.
Publication Year :
2023

Abstract

Objective: Transmetatarsal amputation (TMA) is a durable and important functional limb salvage option. We have presented our results in identifying the angiographic predictors of TMA healing using single-institution retrospective data.<br />Methods: Consecutive patients within our institution who had undergone TMA and lower extremity arteriography from 2012 to 2020 were included. Patients whose TMA had healed were compared with those whose TMA had not healed. Using pre- and perioperative patient factors, in addition to the Global Limb Anatomic Staging System (GLASS) and evaluation of the tibial runoff vessels, multivariate analysis was used to define the predictors of TMA healing at 30 days and 1 year. For those patients who had undergone an intervention after TMA, including repeat interventions, the postintervention GLASS stage was calculated. All patients were followed up by the vascular surgeon using standard ultrasound surveillance and clinical examinations. Once the predictors had been identified, an analysis was performed to correlate the 30-day and 1-year limb salvage rates.<br />Results: A total of 89 patients had met the inclusion criteria for the study period. No difference was found in the GLASS femoropopliteal or infrapopliteal stages for those with a healed TMA and those without. After multivariate regression analysis, the presence of a patent pedal arch vs a nonintact arch had a 5.5 greater odds of TMA healing at 30 days but not at 1 year. Additionally, the presence of a patent arch was strongly associated with limb salvage at both 30 days (86% vs 49%; P < .01) and 1 year (79% vs 49%; P < .01).<br />Conclusions: In the present series of patients who had undergone TMA and arteriography, with appropriate GLASS staging, we found patency of the pedal arch was a significant predictor of healing and limb salvage. The GLASS femoropopliteal and infrapopliteal stages did not predict for TMA healing.<br /> (Copyright © 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1097-6809
Volume :
77
Issue :
5
Database :
MEDLINE
Journal :
Journal of vascular surgery
Publication Type :
Academic Journal
Accession number :
36717038
Full Text :
https://doi.org/10.1016/j.jvs.2023.01.184