Although clinical guidelines recommend amputation as the last resort treatment for CLI, they are not uncommon and many can be avoided. Estimates on annual rates of amputations show 120,000 in the US2,3, 40,000 in Germany4, almost 12,000 in Italy5 and an average of 11,000 in the UK6.
Major Amputation (MA) ranks amongst top 5 surgeries with the highest rates of perioperative morbidity and mortality as well as those of repeat interventions7. Amputation has 20 – 37% major complication rate, and between 5% to 10% of patients undergoing Below-Knee amputation die before being discharged from the hospital8. At 5-years, less than half (35-45%) of amputees survive to losing a limb1.
Furthermore, MA is not the end-point treatment for CLI. Patients continue to require care in the form of repeated interventions for wound care, repeated amputation, and continued treatment for PAD in the contralateral limb9.
Managing amputation is a significant burden to healthcare systems. In the US, the lifetime direct healthcare cost per amputee3 is $794,027, whilst in the UK 0.6% of the annual NHS spend goes to foot ulcer care and amputations10. In addition to being costly, amputations can adversely affect patients’ quality of life. Numerous studies demonstrated that the sicker CLI patients and especially those that lost a limb11 fare worse than the average PAD patients and those with Cancer or Chronic Heart failure12.
Taking all this into account, it is of paramount importance to take all possible steps to salvage an affected limb before considering an amputation.