AB073. SOH25_AB_173. Progression from minor to major lower extremity amputation in a tertiary vascular centre

Background: Minor amputations may be a harbinger of further minor and major amputations in patients with diabetes and peripheral arterial disease. As the incidence of diabetes increases, determining which patients are at elevated risk of progressing is critically important to designing preventative services. The aim of this study was to track patients after toe amputations and identify high-risk characteristics.

Methods: Retrospective audit of all patients who underwent digital amputations by vascular surgeons between 2017–2019. Cases were identified from theatre logs. Demographic and clinical data was documented from electronic records and limbs were followed up until December 31, 2023. Statistical analysis was performed using SPSS.

Results: A total of 113 limbs in 100 patients were included. The mean age at index admission was 67 years and 82% were male. The primary indication for amputation was ischaemia (47.5%) and diabetic foot infection (52.5%). Overall, 78.6% of the patient cohort were diabetic, 78% had documented peripheral arterial disease (PAD) and 22% were dialysis patients. Thirty-four limbs (33.3%) underwent further ipsilateral amputations, including 27 digital (26.5%) and 11 major amputations (10.7%). The median time from index procedure to major amputation was 8.5 months (range, 0.5–49 months). Congestive heart failure was significantly associated with subsequent major amputation (P=0.04) and revascularisation at index admission was protective (P=0.01). Higher proportions of patients with chronic kidney disease (55.5% vs. 43%) and diabetes (89% vs. 74%) progressed to further amputations.

Conclusions: A significant number of patients progress from digital amputation to limb loss, though the percentage was consistent with another Irish centre with a large dialysis cohort.

Keywords: Amputation; arterial; major; minor; vascular