Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1982 Apr;195(4):469–473. doi: 10.1097/00000658-198204000-00014

The role of vascular laboratory criteria in the selection of patients for lower extremity amputation.

G G Nicholas, J L Myers, W E DeMuth Jr
PMCID: PMC1352529  PMID: 7065750

Abstract

We evaluated clinical and vascular laboratory data on 126 patients with below-knee or forefoot amputation. Vascular laboratory examination included Doppler systolic blood pressure and arterial wave form analysis using the segmental plethysmograph. Fifty-four patients had below-knee amputation. A calf systolic pressure greater than 70 torr was associated with 97% (33/34) success (p less than 0.005), an ankle systolic pressure greater than 30 torr yielded 91% (39/43) success (p less than 0.025), and an ankle systolic pressure greater than zero yielded an 87% success (p less than 0.005). In the absence of each of the above criteria, the predictive value of a negative test was only 32%, 40%, and 52%, respectively. The presence of a popliteal pulse was associated with 97% success (p less than 0.025); however, 88% of those with an absent popliteal pulse also achieved successful healing of below-the-knee amputations. Prior vascular reconstructive surgery was detrimental to healing of below-knee amputations. with 33% failure rate (p less than 0.025). For the 72 forefoot amputations, an ankle systolic pressure greater than 70 torr yielded a 65% success (p less than 0.025). The sensitivity of an ankle systolic pressure greater than 70 torr was 80% (32/40) and an ankle systolic greater than 35 yielded a sensitivity of 95% (38/40). The specificity was low for both of these reference values. Clinical and vascular laboratory criteria can identify patients who will have a successful below-knee amputation; however, because of the high false negative rate, patients should not be denied below-knee amputation solely on the basis of Doppler systolic pressure. Vascular laboratory criteria for predicting healing of forefoot amputations are also limited by the high rate of false positive and false negative results.

Full text

PDF
469

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker W. H., Barnes R. W. Minor forefoot amputation in patients with low ankle pressure. Am J Surg. 1977 Mar;133(3):331–332. doi: 10.1016/0002-9610(77)90540-2. [DOI] [PubMed] [Google Scholar]
  2. Barnes R. W., Shanik G. D., Slaymaker E. E. An index of healing in below-knee amputation: leg blood pressure by Doppler ultrasound. Surgery. 1976 Jan;79(1):13–20. [PubMed] [Google Scholar]
  3. Burgess E. M., Marsden F. W. Major lower extremity amputations following arterial reconstruction. Arch Surg. 1974 May;108(5):655–660. doi: 10.1001/archsurg.1974.01350290023002. [DOI] [PubMed] [Google Scholar]
  4. Cranley J. J., Krause R. J., Strasser E. S., Hafner C. D. Below-the-knee amputation for arteriosclerosis obliterans, with and without diabetes mellitus. Arch Surg. 1969 Jan;98(1):77–80. doi: 10.1001/archsurg.1969.01340070095018. [DOI] [PubMed] [Google Scholar]
  5. Dean R. H., Yao J. S., Thompson R. G., Bergan J. J. Predictive value of ultrasonically derived arterial pressure in determination of amputation level. Am Surg. 1975 Nov;41(11):731–737. [PubMed] [Google Scholar]
  6. KELLY P. J., JANES J. M. Criteria for determining the proper level of amputation in occlusive vascular disease; a review of 323 amputations. J Bone Joint Surg Am. 1957 Jul;39-A(4):883-90; discussion, 890-1. [PubMed] [Google Scholar]
  7. Kazmers M., Satiani B., Evans W. E. Amputation level following unsuccessful distal limb salvage operations. Surgery. 1980 Jun;87(6):683–687. [PubMed] [Google Scholar]
  8. Kihn R. B., Warren R., Beebe G. W. The "geriatric" amputee. Ann Surg. 1972 Sep;176(3):305–314. doi: 10.1097/00000658-197209000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Lim R. C., Jr, Blaisdell F. W., Hall A. D., Moore W. S., Thomas A. N. Below-knee amputation for ischemic gangrene. Surg Gynecol Obstet. 1967 Sep;125(3):493–501. [PubMed] [Google Scholar]
  10. Mooney V., Wagner F. W., Jr Neurocirculatory disorders of the foot. Clin Orthop Relat Res. 1977 Jan-Feb;(122):53–61. [PubMed] [Google Scholar]
  11. Pollock S. B., Jr, Ernst C. B. Use of Doppler pressure measurements in predicting success in amputation of the leg. Am J Surg. 1980 Feb;139(2):303–306. doi: 10.1016/0002-9610(80)90281-0. [DOI] [PubMed] [Google Scholar]
  12. Roon A. J., Moore W. S., Goldstone J. Below-knee amputation: a modern approach. Am J Surg. 1977 Jul;134(1):153–158. doi: 10.1016/0002-9610(77)90299-9. [DOI] [PubMed] [Google Scholar]
  13. Stahlgren L. H., Otteman M. Review of Criteria for the Selection of the Level for Lower Extremity Amputation for Arteriosclerosis. Ann Surg. 1965 Nov;162(5):886–892. doi: 10.1097/00000658-196511000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Verta M. J., Jr, Gross W. S., van Bellen B., Yao J. S., Bergan J. J. Forefoot perfusion pressure and minor amputation for gangrene. Surgery. 1976 Dec;80(6):729–734. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES