Evaluating the Success of Limb Salvage via Transmetatarsal Amputation in Patients With PAD

Transmetatarsal amputations can be successful in salvaging the lower extremities of patients with peripheral arterial disease (PAD). A poster presented this week at the Symposium on Advanced Wound Care (SAWC) Fall detailed differences in limb salvage rates in patients with varying runoff rates.¹
 
The study was a 10-year retrospective review of 44 patients with PAD who underwent a transmetatarsal amputation and had an angiogram or computed tomography angiography (CTA) perioperatively. Authors explored the difference in limb salvage success rates in patients with anterior tibialis artery versus posterior tibialis artery versus peroneal artery runoff to the foot, and to determine if there is a difference in single- versus two-vessel runoff in limb salvage outcomes.
 
Of the 44 patients who met the inclusion criteria, authors noted there were 17 (38.6%) failures. Of the 17 failures, 2 (11.8%) patients had no patent vessel runoff to the foot, 9 (52.9%) patients had one-vessel runoff, 4 (23.5%) patients had two-vessel runoff, and 2 (11.8%) patients had three-vessel runoff.
 
The poster notes one-vessel runoff to the foot yielded a highly poor outcome with 56.3% experiencing a higher level of amputation. Runoff to the foot with two or more vessels will have a limb salvage success rate of more than 75 percent with a transmetatarsal amputation, note the authors.
 
Reference
 
1. Truong DH, Tsai S, Wukich DK, Lavery LA. Success of limb salvage in patients with peripheral artery disease. Poster presented at the Symposium on Advanced Wound Care (SAWC) Fall, October 14–16, 2022.