THE PROBLEM OF LOWER LIMB AMPUTATION IN PATIENTS WITH CRITICAL ISCHEMIA: A LITERATURE REVIEW
Introduction. Critical limb ischemia is the most severe stage of peripheral arterial disease and is often an indication for amputation. Peripheral arterial disease and diabetes mellitus are considered the causes of limb amputations in more than 50% of cases.
The aim of the study is to analyze the literature data on the epidemiological and clinical aspects of lower limb amputations, as well as the management of patients after amputations.
Search strategy. The PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to 20 December 2022. A combination of relevant keywords and Medical Subject Heading (MeSH) terms was generated. The search revealed 376 publications. After removal of duplicates, animal studies, low quality studies, the review includes 59 publications.
Results. Early postoperative mortality ranges from 4% to 22% after major limb amputation for any reason. Successful rehabilitation after amputation below the knee is achieved in less than two-thirds of patients and less than half after amputation above the knee; overall, less than 50% of all patients requiring amputation will ever achieve full mobility. In adult patients, the more proximal the amputation is, the more difficult it is to install and fix the prosthesis. Staged amputation has a higher success rate, lower perioperative mortality, and lower 30-day mortality. Minor amputation patients have better indicators of physical functioning, general health, emotional and mental health (p<0.001). However, they have worse indicators of the pain component and social functioning (p<0.001).
Conclusion. Regardless of etiology, a balanced approach to amputation and post-amputation rehabilitation, combined with optimal prosthesis selection, can help achieve improved patient mobility.
Zhassulan Kozhakhmetov1,
Yersyn Sabitov2, https://orcid.org/0000-0003-0937-5813
Tolegen Toleutayev1, https://orcid.org/0000-0002-1898-8614
Yernur Kazymov1, https://orcid.org/0000-0002-4849-6549
Yerlan Salmenbayev1,
Merey Imanbayev1, https://orcid.org/0000-0002-7248-0440
Laura Pak1, https://orcid.org/0000-0002-5249-3359
Kuantkan Zhabagin3, https://orcid.org/0000-0002-4304-5132
1 NCJSC «Semey Medical University», Semey c., Republic of Kazakhstan;
2 University Hospital of NCJSC «Semey Medical University», Semey c., Republic of Kazakhstan;
3 Center of Nuclear Medicine and Oncology, Semey c., Republic of Kazakhstan.
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Kozhakhmetov Zh., Sabitov Ye., Toleutayev T., Kazymov Ye., Salmenbayev Ye., Imanbayev M., Pak L., Zhabagin K. The problem of lower limb amputation in patients with critical ischemia: a literature review // Nauka i Zdravookhranenie [Science & Healthcare]. 2022, (Vol.24) 6, pp. 161-169. doi 10.34689/SH.2022.24.6.021Related publications:
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