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Abstract-In describing functional outcomes and independent living in a cohort of bilateral major amputees, we sought to provide current estimates of function and independence after a second major amputation in an elderly Veteran population with peripheral arterial disease and/or diabetes. After retrospectively reviewing and excluding the electronic health records of those failing to meet the inclusion criteria, we identified 40 patients with a history of unilateral major amputation who underwent a second major amputation during the defined study period. Of these, 43% (17) were bilateral transfemoral amputations (TFAs); bilateral transtibial amputations (TTAs) and TFA-TTA accounted for the rest (33% and 25%, respectively). Of the 19 (48%) patients who were ambulatory prior to bilateral amputation, only 2 (11%) remained ambulatory after the second amputation, while 17 (89%) patients lost ambulatory capabilities. Compared with those who were </=65 yr, those between 66 and 79 yr were 18% less likely to ambulate precontralateral amputation (p = 0.03). All patients with bilateral TFA were nonambulatory. Independence postcontralateral amputation decreased from 88% (35) to 53% (21). When data were available (58%), pre and post Functional Independence Measure scores showed a decrease in 74% of patients, while 22% showed an increase. In conclusion, bilateral lower-limb amputation among dysvascular Veterans is highly associated with a loss of ambulation.
Key words: activities of daily living, ambulation, amputations, diabetes, Functional Independence Measure, functional outcomes, independence, limb loss, transfemoral amputations, transtibial amputations.
Abbreviations: ADL = activity of daily living, CAD = coronary artery disease, ESRD = end-stage renal disease, FIM = Functional Independence Measure, PAD = peripheral arterial disease, TFA = transfemoral amputation, TTA = transtibial amputation, VA = Department of Veterans Affairs.
INTRODUCTION
A previous history of contralateral lower-limb limb loss has been identified as a risk factor for poor outcomes following revascularization and limb preservation efforts [1]. Although these poorer expected outcomes may make some clinicians more cautious in entertaining the idea of limb preservation efforts in patients who have a history of unilateral amputation, the alternative-limb loss in the remaining lower limb-is no more appealing.
Among ambulatory patients with critical limb ischemia and without a history of prior major amputation, ambulation rates following infrainguinal bypass are 97 percent [2- 3] but are only 20 percent among those with such a history...