Level of amputation following failed arterial reconstruction compared to primary amputation - a meta-analysis

Objectives: to determine if the level of amputation after failed vascular r econstruction was comparable to the level of amputation after primary amput ation. Design and methods: medline literature search (1975-1996), meta-analysis. Results: the odds ratio of transtibial to transfemoral (TT/TF) amputations was 927/657 = 1.41 (95% confidence limits: 1.278-1.561) in postrevascularis ation amputation (PRVA) and 1590/1162 = 1.37 (95% confidence limits: 1.269- 1.477) in primary amputation (PA) (p = 0.65). The pooled data show that the number of conversion from transtibial (TT) to transfemoral (TF) amputation s due to amputation stump complications were 85/369 (23%) in PRVA against 9 3/752 (12.4%) in PA (p<0.01). Conclusions: we could not detect any difference in TT/TF ratio between PRVA and PA. However, the risk of conversion i.e. reamputation to a higher leve l is higher after PRVA compared to PA. The chance of having a successful tr anstibial amputation is approximately 58% for postrevacularisation amputati on as well as for primary amputations, An aggressive approach towards vascu lar reconstruction seems justified.