scholarly journals Venous Thromboembolism in Lower Extremity Amputees: A Systematic Review of the Literature

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4980-4980
Author(s):  
Mohammed Abdullah Alsheef ◽  
Sam Schulman ◽  
Marco Donadini ◽  
Abdul Rehman Z. Zaidi
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Lower Extremity ◽  
Conflicts Of Interest ◽  
Lower Extremity Amputation ◽  
Asymptomatic Patients ◽  
Populations At Risk ◽  
Extremity Amputation

Patients undergoing lower extremity amputation (LEA) are at risk of developing deep venous thrombosis (DVT) and pulmonary embolism (PE), but no generally accepted prevention guidelines exist. This systematic review aimed at understanding the incidence of VTE with or without thromboprophylaxis in adult patients with major lower extremity amputation (LEA). Primary outcomes were onset of DVT, PE, or mortality. Secondary outcomes were any major adverse events due to treatment. We searched English language full-text papers in multiple databases using keywords, including amputation/adverse effects, amputation/complications, venous thromboembolism, deep vein thrombosis, and pulmonary embolism. Twenty-eight studies providing observations for 4,841 patients were selected. The fatal PE risk was 2.6% without prophylaxis and significantly decreased to a non-zero residual risk of 0.9% with VTE prophylaxis. Above-knee amputees were at greatest risk of VTE and subsequent complications. The risk was not confined to the amputated stump and can involve the contralateral limb. The role of compression ultrasonography screening in asymptomatic patients remains controversial in various populations at risk for VTE. All patients undergoing major LEA should be considered at high risk for the development of VTE, even after discharge from hospital. We recommend prophylactic anticoagulation (if not contraindicated) and clinical surveillance in all patients undergoing LEA and further studies to determine the optimal prophylactic strategy. Disclosures No relevant conflicts of interest to declare.

scholarly journals Deep Venous Thrombosis (DVT) in Lower Extremity Amputation as Cause of Pulmonary Embolism

2015 ◽  
Vol 2 (3) ◽  
Author(s):  
Montserrat Pérez Pinar ◽  
Regina Pastor Toledo ◽  
Antonio Hernandez Castro ◽  
Julián Solís García del Pozo
Keyword(s):  
Pulmonary Embolism ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lower Extremity Amputation ◽  
Extremity Amputation

Low back pain in persons with lower extremity amputation: a systematic review of the literature

2019 ◽  
Vol 19 (3) ◽  
pp. 552-563 ◽  
Author(s):  
M. Jason Highsmith ◽  
Lisa M. Goff ◽  
Amanda L. Lewandowski ◽  
Shawn Farrokhi ◽  
Brad D. Hendershot ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Low Back ◽  
Review Of The Literature ◽  
Extremity Amputation

scholarly journals Comparison of bone-anchored prostheses and socket prostheses for patients with a lower extremity amputation: a systematic review

2016 ◽  
Vol 39 (11) ◽  
pp. 1045-1058 ◽  
Author(s):  
Ruud A. Leijendekkers ◽  
Gerben van Hinte ◽  
Jan Paul Frölke ◽  
Hendrik van de Meent ◽  
Maria W.G. Nijhuis-van der Sanden ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Extremity Amputation

scholarly journals Interventions to Manage Residual Limb Ulceration Due To Prosthetic Use in Individuals with Lower Extremity Amputation: A Systematic Review of the Literature

2016 ◽  
Vol 18 (2) ◽  
pp. 115-123 ◽  
Author(s):  
M. Jason Highsmith ◽  
Jason T. Kahle ◽  
Tyler D. Klenow ◽  
Casey R. Andrews ◽  
Katherine L. Lewis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Residual Limb ◽  
Review Of The Literature ◽  
Extremity Amputation

Effect of podiatric medical care on rates of lower-extremity amputation in a Medicare population

1999 ◽  
Vol 89 (6) ◽  
pp. 312-317 ◽  
Author(s):  
RD Sowell ◽  
WB Mangel ◽  
CJ Kilczewski ◽  
JM Normington
Keyword(s):  
At Risk ◽  
Lower Extremity ◽  
Medical Care ◽  
Health Care Financing ◽  
Lower Extremity Amputation ◽  
Coding System ◽  
Common Procedure ◽  
Medicare Part B ◽  
Patients At Risk ◽  
Extremity Amputation

The purpose of this study was to determine whether Medicare patients at risk for lower-extremity amputation due to complications from diabetes, peripheral vascular disease, and/or gangrene who receive the services classified under Level II code M0101 of the Health Care Financing Administration's Common Procedure Coding System (cutting or removal of corns, calluses, and/or trimming of nails, application of skin creams and other hygienic and preventive maintenance care) have lower rates of lower-extremity amputation than those who do not receive such services. Analysis of the data suggests that those at-risk beneficiaries who received these services were nearly four times less likely to experience lower-extremity amputation than those who did not receive such services. The study has both methodologic limitations (the study considers only one variable, receipt or nonreceipt of certain types of podiatric medical care, while other variables may affect rates of lower-extremity amputation) and technological limitations (attempts to link the 2 years of per case Medicare Part B data were unsuccessful, limiting the length of the study to 1 year). Further research on this topic is encouraged.

scholarly journals Disparities of Health Care Access Among Hispanics At Risk of Lower Extremity Amputation

2021 ◽  
Vol 74 (3) ◽  
pp. e209
Author(s):  
Tze-Woei (Kevin) Tan ◽  
Diego Urbina ◽  
Chiu-Hsieh Hsu ◽  
David G. Armstrong ◽  
David Marrero ◽  
...  
Keyword(s):  
Health Care ◽  
At Risk ◽  
Lower Extremity ◽  
Health Care Access ◽  
Lower Extremity Amputation ◽  
Care Access ◽  
Extremity Amputation

scholarly journals Health service organisation impact on lower extremity amputations in people with type 2 diabetes with foot ulcers: systematic review and meta-analysis

2021 ◽  
Author(s):  
Bernardo Meza-Torres ◽  
Fabrizio Carinci ◽  
Christian Heiss ◽  
Mark Joy ◽  
Simon de Lusignan
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Lower Extremity ◽  
Meta Analysis ◽  
Lower Extremity Amputation ◽  
Foot Ulcers ◽  
Multidisciplinary Teams ◽  
Care Pathways ◽  
Extremity Amputation

Abstract Aims Despite the evidence available on the epidemiology of diabetic foot ulcers and associated complications, it is not clear how specific organizational aspects of health care systems can positively affect their clinical trajectory. We aim to evaluate the impact of organizational aspects of care on lower extremity amputation rates among people with type 2 diabetes affected by foot ulcers. Methods We conducted a systematic review of the scientific literature published between 1999 and 2019, using the following key terms as search criteria: people with type 2 diabetes, diagnosed with diabetic foot ulcer, treated with specific processes and care pathways, and LEA as primary outcome. Overall results were reported as pooled odds ratios and 95% confidence intervals obtained using fixed and random effects models. Results A total of 57 studies were found eligible, highlighting the following arrangements: dedicated teams, care pathways and protocols, multidisciplinary teams, and combined interventions. Among them, seven studies qualified for a meta-analysis. According to the random effects model, interventions including any of the four arrangements were associated with a 29% reduced risk of any type of lower extremity amputation (OR = 0.71; 95% CI 0.52–0.96). The effect was larger when focusing on major LEAs alone, leading to a 48% risk reduction (OR = 0.52; 95% CI 0.30–0.91). Conclusions Specific organizational arrangements including multidisciplinary teams and care pathways can prevent half of the amputations in people with diabetes and foot ulcers. Further studies using standardized criteria are needed to investigate the cost-effectiveness to facilitate wider implementation of improved organizational arrangements. Similarly, research should identify specific roadblocks to translating evidence into action. These may be structures and processes at the health system level, e.g. availability of professionals with the right skillset, reimbursement mechanisms, and clear organizational intervention implementation guidelines.

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