50-year-olds Face Higher Amputation Risk than 80-year-olds After PAD Surgery—study
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People in their 50s with severe peripheral artery disease (PAD) are more likely to undergo leg amputation within one to five years after emergency revascularization surgery compared to those in their 80s. This is according to a study published in July 2024 in the American Heart Association’s journal Circulation.
PAD and the risks of revascularization
Peripheral artery disease is caused by narrowed arteries due to cholesterol deposits, reducing blood flow in the limbs, particularly the legs. It currently affects 10 million to 12 million adults in the U.S.
This condition can manifest as leg pain during physical activity and poses significant health risks, especially for older adults with risk factors like smoking, diabetes, hypertension, and abnormal cholesterol levels.
Doctors often recommend revascularization surgery to restore blood flow in areas where blood circulation has been compromised. However, recent research has highlighted the varying risks of major amputation (defined in the study as leg amputation above the ankle) and death following revascularization surgery in patients with severe peripheral artery disease.
The study
Researchers analyzed previous data from nearly 95,000 adults over 50 years old with peripheral artery disease who had revascularization surgery between 2013 and 2020 in England. The analysis projected the possibility of major limb amputation and death after revascularization.
The researchers found that there was a higher risk of amputation in patients who underwent emergency revascularization compared to those who had elective revascularization.
Among those who had emergency admissions, younger patients (defined in the study as 50 to 54 years old) had an 18% higher risk of major amputation after one year compared to older patients (defined in the study as 80 to 84 years old). In comparison, the risk of death without amputation increased significantly in older patients.
Among patients who underwent elective revascularization surgery, the risk of leg amputation remained relatively low within five years despite the patient’s age: 10.8% for younger patients and 65% for older patients.
However, the risk of death within five years without a major amputation increased substantially among older patients who had elective and emergency revascularizations: 48.7% and 58.9%, respectively, for older patients and 12.9% and 16.9%, respectively, for younger patients.
Patients who had a leg amputation within six months of revascularization were found to have a higher risk of death. Specifically, older patients had a one-year death rate of 39.2% if the amputation occurred three months after revascularization and 29.8% if it occurred one year after. Meanwhile, younger patients had lower one-year death rates of 20.3% and 14.9% for amputations at three months and one year, respectively, after revascularization.
The bottom line
This study emphasizes the complex relationship between patient characteristics, disease progressions, and outcomes in treating peripheral artery disease. Its findings also underscore the importance of personalized treatment plans tailored to each patient.
Most importantly, the findings emphasize the importance of early diagnosis and treatment to prevent amputation and other complications from peripheral artery disease.
