47
10.3.4. Amputation for CLTI
COR LOE
Recommendations
1 B-NR
1. In patients with CLTI who require amputation, evaluation
should be performed by a multispecialty care team (Table 15)
to assess for the most distal level of amputation that facilitates
healing and provides maximal functional ability.
1 C-EO
2. In patients with CLTI, primary amputation is indicated when
life over limb is the prevailing consideration and clinical
factors suggest the threatened limb to be the cause of the
patient's instability (eg, ischemia, metabolic derangement, or
advanced infection).
1 C-EO
3. In patients with CLTI, a patient-centered approach using
objective classification of the threatened limb, patient risk, and
anatomic pattern of disease combined with patient and family
goals is recommended to identify those patients in whom
primary amputation or palliative management is appropriate.
1 C-EO
4. In patients with CLTI undergoing minor amputation (ie,
inframalleolar level), a customized program of follow-up
care that can include local wound care, pressure offloading,
serial evaluation of foot biomechanics, and use of therapeutic
footwear is recommended to prevent wound recurrence.
2a C-EO
5. For patients with CLTI, retrospective assessment of institutional
outcomes (including amputation) with objective limb threat
classification tools can be useful for quality improvement.
Table 19. Major Factors Influencing QOL Among Amputees
Patient Factors
Higher QOL Lower QOL
• Walking with prosthesis
• Above knee (versus below knee) amputation
• Female sex (especially if age <60 y)
• Living at home
• Age >65 y
• Presence of diabetes
• Isolation (being homebound)
Professional-Controlled Factors
• Timing of amputation
• Informed decision making
• Postamputation support
Data derived from Davie-Smith, et al and Suckow, et al.
Reprinted with permission from Creager, et al. Copyright © 2021 American Heart
Association, Inc
