People in their 50s with severe peripheral artery disease or PAD may be more likely than people in their 80s to undergo leg amputation one to five years after emergency surgery to restore blood flow to the lower limbs, according to new research published today in the American Heart Association’s flagship journal Circulation.
Peripheral artery disease occurs when the arteries leading away from the heart narrow due to cholesterol deposits, preventing adequate blood flow throughout the body — commonly the lower extremities. The condition is estimated to affect 10 million to 12 million adults ages 40 and older in the U.S., according to 2024 guidelines from the American Heart Association and the American College of Cardiology.
Symptomatic PAD is characterized by painful muscle cramping in the hips, thighs, calves, or feet when walking, climbing stairs or exercising. The pain does not subside with rest. Modifiable risk factors for PAD include being a smoker, or former smoker, having diabetes, hypertension and/or abnormal cholesterol.
“People with severe forms of PAD requiring urgent surgery tend to have extremely poor disease progress. They are at high risk of limb loss and all-cause death following the initial surgery,” said study lead author Qiuju Li, Ph.D., a research fellow in medical statistics at the London School of Hygiene and Tropical Medicine in the United Kingdom. “Our primary finding is different from the traditional belief that older people were at an increased risk of major amputation. Our study, interestingly, shows the opposite relationship.”
This study analysed previous data from nearly 95,000 adults older than age 50 with peripheral artery disease who had surgery to restore blood flow (known as revascularization) between 2013 and 2020 in England. The analysis projected the possibility of major limb amputation and death after revascularization. Major limb amputation was defined as leg amputation above the ankle.
Two-thirds of participants in the data review had undergone surgery to restore blood flow during an elective hospital admission, while the remainder had non-elective surgery during an emergency hospital admission. The analysis noted that:
- The risk of major amputation among emergency admissions among patients between 50- to 54-years-old was 18% one year after revascularization and 28.8% five years after the surgery.
- The risk of major amputation under the same circumstances for patients between ages 80 and 84-years-old was 11.9% at one year and 17% at five years.
- Among patients who underwent a revascula