Revision of below-knee amputation stumps to a higher level in patients with peripheral vascular disease

Selected in Journal of Vascular Surgery by Cédric Lacoste

Below-knee amputation (BKA) remains a frequent outcome in patients with advanced peripheral arterial disease (PAD), particularly in the setting of chronic limb-threatening ischemia and uncontrolled infection.

Despite careful patient selection, stump failure requiring revision to a higher-level amputation remains common and carries significant clinical and economic consequences.

This retrospective single-center study evaluates clinical and anatomical factors associated with BKA failure, with a specific focus on identifying predictors of stump healing and reducing the need for revision surgery.

References:

Authors: Mina Abdelmalak, Louise M. Finch, Haydn Richards, Mark Tawadrous, and Ragai Makar

Reference: Published online October 27, 2025

DOI: DOI: 10.1016/j.jvs.2025.10.026

Read the abstract

Objective:

The aim of this study is to evaluate clinical and anatomical factor associated with failure of below-knee amputation.

The objective is then to identify predictors of stump healing and reducing the need of re-operation.

Study:

The study is a retrospective single-center cohort.

Population:

All patients who underwent below-knee amputation between April 2014 and October 2021 for peripheral vascular disease were included.

Other etiologies such as burns, trauma or malignancy were excluded.

Outcomes:

212 patients underwent a below-knee amputation, among them 48 patients (22.6 %) required a revision surgery.

No significant differences in comorbidities, smoking status and revascularisation procedure were founded.

Predictors of re-operation found: diseased profunda femoris and common iliac artery.
Predictors of stump healing found : patent profunda femoris and common iliac artery and unexpectedly, superficial artery occlusion and initial indication for uncontrolled infection.
Length of stay increased in patient requiring a re-operation with an average additional cost of £3105 per patient.

Revision of below-knee amputation stumps to a higher level in patients with peripheral vascular disease

Source: Journal of Vascular Surgery

Conclusion:

Aproximately one in four patient required a revision, which represents a high rate of revision with significant costs.

The patency of the profunda femoris emerged as the strongest predictor of stump healing.

Discussion :

The study has a low level of scientific evidence due to a patient sample that is too small and a weak methodology.