Perioperative management - Right above-knee amputation for Fontaine stage IV peripheral arterial disease (PAD)

• Fontaine stage IV peripheral arterial occlusive disease of the foot and lower leg
• In the case of a non-reconstructable vascular periphery, a below-knee amputation or knee disarticulation must be ruled out, or the options for a more distal amputation must be exhausted
• the A. profunda femoris (APF) should ideally be patent; otherwise, healing of the thigh stump is jeopardised; if necessary, prior reconstruction of the APF

Classification of PAOD according to the Fontaine stages and Rutherford categories

• General inoperability
• Amputation can be performed more distad (knee disarticulation, below-the-knee)

DSA

• Preoperative DSA mandatory to demonstrate local inoperability regarding revascularisation
• No major amputation without angiography in PAOD cases

Laboratory tests

• Complete blood count
• Electrolytes
• Kidney function parameters
• Coagulation
• Blood group

Resting ECG

Chest X-ray

• Perioperative antibiotic prophylaxis
• 2 packed red blood cells available

• Allergy/intolerance, e.g. to latex, drugs; acute cardiovascular response, intensive care measures, possibly permanent damage (e.g., organ failure, brain damage, paralysis).
• Secondary bleeding, haematoma, possibly reoperations
• Transfusion of allogeneic blood / blood components: risk of contracting hepatitis, HIV
• Skin, tissue and nerve damage due to positioning, measures accompanying the procedure (injections, disinfection, current); possibly long-term consequences (pain, paralysis, inflammation, necrosis)
• Impaired wound healing, infection, osteitis, fistula formation; possibly reoperation, reamputation, sepsis
• Thrombosis/embolism
• Keloids, neuroma, phantom (limb) pain
• Functional impairment of the stump, contralateral limb or spine due to incorrect and excessive weight bearing