Hemodynamic evaluation in selection of amputation level.

Although the amputee and his remaining limb present many interesting and challenging problems, no detailed study exists of the progression of vascular changes in the remaining limb of the amputee . Goldner (1) in 1960 stated that the second leg of the unilateral diabetic amputee shares the fate of the first rather often and relatively soon . A somewhat similar fate can be assumed for the patient with arteriosclerotic occlusive disease who may or may not have diabetes. Since a remaining limb of an amputee or a contralateral limb of a vascular patient will eventually manifest vascular problems, the limb or limbs should be followed and assessed until a condition is presented for an initial or second amputation. Peripheral vascular disease in its most common form represents an insidious progressive process of arterial involvement . The exact etiology of the disease is not known . It is, however, characterized by a gradual deposition of fibrous plaques in the intima of the major arteries . The deposits thicken reducing the flow of blood through the vessels . Eventually the vessel or vessels may become stenosed with a resultant inadequate blood supply to dependent tissues, .when critical stenosis is reached. Tissue function is compromised and gangrene will undoubtedly occur. As part of the search for clues and predictors related to the nature of progressive vascular changes, we are studying pulsatile blood flow waveforms (2,3) in the remaining limb of both recent and older amputees, and bilaterally in patients without amputation.