{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:23:24Z","timestamp":1777890204877,"version":"3.51.4"},"reference-count":44,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T00:00:00Z","timestamp":1735257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: Despite advancements in vascular surgery, the mortality among peripheral arterial disease (PAD) patients undergoing major amputations remains high. While a large body of evidence has previously covered survival rates after major amputation, there is less evidence regarding the associated survival penalty from an epidemiological perspective. The present analysis aimed at quantifying the survival disadvantage after major lower limb amputation while investigating which factors are associated with mortality in this patient cohort. Methods: Data from 246 PAD patients undergoing major amputations were retrospectively collected and matched with mortality records from the Austrian National Death Registry. Life expectancy was estimated using population-based life tables, and differences between observed and expected survival were analyzed across subgroups. Results: The median follow-up was 492 days (Q1\u2013Q3: 73\u20131438), and 82.5% (n = 203) of patients died, with cardiovascular events being the leading cause (41%). A profound discrepancy between estimated (4697 days, Q1\u2013Q3: 2962\u20136236) and observed survival (457 days, Q1\u2013Q3: 73\u20131438, p &lt; 0.001) was seen. In men, an associated median survival penalty of 11.2 years was observed, equivalent to a proportionate reduction in life expectancy of over 90%, while the difference in women was 8.7 years, equaling a reduction of 84.6%. In a multiple regression model, 1 year in life expectancy was associated with a survival penalty of \u22120.96 years, thereby affecting younger patients with the highest life expectancies the most. Conclusions: Major amputation in PAD patients is associated with a significant reduction in survival compared to standardized mortality rates in the general population. The survival disadvantage exceeds 70% of estimated survival times in over 70% of patients. Elevated mortality rates after major amputation in PAD patients should not be interpreted as a causal relationship but as a surrogate for impaired systemic cardiovascular health.<\/jats:p>","DOI":"10.3390\/jcm14010104","type":"journal-article","created":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T04:10:23Z","timestamp":1735618223000},"page":"104","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Quantification of the Survival Disadvantage Associated with Major Amputation in Patients with Peripheral Arterial Disease"],"prefix":"10.3390","volume":"14","author":[{"given":"Maria Elisabeth","family":"Leinweber","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, KliniK Ottakring, Montleartstrasse 37, 1160 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuel","family":"Greistorfer","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, KliniK Ottakring, Montleartstrasse 37, 1160 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Rettig","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, KliniK Ottakring, Montleartstrasse 37, 1160 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fadi","family":"Taher","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, KliniK Ottakring, Montleartstrasse 37, 1160 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Kliewer","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, KliniK Ottakring, Montleartstrasse 37, 1160 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afshin","family":"Assadian","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, KliniK Ottakring, Montleartstrasse 37, 1160 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8264-7796","authenticated-orcid":false,"given":"Amun Georg","family":"Hofmann","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, KliniK Ottakring, Montleartstrasse 37, 1160 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1111\/iwj.13594","article-title":"The perioperative and long-term fates of patients with chronic limb-threatening ischaemia who underwent secondary major amputations","volume":"19","author":"Ogaki","year":"2022","journal-title":"Int. Wound J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.ejvs.2018.04.017","article-title":"International Variations in Amputation Practice: A VASCUNET Report","volume":"56","author":"Behrendt","year":"2018","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1093\/eurheartj\/ehx095","article-title":"2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)","volume":"39","author":"Aboyans","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ejvs.2023.08.067","article-title":"Editor\u2019s Choice\u2014European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication","volume":"67","author":"Nordanstig","year":"2024","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-023-47028-5","article-title":"Global disease burden and its attributable risk factors of peripheral arterial disease","volume":"13","author":"You","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1016\/S0140-6736(13)61249-0","article-title":"Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: A systematic review and analysis","volume":"382","author":"Fowkes","year":"2013","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3538","DOI":"10.1093\/eurheartj\/ehae179","article-title":"2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM)","volume":"45","author":"Mazzolai","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"187","DOI":"10.2147\/VHRM.S209241","article-title":"The burden of critical limb ischemia: A review of recent literature","volume":"15","author":"Duff","year":"2019","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1055\/s-0032-1324738","article-title":"Critical limb ischemia and its impact on patient health preferences and quality of life-an international study","volume":"21","author":"Pisa","year":"2012","journal-title":"Int. J. Angiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.jvs.2010.04.057","article-title":"Quality of life in patients with no-option critical limb ischemia underlines the need for new effective treatment","volume":"52","author":"Sprengers","year":"2010","journal-title":"J. Vasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.avsg.2016.12.015","article-title":"A Meta-analysis of Long-term Mortality and Associated Risk Factors following Lower Extremity Amputation","volume":"42","author":"Stern","year":"2017","journal-title":"Ann. Vasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.atherosclerosis.2018.05.006","article-title":"YKL-40 levels increase with declining ankle-brachial index and are associated with long-term cardiovascular mortality in peripheral arterial disease patients","volume":"274","author":"Tscharre","year":"2018","journal-title":"Atherosclerosis"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.numecd.2022.11.020","article-title":"Mortality rate related to peripheral arterial disease: A retrospective analysis of epidemiological data (years 2008\u20132019)","volume":"33","author":"Voci","year":"2023","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Aursulesei Onofrei, V., Ceasovschih, A., Marcu, D.T.M., Adam, C.A., Mitu, O., and Mitu, F. (2022). Mortality Risk Assessment in Peripheral Arterial Disease\u2014The Burden of Cardiovascular Risk Factors over the Years: A Single Center\u2019s Experience. Diagnostics, 12.","DOI":"10.3390\/diagnostics12102499"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1177\/1538574413503715","article-title":"Lower extremity amputations: Factors associated with mortality or contralateral amputation","volume":"47","author":"Shah","year":"2013","journal-title":"Vasc. Endovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1053\/j.jfas.2016.01.012","article-title":"Mortality After Nontraumatic Major Amputation Among Patients with Diabetes and Peripheral Vascular Disease: A Systematic Review","volume":"55","author":"Thorud","year":"2016","journal-title":"J. Foot Ankle Surg."},{"key":"ref_17","unstructured":"(2024, November 10). Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=major+amputation&filter=years.2012-2024."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1161\/CIRCOUTCOMES.119.006399","article-title":"Incidence and Factors Associated with Major Amputation in Patients with Peripheral Artery Disease: Insights from the EUCLID Trial","volume":"13","author":"Long","year":"2020","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.atherosclerosis.2012.01.002","article-title":"Fate of individuals with ischemic amputations in the REACH Registry: Three-year cardiovascular and limb-related outcomes","volume":"221","author":"Abola","year":"2012","journal-title":"Atherosclerosis"},{"key":"ref_20","first-page":"799","article-title":"Social isolation, loneliness and health in old age: A scoping review. Health Soc","volume":"25","author":"Courtin","year":"2017","journal-title":"Care Community"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.ahj.2006.05.009","article-title":"Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality","volume":"152","author":"Friedmann","year":"2006","journal-title":"Am. Heart J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1093\/eurjhf\/hfs064","article-title":"Social isolation, vital exhaustion, and incident heart failure: Findings from the Atherosclerosis Risk in Communities Study","volume":"14","author":"Cen","year":"2012","journal-title":"Eur. J. Heart Fail."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1097\/00006842-200103000-00010","article-title":"Characteristics of socially isolated patients with coronary artery disease who are at elevated risk for mortality","volume":"63","author":"Brummett","year":"2001","journal-title":"Psychosom. Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kamiya, Y., Whelan, B., Timonen, V., and Kenny, R.A. (2010). The differential impact of subjective and objective aspects of social engagement on cardiovascular risk factors. BMC Geriatr., 10.","DOI":"10.1186\/1471-2318-10-81"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/00006842-200205000-00005","article-title":"Loneliness and health: Potential mechanisms","volume":"64","author":"Cacioppo","year":"2002","journal-title":"Psychosom. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.jvs.2024.04.026","article-title":"Prosthetic fitting and mortality after major lower extremity amputation","volume":"80","author":"Forrester","year":"2024","journal-title":"J. Vasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"E5383","DOI":"10.1097\/GOX.0000000000005383","article-title":"Ambulatory Status before Diabetic Foot Ulcer Development as a Predictor of Amputation and 1-Year Outcomes: A Retrospective Analysis","volume":"11","author":"Clegg","year":"2023","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1016\/j.apmr.2007.11.034","article-title":"Rehabilitation setting and associated mortality and medical stability among persons with amputations","volume":"89","author":"Dillingham","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1177\/0309364617690394","article-title":"Factors influencing quality of life following lower limb amputation for peripheral arterial occlusive disease: A systematic review of the literature","volume":"41","author":"Coulter","year":"2017","journal-title":"Prosthet. Orthot. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1097\/00003086-199904000-00014","article-title":"The psychologic assessment and psychosocial recovery of the patient with an amputation","volume":"361","author":"Fitzpatrick","year":"1999","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.avsg.2014.12.005","article-title":"Domains that Determine Quality of Life in Vascular Amputees","volume":"29","author":"Suckow","year":"2015","journal-title":"Ann. Vasc. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1001\/jamainternmed.2015.0486","article-title":"Functional outcomes after lower extremity revascularization in nursing home residents: A national cohort study","volume":"175","author":"Oresanya","year":"2015","journal-title":"JAMA Intern. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"100156","DOI":"10.1016\/j.jvsvi.2024.100156","article-title":"A framework for perioperative care in lower extremity major limb amputation: A consensus statement by the Enhanced Recovery After Surgery (ERAS) Society and Society for Vascular Surgery","volume":"2","author":"McGinigle","year":"2024","journal-title":"JVS-Vasc. Insights"},{"key":"ref_34","first-page":"12","article-title":"A Closer Look at Mortality After Lower Extremity Amputation","volume":"31","author":"Thorud","year":"2018","journal-title":"Pod. Today"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.apmr.2005.07.310","article-title":"The effects of prosthetic foot design on physiologic measurements, self-selected walking velocity, and physical activity in people with transtibial amputation","volume":"87","author":"Hsu","year":"2006","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1007\/s00421-008-0764-0","article-title":"Effect of speed on the energy cost of walking in unilateral traumatic lower limb amputees","volume":"103","author":"Genin","year":"2008","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1016\/j.jvs.2016.03.452","article-title":"Mortality rates and walking ability transition after lower limb major amputation in hemodialysis patients","volume":"64","author":"Serizawa","year":"2016","journal-title":"J. Vasc. Surg."},{"key":"ref_38","first-page":"222","article-title":"Cardiorespiratory status and movement capabilities in adults with limb amputation","volume":"31","author":"Kurdibaylo","year":"1994","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"E4727","DOI":"10.1097\/GOX.0000000000004727","article-title":"Analysis of 5-year Mortality following Lower Extremity Amputation due to Vascular Disease","volume":"11","author":"Beeson","year":"2023","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1016\/j.jvs.2020.07.086","article-title":"A meta-analysis of mortality after minor amputation among patients with diabetes and\/or peripheral vascular disease","volume":"72","author":"Yammine","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1111\/iwj.12404","article-title":"The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review","volume":"13","author":"Jupiter","year":"2016","journal-title":"Int. Wound J."},{"key":"ref_42","first-page":"502","article-title":"Long-term clinical outcomes in critical limb ischemia\u2014A retrospective study of 181 patients","volume":"20","author":"Melillo","year":"2016","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.apmr.2007.11.005","article-title":"Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050. Arch","volume":"89","author":"MacKenzie","year":"2008","journal-title":"Phys. Med. Rehabil."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"E875","DOI":"10.1161\/CIR.0000000000000967","article-title":"Reducing Nontraumatic Lower-Extremity Amputations by 20% by 2030: Time to Get to Our Feet: A Policy Statement from the American Heart Association","volume":"143","author":"Creager","year":"2021","journal-title":"Circulation"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/104\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:54:57Z","timestamp":1760115297000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/104"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,27]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14010104"],"URL":"https:\/\/doi.org\/10.3390\/jcm14010104","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,27]]}}}