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Understanding The Impact Of Microvascular Disease On Amputation Risk

In a recent study, researchers found that microvascular disease alone, defined in this study as retinopathy, neuropathy and nephropathy, is associated with a 3.7 times greater risk of amputation.1 Combine this with PAD, and the risk rises to over 22 times increase from baseline.1 This is taken from data recently published in Circulation by Beckman and colleagues.

With this data obtained from the Veterans Aging Cohort Study between 2003 and 2014, Beckman and colleagues noted that over 125,000 veterans had no evidence of prior amputation at baseline.1 However, after a median 9.3 years of follow up, there was a total of 1,185 amputations. Further analysis yielded the correlation between these amputations and PAD and/or microvascular disease.

This is extremely important work from Beckman and colleagues. I think that the data speaks for itself. It is not just about diabetes or PAD. 

The study offers further information supporting the fact that, independent of diabetes, these macro- and microvascular complications matter. When looking at an amputation prevention algorithm, this also adds to data supporting a team approach. For example, neuropathy is one of the complications discussed. Podiatrists treat this on a regular basis. However, we may want to examine it in a broader context, not just as a constellation of symptoms but as a smaller part of the larger problem of amputation risk. 

If we broaden our outlook on risk factors for amputation to include these conditions, we may be able to intervene and educate sooner and more efficiently, ultimately helping patients avoid amputations.

Dr. Armstrong is a Professor of Surgery at Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA). 


  1. Beckman JA, Duncan MS, Damrauer SM, et al. Microvascular disease, peripheral artery disease and amputation. Circulation. 2019. doi: 10.1161/CIRCULATIONAHA.119.040672.

Editor’s Note: This blog originally appeared at It is adapted with permission from the author.

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