From the Guidelines
The patient with bipedal edema can undergo below-knee amputation (BKA) after careful preoperative management, as there is no absolute contraindication for the procedure in the presence of edema. According to the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1, the decision to perform a BKA should be based on the individual patient's needs and the extent of necrosis or infectious gangrene. Key considerations in the preoperative management of the patient with bipedal edema include:
- Reducing the edema through elevation of the affected limb, compression therapy, and diuretic medications
- Identifying and addressing the underlying cause of the edema, whether it's venous insufficiency, heart failure, renal disease, or lymphatic obstruction
- Carefully evaluating the level of amputation, as severe edema may influence tissue viability and healing potential The guidelines suggest that pre-amputation revascularization enhances wound healing, but in cases of extensive necrosis or infectious gangrene, primary major amputation without revascularization may be preferable to avoid complications 1. A multidisciplinary approach involving the surgeon, anesthesiologist, cardiologist, and rehabilitation specialists is recommended to ensure the best possible outcome. Postoperatively, continued management of fluid status and proper positioning of the residual limb will be essential for optimal outcomes.
From the Research
Bipedal Edema and BKA Considerations
- Bipedal edema refers to swelling in both legs, which can be caused by various factors such as venous insufficiency, heart failure, or liver disease 2.
- The management of bipedal edema typically involves treating the underlying cause, and may include the use of diuretics, compression therapy, or other interventions 3, 4, 2, 5.
- Compression therapy is a cornerstone of treatment for venous edema and lymphatic disorders, and can be achieved through various modalities such as bandages, wraps, or graduated compression stockings 4.
- In cases of refractory edema, combination therapy with diuretics and compression may be effective, as shown in a study where patients with advanced disease and severe bilateral leg edema resistant to parenteral diuretic therapy were treated with a combination of multilayer short-stretch compression bandaging and furosemide in hypersaline intravenous infusion 3.
BKA Procedure Considerations
- Below-knee amputation (BKA) is a surgical procedure that involves removing the lower leg, and is typically performed in cases of severe injury, infection, or vascular disease.
- The presence of bipedal edema may pose challenges for BKA surgery, as it can increase the risk of complications such as wound infection or delayed healing.
- However, there is no direct evidence to suggest that bipedal edema is a contraindication for BKA surgery, and the decision to proceed with surgery should be made on a case-by-case basis, taking into account the individual patient's overall health and medical history.
- Preoperative management of edema, such as through the use of compression therapy or diuretics, may be necessary to reduce the risk of complications and improve outcomes 5.