Five-Year Survival After Transmetatarsal Amputation (TMA): Why Early Endovascular Revascularization Matters

They told you amputation was the only option. We disagree.

At Tulsa Cardiovascular Center of Excellence (TCCE), our primary mission is limb salvage through advanced endovascular revascularization — often preventing the need for amputation altogether in patients with Chronic Limb-Threatening Ischemia (CLTI).

A recent retrospective study of 129 patients who underwent transmetatarsal amputation (TMA) between 2009 and 2011 provides important context on outcomes when amputation becomes necessary:

• Five-year mortality after TMA: 39%

• This compares favorably to historical five-year mortality rates after below-knee amputation (BKA), which range from 40% to 82%.

• One-year mortality in the TMA group was 14%, with 33% of all deaths occurring within the first year.

  
  

Patient Profile & Co-Morbidities

The study population had high rates of common CLTI risk factors:

• Hypertension: 89.9%

• Diabetes: 79%

• Neuropathy: 68%

• Smoking history: 62%

• Peripheral vascular disease: 53%

• Renal disease: 45% (notably higher mortality in this subgroup)

Importantly, 24% of patients who had a TMA later required a higher-level amputation (BKA or AKA).

The TCCE Approach: Preventing Amputation Whenever Possible

While TMA remains a valuable limb-salvage option in select cases, our team focuses first on restoring blood flow through minimally invasive endovascular techniques. We specialize in complex below-the-knee and below-the-ankle revascularization, using complete bilateral lower extremity arterial ultrasound (including pedal artery evaluation and pedal acceleration time when clinically indicated) to identify treatable disease patterns that many centers overlook.

By intervening earlier with angioplasty, stenting, atherectomy, and other advanced outpatient procedures, we can often preserve the foot and avoid TMA or higher amputations entirely — all with same-day discharge and no hospital stay.

Our Collaborative Commitment

We work closely with podiatrists, wound care specialists, and referring hospitals to ensure patients receive timely evaluation and the most appropriate intervention. Early referral for endovascular assessment frequently changes the trajectory from amputation to limb preservation.

Take the Next Step

If you or your patient has CLTI, non-healing wounds, or rest pain, early endovascular evaluation at TCCE may prevent the need for amputation.

Limb Salvage Starts Here at TCCE.

Saving your life and leg begins with saving your foot.

Schedule a vascular assessment today:

(918) 943-5303 | www.tulsacardiovascularcenter.com