Nobody should agree to a major surgical procedure without fully understanding why it is being recommended, what alternatives were considered, and what the realistic outcomes look like.
When that procedure is an amputation, the stakes are higher than almost any other surgical decision a patient will face. And yet research consistently shows that many patients are not given adequate information or genuine participation in the decision-making process.
A 2025 study in the Journal of Wound Management surveyed amputation patients and found that while 71% wanted to be actively involved in the decision about their amputation, only half were directly asked whether they wanted to participate.
You have the right to be involved. Here are the questions that give you that involvement.
About Your Vascular Assessment
- Have I had a formal angiogram or contrast imaging to map the full extent of my arterial disease? If not, why not?
- Has a toe-brachial index or transcutaneous oxygen pressure been measured to establish the severity of ischemia?
- Has my wound been classified using the WIfI score (Wound, Ischemia, and foot Infection), which is now recommended by the 2024 ACC/AHA guidelines to guide treatment decisions?
About Your Treatment Options
- Has my case been reviewed by a multidisciplinary limb salvage team, including a vascular surgeon, podiatrist, and wound care specialist?
- Has transcatheter deep vein arterialization been considered? This procedure was included in 2024 multi-specialty consensus guidelines and is now available at select centres for no-option CLTI patients.
- Are there any investigational research programs I may qualify for before proceeding with amputation?
- Has a second opinion from a specialist in complex distal vascular reconstruction been obtained or offered?
About the Decision Itself
- What is the expected outcome if I choose not to have amputation at this time?
- What level of amputation is being recommended, and why that level rather than a more conservative option?
- What does rehabilitation look like after this procedure, and what is a realistic timeline for recovery?
- What happens if I want more time to consider or seek another opinion?
About Your Treatment Options
Amputation is not the end of medical care. It is the beginning of a different phase. For patients who proceed, understanding the rehabilitation pathway, the prosthetics process, and the ongoing cardiovascular monitoring required is important.
For patients who want to explore whether amputation can be delayed or avoided, investigational options for no-option CLTI do exist, and they are being studied at regulated clinical centres. You are entitled to know that those options exist before you make this decision.
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At this point, most patients are not looking for another opinion. They are looking for a reason not to give up. If your condition is not responding to current treatment... Some patients in this situation are exploring investigational approaches focused on restoring blood flow at the cellular level. Our guide on Am I Eligible for ACP-01? What Patients Need to Know explores what the research is showing and who may be a candidate. |