OBJECTIVES: To evaluate initial treatment and risk factors for amputation-free survival in patients with critical limb ischaemia (CLI). DESIGN: Prospective clinical cohort study at a single vascular surgical centre in Germany. METHODS: Data on 104 consecutive patients (115 ischaemic limbs) presenting with their first episode of CLI were collected prospectively over a 3-year period. Initial treatment was classified as conservative therapy, intervention, surgery, or major amputation. Patient co-morbidities were assessed by uni- and multivariate analysis to determine risk factors for limb salvage, survival and amputation-free survival. RESULTS: Indications for treatment were rest pain in 27 (23.5%) and tissue loss in 88 (76.5%) limbs. Revascularisation was attempted in 65% of all limbs: 45% by intervention and 55% by surgery. In 9% primary amputation was necessary and 22% received conservative therapy. Median follow-up was 28 months (1-42). The 3-year limb salvage, patient survival, and amputation-free survival rates were 73%, 41%, and 31%, respectively. Diabetes, cardiac disease and renal insufficiency were associated with poor survival. Combined cardiac and renal disease adversely affected amputation-free survival (HR, 3.68; 95% CI, 1.51-8.94; P < 0.001). CONCLUSIONS: At least two third of all patients presenting with CLI can be offered some type of direct revascularisation. In patients with major cardiac disease and renal insufficiency, a poor outcome in terms of amputation-free survival is to be anticipated.
OBJECTIVES: To evaluate initial treatment and risk factors for amputation-free survival in patients with critical limb ischaemia (CLI). DESIGN: Prospective clinical cohort study at a single vascular surgical centre in Germany. METHODS: Data on 104 consecutive patients (115 ischaemic limbs) presenting with their first episode of CLI were collected prospectively over a 3-year period. Initial treatment was classified as conservative therapy, intervention, surgery, or major amputation. Patient co-morbidities were assessed by uni- and multivariate analysis to determine risk factors for limb salvage, survival and amputation-free survival. RESULTS: Indications for treatment were rest pain in 27 (23.5%) and tissue loss in 88 (76.5%) limbs. Revascularisation was attempted in 65% of all limbs: 45% by intervention and 55% by surgery. In 9% primary amputation was necessary and 22% received conservative therapy. Median follow-up was 28 months (1-42). The 3-year limb salvage, patient survival, and amputation-free survival rates were 73%, 41%, and 31%, respectively. Diabetes, cardiac disease and renal insufficiency were associated with poor survival. Combined cardiac and renal disease adversely affected amputation-free survival (HR, 3.68; 95% CI, 1.51-8.94; P < 0.001). CONCLUSIONS: At least two third of all patients presenting with CLI can be offered some type of direct revascularisation. In patients with major cardiac disease and renal insufficiency, a poor outcome in terms of amputation-free survival is to be anticipated.
Authors: Thomas C F Bodewes; Jeremy D Darling; Sarah E Deery; Thomas F X O'Donnell; Alexander B Pothof; Katie E Shean; Frans L Moll; Marc L Schermerhorn Journal: J Vasc Surg Date: 2017-08-24 Impact factor: 4.268
Authors: Jeremy D Darling; John C McCallum; Peter A Soden; Lindsey Korepta; Raul J Guzman; Mark C Wyers; Allen D Hamdan; Marc L Schermerhorn Journal: J Vasc Surg Date: 2017-03-06 Impact factor: 4.268
Authors: Sara L Zettervall; Peter A Soden; Klaas H J Ultee; Crystal Seldon; Jinhee Oh; Kevin McGann; Marc L Schermerhorn; Raul J Guzman Journal: J Vasc Surg Date: 2016-09-22 Impact factor: 4.268
Authors: Natasha Chinai; Graeme K Ambler; Bethany G Wardle; Dafydd Locker; Dave Bosanquet; Nimit Goyal; Christopher Chick; Robert J Hinchliffe; Christopher P Twine Journal: PLoS One Date: 2020-06-11 Impact factor: 3.240