F Biancari1. 1. Department of Surgery Oulu University Hospital, Oulu, Finland - faustobiancari@yahoo.it.
Abstract
AIM: Critical limb ischemia (CLI) is a significant morbid condition among the elderly. The epidemiology and natural history of this condition are poorly defined. METHODS: Systematic review and meta-analysis of studies evaluating the prevalence, incidence and natural history of CLI were performed. RESULTS: Six studies reported on the prevalence of severe lower limb ischemia (ABI <0.60, ankle pressure <70 mmHg or Fontaine III-IV) in 82,923 subjects and its pooled prevalence was 800/100,000 population (95%CI 300-1400). The Oxford Vascular Study assessed the incidence of vascular events in the general population and estimated an incidence of CLI of 22/100,000 population per year (95%CI 17-28). Two studies reported an incidence of CLI in subjects >65 years old of 113 and 200/100,000 population per year, respectively. Nine studies reported on the treatment strategy in 2144 legs with CLI: the pooled rate of any revascularization procedure was 70.4%, of primary amputation 8.4%, and of conservative treatment 20.3%. After conservative treatment for CLI, one-year pooled leg salvage rate was 57.4% (95%CI 45.1-69.7%, ten studies reporting on 734 legs included), survival 75.4% (95%CI 59.2-91.6%, four studies included) and amputation-free survival 51.4% (95%CI 32.7-71.2%, five studies included). CONCLUSION: The incidence of CLI in the elderly is rather high. Series reporting on treatment strategies in these patients showed that a revascularization is attempted in 70% of cases. Conservative treatment in patients with unreconstructable CLI, high operative risk and/or refusing any revascularization procedure is associated with acceptable one year leg salvage.
AIM: Critical limb ischemia (CLI) is a significant morbid condition among the elderly. The epidemiology and natural history of this condition are poorly defined. METHODS: Systematic review and meta-analysis of studies evaluating the prevalence, incidence and natural history of CLI were performed. RESULTS: Six studies reported on the prevalence of severe lower limb ischemia (ABI <0.60, ankle pressure <70 mmHg or Fontaine III-IV) in 82,923 subjects and its pooled prevalence was 800/100,000 population (95%CI 300-1400). The Oxford Vascular Study assessed the incidence of vascular events in the general population and estimated an incidence of CLI of 22/100,000 population per year (95%CI 17-28). Two studies reported an incidence of CLI in subjects >65 years old of 113 and 200/100,000 population per year, respectively. Nine studies reported on the treatment strategy in 2144 legs with CLI: the pooled rate of any revascularization procedure was 70.4%, of primary amputation 8.4%, and of conservative treatment 20.3%. After conservative treatment for CLI, one-year pooled leg salvage rate was 57.4% (95%CI 45.1-69.7%, ten studies reporting on 734 legs included), survival 75.4% (95%CI 59.2-91.6%, four studies included) and amputation-free survival 51.4% (95%CI 32.7-71.2%, five studies included). CONCLUSION: The incidence of CLI in the elderly is rather high. Series reporting on treatment strategies in these patients showed that a revascularization is attempted in 70% of cases. Conservative treatment in patients with unreconstructable CLI, high operative risk and/or refusing any revascularization procedure is associated with acceptable one year leg salvage.
Authors: Stefano de Franciscis; Giovanni De Caridi; Mafalda Massara; Francesco Spinelli; Luca Gallelli; Gianluca Buffone; Francesco G Caliò; Lucia Butrico; Raffaele Grande; Raffaele Serra Journal: Int Wound J Date: 2014-12-03 Impact factor: 3.315
Authors: Caitlin W Hicks; Chao Yang; Chiadi E Ndumele; Aaron R Folsom; Gerardo Heiss; James H Black; Elizabeth Selvin; Kunihiro Matsushita Journal: J Am Heart Assoc Date: 2018-08-21 Impact factor: 5.501