District hospital management and outcome of critical lower limb ischaemia: comparison with national figures.

OBJECTIVE: To compare local with national management and outcome of critical limb ischaemia (CLI).
DESIGN: Use of nationally identified management groups for allocation of local patients. These were: revascularisation, primary major amputation, medical/minor surgical treatment and no treatment. MATERIAL: All admissions with CLI for the 5 year period January 1990 to December 1994.
RESULTS: Local compared to national revascularisation of 43% vs. 63%, primary major amputation of 18% vs. 16%, medical/minor surgical of 20% vs. 8% and no treatment of 19% vs. 13%. During the fifth year 59% of limbs were revascularised. Fewer patients died in hospital locally (8% vs. 14%), particularly the group having no treatment (9% vs. 44%), but by 6 months only 58% of this group had survival. Local compared to national hospital limb salvage of 76% vs. 68% and patency of revascularisation of 86% vs. 75%. Of the revascularisations a low rate of percutaneous transluminal angioplasty (PTA) was noted locally (16% vs. 34%) and more grafts were being taken to above-nee popliteal artery (26% vs. 13%). Crural grafts were revised to a secondary amputation in 42%.
CONCLUSION: Although differences were observed between local and national management of CLI, overall acceptable outcomes were being obtained locally despite there being an identifiable deficiency in the availability of radiological services with regard to urgent PTA and thrombolysis.