Changes in the management of critical limb ischaemia

Varty, K.; Nydahl, S.; Butterworth, P.C.; Er̀rington, M.L.; Bolia, A.; Bell, P. R. F.; London, N.J.M.

doi:10.1002/bjs.1800830722

Cited by 73 publications

(29 citation statements)

References 9 publications

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“…10–12 This may be due to patients with diabetes having increased disease severity. 13 Despite this, our study did not demonstrate an association between diabetes and risk of amputation.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Critical Limb Ischemia in an Urban, Safety Net Hospital Population with High WIfI Amputation Scores

Ward

Dunn

Clavijo

et al. 2017

Annals of Vascular Surgery

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Background Patients presenting to a public hospital with critical limb ischemia (CLI) typically have advanced disease with significant comorbidities. The purpose of this study was to assess the influence of revascularization on 1-year amputation rate of CLI patients presenting to Los Angeles County USC Medical Center, classified according to the Society for Vascular Surgery Wound, Ischemia and foot Infection (WIfI). Methods A retrospective review of patients who presented to a public hospital with CLI from February 2010 to July 2014 was performed. Patients were classified according to the WIfI system. Only patients with complete data who survived at least 12 months after presentation were included. Results Ninety-three patients with 98 affected limbs were included. The mean age was 62.8 years. Eighty-two patients (84%) had hypertension and 71 (72%) had diabetes. Fifty (57.5%) limbs had Trans-Atlantic Inter-Society Consensus (TASC) C or D femoral–popliteal lesions and 82 (98%) had significant infrapopliteal disease. The majority had moderate or high WIfI amputation and revascularization scores. Eighty-four (86%) limbs underwent open, endovascular, or hybrid revascularization. Overall, one year major amputation (OYMA) rate was 26.5%. In limbs with high WIfI amputation score, the OYMA was 34.5%: 21.4% in those who were revascularized and 57% in those who were not. On univariable analysis, factors associated with increased risk of OYMA were nonrevascularization (P = 0.005), hyperlipidemia (P = 0.06), hemodialysis (P = 0.005), gangrene (P = 0.02), ulcer classification (P = 0.05), WIfI amputation score (P = 0.026), and WIfI wound grade (P = 0.04). On multivariable analysis, increasing WIfI amputation score (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.0–3.39) was associated with increased risk of OYMA while revascularization (OR 0.24, 95% CI 0.07–0.80) was associated with decreased risk of OYMA. Conclusions The OYMA rates in this population were consistent with those predicted by the WIfI classification system. In this population, revascularization significantly reduced the risk of amputation. Comorbidities including diabetes mellitus and TASC classification did not moderate the association of WIfI amputation score with risk of 1-year major amputation.

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“…10–12 This may be due to patients with diabetes having increased disease severity. 13 Despite this, our study did not demonstrate an association between diabetes and risk of amputation.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Critical Limb Ischemia in an Urban, Safety Net Hospital Population with High WIfI Amputation Scores

Ward

Dunn

Clavijo

et al. 2017

Annals of Vascular Surgery

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“…The Leicester group have shown that 42.3% of patients with CLI can be treated with angioplasty alone, with a further 6.3% treated by a combination of bypass and angioplasty. 21 In attempting to hone our own indications for SA, we now consider claudication to be a relative contraindication. Although our morbidity from intervention in claudicants was low, there were three technical failures, of whom two required elective bypass surgery.…”

Section: Discussionmentioning

confidence: 99%

Role of Subintimal Angioplasty in the Treatment of Chronic Lower Limb Ischaemia

Tisi¹,

Mirnezami²,

Baker³

et al. 2002

European Journal of Vascular and Endovascular Surgery

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SA carries a low risk of major complications and high immediate technical success. Poor long-term patency suggests that SA is not as durable as bypass surgery. However, failed SA did not compromise subsequent surgery, which only became necessary in a proportion of patients. Our data suggests that there is little to be lost by using SA as first-line treatment for patients with limb-threatening ischaemia who are poor operative risks or who have no autologous vein available.

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“…In a more recent study, Yeager et al (24) reported a 70% limb salvage and 85% survival in 74 patients (92% of the patients had acute thrombosis) with acute limb-threatening ischemia treated surgically. A recently published study of 188 patients and 198 limbs with acute threatening ischemia treated with surgery, PTA, or both reported an in-hospital mortality of 10% and a limb salvage rate of 79% [25].…”

Section: Discussionmentioning

confidence: 99%