Determinants of functional outcome after revascularization for critical limb ischemia: An analysis of 1000 consecutive vascular interventions

Abstract

Functional outcome for patients undergoing intervention for critical limb ischemia is not solely determined by the traditional measures of reconstruction patency and limb salvage, but also by certain intrinsic patient comorbidities at the time of presentation. These findings question the benefit of our current approach to critical limb ischemia in functionally impaired, chronically ill patients--patients who undoubtedly will be more prevalent as our population ages.

National trends in lower extremity bypass surgery, endovascular interventions, and major amputations

“…26 However, in patients with critical limb ischemia, amputation-free survival is an important outcome, as are other functional measures such as ambulatory status and independent living. 27 Some may conclude that the data presented here suggests that the increase in utilization of endovascular interventions has improved the care of patients with lower extremity PAD, by decreasing amputation rates. However, this conclusion cannot be directly established, and is overly simplistic in nature.…”

Vascular Complications of Diabetes

“…In a study of 1000 consecutive patients who underwent revascularization for critical limb ischemia, diabetes mellitus portended a 40% higher rate of deterioration of ambulatory status after the procedure. 104 In a population-based cohort of linked nationwide databases in Sweden of 1840 patients, amputation rates were 65% higher over the course of 2.2 years after lower extremity bypass surgery for critical limb ischemia in patients with diabetes mellitus compared with those without diabetes mellitus. 105 Patients with diabetes mellitus have other conditions that contribute to foot wounds and exacerbate the complications of vascular insufficiency, such as neuropathy and altered foot mechanics.…”

Surgical Technique and Peripheral Artery Disease

“…12,13 Functional outcome, which includes survival, maintenance of ambulation, and maintenance of independent living status, was assessed in a cohort of 841 patients who underwent 1000 revascularization procedures for CLI. 13 The most important predictors of poor functional outcome were impaired ambulatory status at the time of presentation and dementia. In the NSQIP database, patients were classified as independent or dependent, defined as someone who requires some or total assistance from another person for activities of daily living.…”