Nonoperative Active Management of Critical Limb Ischemia: Initial Experience Using a Sequential Compression Biomechanical Device for Limb Salvage

Abstract

Critical limb ischemia (CLI) patients are at high risk of primary amputation. Using a sequential compression biomechanical device (SCBD) represents a nonoperative option in threatened limbs. We aimed to determine the outcome of using SCBD in amputation-bound nonreconstructable CLI patients regarding limb salvage and 90-day mortality. Thirty-five patients with 39 critically ischemic limbs (rest pain = 12, tissue loss = 27) presented over 24 months. Thirty patients had nonreconstructable arterial outflow vessels, and five were inoperable owing to severe comorbidity scores. All were Rutherford classification 4 or 5 with multilevel disease. All underwent a 12-week treatment protocol and received the best medical treatment. The mean follow-up was 10 months (SD +/- 6 months). There were four amputations, with an 18-month cumulative limb salvage rate of 88% (standard error [SE] +/- 7.62%). Ninety-day mortality was zero. Mean toe pressures increased from 38.2 to 67 mm Hg (SD +/- 33.7, 95% confidence interval [CI] 55-79). Popliteal artery flow velocity increased from 45 to 47.9 cm/s (95% CI 35.9-59.7). Cumulative survival at 12 months was 81.2% (SE +/- 11.1) for SCBD, compared with 69.2% in the control group (SE +/- 12.8%) (p = .4, hazards ratio = 0.58, 95% CI 0.15-2.32). The mean total cost of primary amputation per patient is euro29,815 ($44,000) in comparison with euro13,900 ($20,515) for SCBD patients. SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.

The Role of Sequential Pneumatic Compression in Limb Salvage in Non-reconstructable Critical Limb Ischemia

“…The 5-year mortality rate for CLI patients is 70%, and most of these deaths are cardiovascularly related. 8 At the start, the aim was to answer whether SPC use in non-reconstructable CLI would lead to limb salvage and evasion of amputation. The incidence of CLI has been exponentially increasing over the last decade, especially with the ageing of nations and increased prevalence of diabetes.…”

“…The incidence of CLI has been exponentially increasing over the last decade, especially with the ageing of nations and increased prevalence of diabetes. 8 Given the grave impact of amputation on social, .752 * Ischemic heart disease 86.2% (56) 13.8% (9) .342 * Chronic kidney disease 76.5% (26) 23.5% (8) .486 * Hyperhomocysteinemia 87% 2013% ( .714** * p-value calculated using chi square; ** p-value calculated using likelihood ratio. Figure 2.…”

Prospective Study of Sarpogrelate Hydrochloride on Patients with Arterioscler osis Obliterans

“…4,5,10) Therefore, the cardinal management is medical therapy using anticoagulants, thrombolysis, antiplatelet agents, consecutive alternative biological pressure, etc. 11,12) The mechanism of those medications is dilation of blood vessels, anticoagulation, alteration of blood viscosity, improving the collateral circulation. In addition, it is reported that the clinical symptoms could be improved after injecting of automarrow mononuclear cells, however, the survival rate could not be changed.…”

Safety of a compression stocking for patients with chronic venous insufficiency (CVI) and peripheral artery disease (PAD)

“…Good Satisfactory Sufficient Poor Insufficient pneumatic compression" published in 2018 [12]. Most studies on intermittent pneumatic compression included between 18 and 42 patients [13][14][15][16][17][18][19][20][21][22]. Only two publications featured larger patient populations (171 and 187 patients) [23,24].…”