Outcomes of Conservative Treatment in Patients with Chronic Limb Threatening Ischaemia: A Systematic Review and Meta-Analysis

Reijen, Nick S. van; Hensing, Tom; Santema, T.B.; Ubbink, Dirk T.; Koelemay, M.J.W.

doi:10.1016/j.ejvs.2021.01.005

Cited by 24 publications

(10 citation statements)

References 44 publications

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“…Conservative treatment of patients with CLTI has been reported to have acceptable results with respect to limb loss and patient death. A systematic review of conservative treatment for patients with CLTI reported an all-cause mortality rate of 18%, major lower-extremity amputation rate of 27%, and amputation-free survival rate of 60% after one year of follow-up [ 10 , 11 ]. The results from the systematic review suggest that conservative treatment is feasible for some patients with CLTI.…”

Section: Discussionmentioning

confidence: 99%

“…The importance of assessing perioperative risk and life expectancy in determining the treatment strategy for CLTI is already known [ 1 , 8 , 9 ]. Recent studies have suggested the effectiveness of conservative treatment for patients with CLTI who have foot wounds [ 10 , 11 ], and short-term life expectancy risks and expected wound healing rates should be considered in treatment decisions.…”

Section: Introductionmentioning

confidence: 99%

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Poor short-term outcomes for prognostic high-risk patients with chronic limb-threatening ischemia undergoing endovascular therapy

Takei,

Kajiya,

Ohura

et al. 2024

CVIR Endovasc

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Background The prognosis of chronic limb-threatening ischemia (CLTI) is poor, with an expected life expectancy of 2 or more years, which significantly influences treatment decisions. However, death may occur at the early stages of treatment for wound healing, and aggressive treatment may limit the quality of life of such patients. In patients with CLTI undergoing endovascular therapy (EVT), the Wound, Ischemia, and foot Infection (WIfI) clinical stage, male sex, older age, non-ambulatory status, low body mass index, and dialysis have been reported as predictors of mortality risk. However, most studies have not fully investigated the WIFI clinical stage as a prognostic predictor of CLTI. This study aimed to evaluate short-term prognosis and wound healing rates using the prognostic predictors (PPs) indicated above in risk-stratified patients with CLTI who underwent EVT. Methods This retrospective single-center observational study included 61 CLTI patients undergoing EVT from April 2020 to October 2022. The patients were divided into a high-risk group (PPs ≥ 4, n = 20) and low-risk group (PPs ≤ 3, n = 41) according to the number of PPs. Survival and wound healing rates within one year were compared between these two groups. Results The mean age of the patients was 74.7 ± 1.6 years, and 42 (68.9%) were male. Among these patients, the high-risk group compared with the low-risk group had a significantly worse survival rate within one year (46.4% vs. 84.7%, log-rank p < 0.001). Fifteen patients died within one year. Of these, seven deaths were cardiovascular deaths and six were deaths from infectious diseases. Cox proportional hazards analysis showed that WIfI clinical stage 4 (p = 0.043, hazard ratio [HR] = 4.85) and the male sex (p = 0.037, HR = 6.34) influenced the prognosis of this population. The high-risk group tended to have a worse wound healing rate within one year than that had by the low-risk group (55.4% vs. 83.0%, log-rank p = 0.086). Conclusions The assessment of short-term prognosis and wound healing rates using PPs may be useful. Discussing the results of short-term clinical outcome assessments with patients should be considered when determining their individualized treatment plans.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Poor short-term outcomes for prognostic high-risk patients with chronic limb-threatening ischemia undergoing endovascular therapy

Takei,

Kajiya,

Ohura

et al. 2024

CVIR Endovasc

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“…In non-revascularisable CTLI, amputation-free survival was 43% at 5 years (251). A meta-analysis of 27 randomised control studies assessing conservative treatment found a 12-month mortality of 18% and amputation rate of 27% (252).…”

Section: Pathology and Patientsmentioning

confidence: 99%

New technologies for tissue replacement

2023

JOWM

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This publication was supported by Bonalive, COOK Biotech, Emoled, Gunze, Integra, Kerecis and MiMedx The supporting companies did not have any influence on the content of the publication. © EWMA 2023Copyright of published material and illustrations is the property of the European Wound Management Association. However, provided prior written consent for their reproduction, including parallel publishing (e.g. via repository), obtained from EWMA via the Editorial Board of the Journal, and proper acknowledgement, such permission will normally be readily granted. Requests to produce material should state where material is to be published, and, if it is abstracted, summarised, or abbreviated, then the proposed new text should be sent to Journal of Wound Management Editor for final approval. Although EWMA has taken great care to ensure accuracy, EWMA will not be liable for any errors of omission on inaccuracies in this publication.

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“…There is lack of knowledge and studies concerning the best endovascular treatment in CLTI and in particular treatment with DES in a cohort with only CLTI, and more complex FP lesions. 31,40,41 As a consequence of this, no fully relevant systematic reviews regarding this population yet appear in the literature. The aim of the current study was to determine any differences in treatment efficacy between BMS and DES treatment up to two years, in a parallel group trial with randomly allocated subjects.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical Trial Comparing drug Eluting Stent Zilver PTX® Versus Bare Metal Stent Zilver Flex® for Treatment of Lesions in Femoral and Popliteal Arteries in Chronic Limb Threatening Ischemia

Fransson

Gottsäter

Abdulrasak

et al. 2023

Vasc Endovascular Surg

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Objective Drug eluting stents (DES) might improve the results of stenting in the femoropopliteal (FP) segment, but randomized data between DES and BMS in the treatment of patients with chronic limb threatening ischemia (CLTI) is lacking. The aim of this study was to perform a randomized comparison, between DES and bare metal stent (BMS) implantation in a subgroup of CLTI patients with lesions in the superficial femoral artery (SFA) and the P1-P2 portion of the popliteal artery. Methods Patients presenting with CLTI scheduled for endovascular treatment of FP lesions were randomly assigned by blinded envelopes 1:1 in a single blinded, parallel group design to DES or BMS after lesion crossing. Primary endpoints were target lesion revascularization (TLR) at 12 and 24 months and primary patency at 12 and 24 months. Secondary endpoints were technical success (TS), clinical success, secondary patency at 12 and 24 months, limb salvage, serious adverse events (SAE) at 24 month and survival at five years. Results A total of 48 CLTI patients and 49 limbs, were enrolled, 22 in the BMS group and 27 in the DES group. Demographics, comorbidities, and Rutherford class were similar in both treatment arms. The overall rate of total occlusions was 96% and the corresponding overall median lesion length was 240 mm. No patients were lost to follow up. No significant differences were detected between groups regarding TLR and primary patency. The overall primary patency at 12 and 24 months was 42.9% and 36.7% respectively and the overall freedom from TLR was 67.3% and 61.2% respectively. The results in the two groups were also similar regarding secondary outcomes. Conclusions This single centre, randomized study could not demonstrate superiority of DES compared to BMS when treating long FP lesions in patients with CLTI but was limited by insufficient patient inclusion.

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Outcomes of Conservative Treatment in Patients with Chronic Limb Threatening Ischaemia: A Systematic Review and Meta-Analysis

Cited by 24 publications

References 44 publications

Poor short-term outcomes for prognostic high-risk patients with chronic limb-threatening ischemia undergoing endovascular therapy

Poor short-term outcomes for prognostic high-risk patients with chronic limb-threatening ischemia undergoing endovascular therapy

New technologies for tissue replacement

Randomized clinical Trial Comparing drug Eluting Stent Zilver PTX® Versus Bare Metal Stent Zilver Flex® for Treatment of Lesions in Femoral and Popliteal Arteries in Chronic Limb Threatening Ischemia

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