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Predicting which patients will develop chronic critical leg ischemia
1Department of Vascular Surgery, St George's Hospital Medical School, London, England, United Kingdom.
Insights
Critical leg ischemia (CLI) patients require significant medical resources. Smoking and diabetes are key risk factors for CLI, with diabetic patients facing a substantially higher amputation risk.
Area of Science:
- Vascular Surgery
- Epidemiology
- Diabetology
Background:
- Critical leg ischemia (CLI) represents a significant workload for vascular surgical units, despite lower patient numbers compared to intermittent claudication.
- The incidence and prevalence of CLI are estimated at 500 to 1,000 cases per million people annually.
Purpose of the Study:
- To outline the epidemiological characteristics and risk factors associated with critical leg ischemia.
- To highlight the disproportionate medical and economic burden of CLI.
Main Methods:
- Review of existing literature on critical leg ischemia and peripheral artery occlusive disease (PAOD).
- Analysis of risk factors including age, smoking, and diabetes.
Main Results:
- Smoking and diabetes are primary risk factors for CLI development and progression.
- Diabetic patients with PAOD are approximately 10 times more likely to undergo amputation than non-diabetic patients.
- Gangrene prevalence is 20-30 times higher in diabetic PAOD patients.
Conclusions:
- Risk factors for CLI, such as smoking and diabetes, appear to have additive effects.
- While smoking cessation may slow vascular changes, it does not immediately reduce major amputation risk in smokers.
- Diabetes significantly elevates amputation risk in patients with PAOD.
Abstract:
Although numerically far less than claudicants, patients with critical leg ischemia (CLI) demand a disproportionately large commitment both in medical effort and economically and represent the major workload for vascular surgical units. The incidence and prevalence of CLI is approximately 500 to 1,000/million/year. The risk factors for the development of CLI are largely the same as those for the progression of local disease in IC, the most important, apart from age, being smoking and diabetes. Major amputation is more common amongst claudicants who are heavy smokers and who continue to smoke, and although stopping smoking slows down the vascular changes and reduces the likelihood of symptomatic progression, it does not reduce the risk of major amputation over the following 2 to 3 years. Diabetic PAOD patients are about 10 times more likely to come to amputation than nondiabetic PAOD patients, and the prevalence of gangrene is 20 to 30 times higher in individuals with diabetes and PAOD compared with nondiabetics with PAOD. There is some evidence that most of these effects of risk factors are additive.