Related Experiment Video
Updated: Sep 27, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
A 1 year prospective study of management and outcome of patients presenting with critical lower limb ischaemia
C M H Bailey1, S Saha, T R Magee
1Department of Vascular Surgery, Royal Berkshire Hospital, London Road, Reading, RG1 5AN, U.K.
Insights
Patients with critical lower limb ischaemia (CLI) experience long delays before specialist review, with many referred non-urgently. This impacts treatment and outcomes, highlighting a need for faster management pathways for CLI.
Area of Science:
- Vascular Surgery
- Patient Management
- Clinical Outcomes
Background:
- Critical lower limb ischaemia (CLI) presents a significant challenge in vascular care.
- Timely diagnosis and intervention are crucial for limb salvage and patient survival.
Purpose of the Study:
- To evaluate the management pathway for patients with critical lower limb ischaemia (CLI) from initial presentation through to investigation and treatment.
- To identify delays and assess referral patterns in CLI patient care.
Main Methods:
- A prospective study involving patients presenting with critical lower limb ischaemia.
- Data collected over a one-year period (May 2000-May 2001) with follow-up ranging from 3 to 15 months.
Main Results:
- 134 CLI patients were analyzed; 49% male, 30% diabetic, median age 81. Most were referred non-urgently, with a median wait of 25 days for outpatient review.
- Treatment included conservative management (70), major amputations (17), and revascularization procedures (62).
- At follow-up, major amputation and death rates were 12% and 27%, respectively. Diabetics had higher amputation rates, and those with ulceration/gangrene faced increased mortality risk.
Conclusions:
- Patients with CLI often experience prolonged symptom duration before specialist assessment, with a high proportion referred as non-urgent.
- The current management pathway for CLI contrasts sharply with urgent referral standards for suspected malignancies, indicating potential system inefficiencies.
- There is a critical need to improve the speed and urgency of specialist assessment for CLI patients to improve outcomes.
Objectives:
to determine management of patients with critical lower limb ischaemia (CLI) from first presentation to investigation and treatment.
Design:
prospective study of critical ischaemia patients.
Methods:
one-year prospective survey (May 2000-May 2001). Follow-up 3-15 months.
Results:
some 873 arterial cases presented, 134 patients had CLI. Of the latter 49% were men, 30% diabetic, the median age was 81 years. Only 15 (24%) of 62 cases were referred to outpatients as urgent. Patients waited a median of 25 days (range 1-100) to be seen in outpatients, and had symptoms for a median of 8 weeks. Treatment was conservative for 70 patients, and 11 primary amputations, six secondary amputations, and 62 revascularisation procedures (34 operative, 28 percutaneous transluminal angioplasty) were performed. At follow-up (3-15 months, median 9 months), rates of major amputation and death were 12 and 27% respectively. Significantly more diabetics underwent major amputation (p < 0.02) than non diabetics. Patients presenting with ulceration or gangrene were at greater risk of death than those with rest pain alone (p < 0.01).
Conclusion:
patients with CLI often have symptoms for many weeks before being seen by a specialist, and 76% are referred as non-urgent cases. This compares with patients with suspected malignant disease in the U.K. who are required to be seen within 2 weeks.
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Peripheral Artery Disease IV: Nursing Management
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation