Related Experiment Videos
Does infection affect amputation rate in chronic critical leg ischemia?
O Kummer1, M K Widmer, S Plüss
1Swiss Cardiovascular Center Bern, Division of Angiology and Division of Cardiovascular Surgery, University Hospital, Bern, Switzerland.
Insights
Local infections significantly increase amputation rates in chronic critical limb ischemia (CLI) patients, even after successful revascularization. Prompt antibiotic treatment is crucial for managing these infections and improving outcomes.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Limb Salvage
Background:
- Chronic critical limb ischemia (CLI) poses a significant risk for amputation.
- The role of local infection in amputation rates among CLI patients requires further elucidation.
- Understanding infection's impact is vital for optimizing treatment strategies.
Purpose of the Study:
- To investigate the association between local infection and amputation rates in patients with chronic critical limb ischemia (CLI).
- To analyze this association in both successfully revascularized and non-revascularized CLI patients.
- To determine the clinical significance of infection in limb salvage outcomes.
Main Methods:
- Retrospective analysis of 57 CLI limbs from 56 patients.
- Infection defined by specific inflammatory markers (temperature, CRP, leukocytes) or putrid secretion.
- Comparison of amputation rates based on revascularization success and infection presence.
Main Results:
- Successful revascularization shifted amputations from major to minor.
- Infection criteria were met in 41.5% and 52.6% of limbs.
- Infections were significantly more prevalent in patients undergoing amputation (p=0.001).
Conclusions:
- Successful revascularization reduces major amputations and promotes ulcer healing.
- Secondary foot infections are common in CLI patients.
- Infections are linked to higher minor and major amputation rates, necessitating timely and adequate antibiotic treatment.
Background:
Aim was to analyze the association between local infection and amputation rate in patients with chronic critical limb ischemia (CLI) with or without successful revascularization.
Patients And Methods:
We performed a retrospective analysis of 56 consecutive patients with 57 critically ischemic legs seen at the University Hospital Bern. Patients with CLI were selected if ischemic lesions and follow-up of more than 2 months were documented. Infection was suggested when 2 of the following criterion were present: temperature > 37 degrees C, C-reactive protein > 50 mg/L, leukocytes > 10 x 10(3)/microliter ("2 of 3" criterion), or a putrid secretion was documented ("secretion" criterion).
Results:
In patients with successful revascularization (n = 39), there was a significant shift from 10.3% major to 33.3% minor amputations (Chi Square p value = 0.014) as compared to patients without or with failed revascularization (n = 18) with 44.4% and 11.1% (Chi Square p value = 0.008), respectively. An infection was suggested in 22 of 53 limbs (41.5%) according to the "2 of 3" criterion, and 30 of 57 limbs (52.6%) satisfying the "secretion" criterion. Both criteria, were significantly more common in patients undergoing amputation as compared to patients without amputation (p = 0.001). Multiple lesions were more common in patients with major amputations (p = 0.026).
Conclusion:
Successful revascularization effectively reduces major amputations and leads to healing of ischemic ulcers. Secondary foot infections are frequent. Infections are associated with a significantly higher rate of minor and major amputations, also in patients with successful revascularization, and should be treated adequately as well as in time with antibiotics.