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Published on: September 22, 2020
Functional outcomes following revascularisation for critical limb ischaemia
1Department of Vascular Surgery, Addenbrookes Hospital, Cambridge, UK.
Insights
Infrainguinal bypass surgery for critical limb ischaemia (CLI) offers limited improvements in patient mobility and residential independence. More research is needed to enhance functional outcomes post-surgery.
Area of Science:
- Vascular Surgery
- Patient Outcomes
- Critical Limb Ischaemia
Background:
- Traditional outcome measures for lower limb bypass are insufficient for predicting functional recovery.
- Critical limb ischaemia (CLI) significantly impacts patient mobility and independence.
Purpose of the Study:
- To review the impact of infrainguinal bypass surgery (ILLB) on residential and mobility status in patients with CLI.
- To assess functional outcomes beyond traditional surgical success metrics.
Main Methods:
- Systematic literature review of studies published up to April 2011.
- Included studies focused on infrainguinal bypass (ILLB) and percutaneous transluminal angioplasty (PTA) for CLI patients.
- Data extraction focused on pre- and post-operative ambulatory and residential status.
Main Results:
- Ten studies on ILLB involving 3381 patients were reviewed.
- Only three studies reported improvements in ambulation; no studies reported improved residential status post-ILLB.
- One study noted ambulatory improvements after PTA for CLI.
Conclusions:
- Infrainguinal bypass surgery for CLI carries risks and does not consistently restore patient independence or mobility.
- Further research is required to understand and address the lack of functional recovery.
- Standardized reporting of functional outcomes in CLI studies is essential.
Objectives:
More traditional outcome measures following lower limb bypass procedures are poor predictors of functional outcome. This paper aimed to review the effect of infrainguinal bypass surgery on residential and mobility status in patients with critical limb ischaemia.
Design:
Review.
Methods:
A Medline search up until April 2011 was undertaken of all studies involving patients with CLI undergoing ILLB and PTA. Studies were reviewed if they addressed the ambulatory/residential status of the patients pre- and post-operatively. Ambulatory status was defined as the ability to walk even with the help of a stick/frames. Independent residential status was defined as living at home with no help.
Results:
A total of 10 studies on IILB were deemed suitable for inclusion in the review, reporting 3381 patients (2064 men). Median age ranged from 66 years to 84 years. Thirty day mortality ranged from 0% to 6.3%. Follow-up ranged from 30 days to 1 year. Three studies noted an improvement in ambulation status. No study reported any improvement in residential status after ILLB. Only one study reported on specific improvements in ambulatory status in patients with CLI after PTA.
Conclusions:
ILLB for patients with CLI is not without risk. Patients are not as independent or mobile following surgery. Further studies need to firstly identify the cause(s) of this and to determine optimal methods to return more patients to independence. Furthermore, CLI studies need to routinely report data on functionality.
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Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...