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Published on: September 22, 2020
Conservative Treatment in Selected Patients with Severe Critical Limb Ischemia
Adriaan R Thomas1, Jelle W Raats, Mare M A Lensvelt
1Department of Surgery, Amphia Hospital, P.O. Box 90518, 4800 RK, Breda, The Netherlands, rthomas@amphia.nl.
Insights
Conservative treatment for severe critical limb ischemia (CLI) in Rutherford 5/6 patients yielded a 16% amputation rate and 58% wound closure. While mortality was high at 58%, it offers an alternative to amputation when revascularization isn't possible.
Area of Science:
- Vascular Surgery
- Critical Limb Ischemia Management
- Conservative Treatment Outcomes
Background:
- Standard treatments for critical limb ischemia (CLI) include endovascular revascularization or bypass surgery.
- An aging population with comorbidities often makes these interventions unsuitable.
- Conservative therapy outcomes for CLI are underrepresented in current literature.
Purpose of the Study:
- To evaluate the effectiveness of conservative treatment for severe critical limb ischemia (CLI) in Rutherford classification 5/6.
- To determine limb salvage rates, wound closure, and mortality in this patient group.
Main Methods:
- Retrospective review of hospital charts for patients with Rutherford 5-6 CLI who received conservative treatment.
- Exclusion of patients with available interventional options.
- Assessment of mortality, complete wound closure, and limb salvage rates as primary outcomes.
Main Results:
- The study included 38 patients, with a median age of 80 years.
- The amputation rate was 16% during follow-up.
- Complete wound closure was achieved in 58% of patients, with an all-cause mortality of 58% and a 2-year survival rate of 55%.
Conclusions:
- Conservative management for Rutherford 5/6 CLI offers moderate wound closure and acceptable amputation rates.
- Despite a high mortality rate (58%), conservative treatment is a viable alternative to primary amputation for patients ineligible for revascularization.
- This approach can improve quality of life by preserving limbs when surgical options are not feasible.
Objective:
To assess the outcome of conservative treatment of severe critical limb ischemia (CLI) classified as Rutherford 5/6.
Background:
The preferred therapy for CLI is either endovascular revascularization or bypass surgery. With a growing aged population with more serious comorbidities, these therapies are not always a viable option. Primary amputation leads to decreased mobility and a reduced quality of life. There is a lack of literature regarding the outcome of conservative therapy.
Methods:
Hospital charts were reviewed of all patients who were diagnosed with Rutherford classification 5-6 and received conservative treatment and lacked interventional options. Outcome measures were mortality, complete wound closure, and limb salvage rate.
Results:
38 patients were included with a median age of 80 years (range 57-97). The amputation rate during follow-up was 16%. In 58% of patients, complete wound closure was achieved. All-cause mortality was 58% with a 2-year survivability rate of 55%.
Conclusions:
Conservative management in our selected patients with CLI results in a moderate rate of wound closure and acceptable amputation rates albeit with a high mortality rate. For patients not eligible for endovascular revascularization or bypass surgery, conservative treatment could be a viable option besides primary limb amputation.
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