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Nonrevascularization-based treatments in patients with severe or critical limb ischemia

Abd Moain Abu Dabrh1, Mark W Steffen2, Noor Asi3

  • 1Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn; The Knowledge Synthesis Program, the Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, Minn.

Journal of Vascular Surgery
|September 28, 2015
PubMed

Insights

For severe or critical limb ischemia (CLI) patients ineligible for surgery, intermittent pneumatic compression and spinal cord stimulators may reduce amputation risk. Evidence for other nonrevascularization therapies is insufficient.

Area of Science:

  • Vascular Medicine
  • Regenerative Medicine
  • Medical Devices

Background:

  • Severe or critical limb ischemia (CLI) poses a significant risk of amputation for patients unsuitable for surgical revascularization.
  • Nonrevascularization therapies offer alternative treatment strategies for this patient population.

Purpose of the Study:

  • To systematically review and synthesize evidence on nonrevascularization therapies for severe or critical limb ischemia (CLI).
  • To evaluate the efficacy of medical therapies and devices in preventing amputation and mortality in CLI patients.

Main Methods:

  • Systematic search of multiple databases for randomized and nonrandomized studies up to November 2014.
  • Meta-analysis of 19 studies involving 2779 patients, pooling data using a random effects model.
  • Reported outcomes included mortality and amputation risk, with odds ratios (ORs) and 95% confidence intervals (CIs).

Main Results:

  • No significant effect on mortality was observed for any nonrevascularization therapy.
  • Intermittent pneumatic compression (OR, 0.14; 95% CI, 0.04-0.55) and spinal cord stimulators (OR, 0.53; 95% CI, 0.36-0.79) were associated with a reduced risk of amputation.
  • Subgroup analyses did not yield statistically significant differences.

Conclusions:

  • Very low-quality evidence suggests intermittent pneumatic compression and spinal cord stimulators may reduce amputation risk in CLI patients.
  • The evidence is limited by imprecision and risk of bias.
  • Insufficient evidence supports other medical therapies for CLI.
Abstract

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