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Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Long-term clinical outcomes in critical limb ischemia--A retrospective study of 181 patients
E Melillo1, L Micheletti, M Nuti
1Angiology Unit, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy. a.farina@italfarmaco.com.
Insights
Critical limb ischemia (CLI) is a severe peripheral arterial disease. Long-term follow-up shows high mortality, but iloprost treatment improves outcomes and survival rates.
Area of Science:
- Vascular Surgery
- Cardiology
- Critical Limb Ischemia
Background:
- Critical limb ischemia (CLI) is the most severe manifestation of peripheral arterial disease.
- Long-term follow-up data for CLI patients in real-world settings are limited.
- Identifying prognostic factors is crucial for managing CLI patients.
Purpose of the Study:
- To describe a large cohort of CLI patients.
- To identify prognostic factors associated with long-term outcomes in CLI.
- To evaluate the effectiveness of iloprost treatment in CLI patients.
Main Methods:
- Retrospective case-control study.
- Inclusion of 181 consecutive CLI patients with a minimum 5-year follow-up.
- Analysis of mortality, amputation rates, need for vascular surgery, and correlation with risk factors and treatment.
Main Results:
- Overall mortality rates at 1, 2, and 5 years were 15%, 24%, and 43%, respectively.
- Arterial hypertension was the only significant predictor of survival; diabetes status did not impact survival.
- Iloprost treatment was associated with significantly lower amputation rates (6% vs. 21%), reduced need for vascular surgery (4% vs. 32%), and improved 5-year survival (69% vs. 47%).
Conclusions:
- CLI patients face a poor prognosis even with long-term follow-up, highlighting significant metabolic damage.
- Intravenous iloprost demonstrated a favorable role in improving limb salvage and survival rates.
- Transcutaneous oxygen and carbon dioxide levels correlate with amputation risk.
Objective:
Critical limb ischemia (CLI) is the most severe manifestation of the peripheral arterial disease. To date, several prognostic factors have been identified but the data of long-term follow-up in real life setting are scarce. The aim of our study is to describe a large group of CLI patients and identify possible prognostic factors, in a long-term follow-up.
Patients And Methods:
Case-control, retrospective study. 181 consecutive CLI patients with a minimum follow-up of 5 years were included in the study.
Results:
Overall mortality was 15%, 24%, and 43% at 1, 2, and 5 years, respectively. Among known risk factors, only arterial hypertension was significantly correlated with survival rate; no differences were found between diabetics and non-diabetics. Patients treated with intravenous iloprost (46%), compared to untreated patients, showed a better (p < 0.0001) long-term outcome in terms of major amputation (6% vs. 21%), subsequent vascular surgery (4% vs. 32%) and survival rates (69% vs. 47%), at 5-year follow-up. Major amputations were significantly correlated with lower median forefoot transcutaneous values of O2 (0/3 mmHg, p < 0.001) and higher median values of CO2 (83/53 mmHg, p < 0.0001) in supine/dependent position, respectively.
Conclusions:
Our results confirm the poor prognosis of CLI patients in a very long-term follow-up and the severe metabolic damage caused by ischemia. A favourable role of iloprost was observed, in agreement with previous evidence in the literature.
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