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The efficacy of a multidisciplinary team approach in critical limb ischemia

Hiroshi Suzuki1, Atsuo Maeda2, Hideyuki Maezawa2

  • 1Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan. hrsuzuki@med.showa-u.ac.jp.

Heart and Vessels
|April 24, 2016
PubMed

Insights

Japanese critical limb ischemia (CLI) patients face high mortality and amputation rates. Early specialized hospital referral is crucial for better outcomes in Fontaine stage IV CLI.

Area of Science:

  • Vascular Surgery
  • Cardiology
  • Public Health

Background:

  • Critical limb ischemia (CLI) is a severe manifestation of peripheral artery disease.
  • Fontaine stage IV CLI indicates critical reduction in limb perfusion, posing significant risks.
  • Multidisciplinary care is increasingly recognized for managing complex vascular conditions.

Purpose of the Study:

  • To characterize Japanese patients with Fontaine stage IV CLI.
  • To analyze real-world mortality and amputation-free survival (AFS) rates.
  • To identify factors influencing outcomes in CLI patients treated with or without revascularization.

Main Methods:

  • Prospective registration of 145 consecutive CLI patients (Fontaine stage IV) at a single institution.
  • Inclusion of patients treated with or without revascularization therapy.
  • Follow-up assessment of all-cause mortality and AFS, analyzed using multivariate Cox regression.

Main Results:

  • The all-cause mortality rate was 21.4% over a mean follow-up of 15.5 months.
  • The amputation-free survival (AFS) rate was 58.6% over a mean follow-up of 14.1 months.
  • Age >75 years and hemodialysis were linked to mortality; age >75 years, Rutherford 6, and wound infection were linked to AFS.

Conclusions:

  • A multidisciplinary approach can enhance CLI patient outcomes.
  • Despite care, mortality remains high in Fontaine stage IV CLI.
  • Early specialized referral is vital to prevent major tissue loss, infection, and primary amputation.

Keywords:
Critical limb ischemiaMultidisciplinary carePeripheral artery disease

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