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Related Experiment Video

Updated: Mar 10, 2026

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Not All Patients with Critical Limb Ischaemia Require Revascularisation.

T B Santema1, R M Stoekenbroek1, J van Loon1

  • 1Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|December 7, 2016
PubMed
Summary

Critical limb ischaemia (CLI) patients treated conservatively showed similar amputation-free survival (AFS) and overall survival (OS) to those undergoing revascularisation. Further research is needed to identify which CLI patients can safely omit revascularisation.

Keywords:
Amputation free survivalConservative managementCritical limb ischaemiaMajor amputationPeripheral vascular diseaseRevascularisation

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Area of Science:

  • Vascular Surgery
  • Clinical Outcomes Research
  • Patient Management

Background:

  • International guidelines advocate revascularisation for critical limb ischaemia (CLI).
  • Limited data exists on the outcomes of conservative management for CLI.
  • This study investigates amputation-free survival (AFS) and overall survival (OS) in CLI patients with varying treatment approaches.

Purpose of the Study:

  • To compare AFS and OS in CLI patients who received immediate revascularisation, delayed revascularisation, or conservative treatment.
  • To identify factors associated with clinical outcomes in CLI patients.

Main Methods:

  • Retrospective cohort study of 144 CLI patients (2010-2014) in a Dutch university hospital.
  • CLI defined by ischemic rest pain or tissue loss with specific ankle/toe pressures.
  • Patients categorized into immediate invasive, deferred invasive, or conservative groups; survival analyses performed.

Main Results:

  • 66.7% of patients underwent revascularisation within 6 weeks; 18.1% had deferred treatment; 15.3% received conservative care.
  • No significant difference in AFS or OS was observed between the three treatment groups.
  • Age, COPD, heart disease, and hypertension were independent predictors of survival, but treatment type was not.

Conclusions:

  • Conservative management may yield similar AFS and OS to revascularisation in some CLI patients.
  • The optimal treatment strategy for CLI remains unclear.
  • Prospective studies are needed to identify patient subgroups who may not require revascularisation.