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Coronary Artery Disease in Patients with Critical Limb Ischemia Undergoing Major Amputation or Not

Akio Nishijima1, Naoto Yamamoto1, Ryuichi Yoshida1

  • 1Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Chiba, Japan; Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; Department of Cardiovascular Medicine, New Tokyo Hospital, Chiba, Japan; Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; and Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan.

Plastic and Reconstructive Surgery. Global Open
|July 26, 2017
PubMed

Insights

Coronary artery disease (CAD) is more common in critical limb ischemia (CLI) patients needing major amputation. Early CAD evaluation and perioperative care are crucial for these high-risk patients.

Area of Science:

  • Vascular Surgery
  • Cardiology
  • Geriatric Medicine

Background:

  • Increasing prevalence of elderly and diabetic patients with critical limb ischemia (CLI).
  • Systemic arteriosclerotic diseases often coexist with CLI, complicating treatment.
  • Retrospective analysis of coronary artery disease (CAD) in CLI patients undergoing surgical intervention.

Purpose of the Study:

  • To determine the prevalence of CAD in CLI patients undergoing major or nonmajor amputation.
  • To compare CAD prevalence between surgical amputation groups.
  • To evaluate CAD prevalence in non-surgically treated CLI patients.

Main Methods:

  • Retrospective review of 129 CLI patients surgically managed (Jan 2013-Dec 2015).
  • CAD defined by cardiac history or >75% vascular stenosis.
  • Comparison of outcomes between major (n=36) and nonmajor (n=93) amputation groups.
  • Analysis of 566 non-surgically treated CLI patients for comparison.

Main Results:

  • CAD prevalence was 69% overall, significantly higher in the major amputation group (82%) versus nonmajor (63%) (P=0.042).
  • No significant difference in ejection fraction between groups (P>0.05).
  • CAD prevalence was significantly lower in non-surgically treated CLI patients (40%) compared to surgically treated (P<0.001).

Conclusions:

  • Higher CAD prevalence in CLI patients requiring extensive surgical limb management.
  • Importance of CAD evaluation and meticulous perioperative management for CLI patients.
  • Surgical intervention for CLI is associated with a higher burden of comorbid CAD.
Abstract

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