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Evolution of Major Amputation Risk in Patients Hospitalized in France for Critical Limb Ischemia: The COPART Registry

Alice Coudene1, Francois-Xavier Lapébie2, Ileana Desormais3

  • 1Médecine vasculaire, Hôpital St André, Bordeaux, France.

Angiology
|December 3, 2020
PubMed

Insights

Peripheral artery disease patients with critical limb ischemia (CLI) saw fewer major amputations after 2011. Improved revascularization techniques and increased statin use likely contributed to better limb outcomes.

Area of Science:

  • Vascular Surgery
  • Cardiovascular Medicine
  • Clinical Outcomes Research

Background:

  • Peripheral artery disease (PAD) management has evolved, particularly for critical limb ischemia (CLI).
  • Improvements in medical treatments and revascularization techniques may impact amputation rates.
  • The Cohorte des Patients ARTeriopathes (COPART) cohort provides data to assess these changes over time.

Purpose of the Study:

  • To evaluate the trend in major amputation rates among critical limb ischemia patients.
  • To assess the impact of treatment advancements on limb salvage in CLI patients.
  • To identify factors associated with changes in major amputation rates over a decade.

Main Methods:

  • Retrospective analysis of the multicenter COPART cohort (2006-2016).
  • Comparison of patients with CLI (defined by Trans-Atlantic Inter-Society Consensus II criteria) before and after 2011.
  • Primary outcome: major amputation rate; secondary outcomes: minor amputations, all-cause mortality, cardiovascular mortality. Follow-up was 1 year.

Main Results:

  • A significant decrease in major amputation rates was observed after 2011 (17% vs. 25% previously).
  • Multivariate analysis confirmed this reduction (odds ratio [OR]: 1.5).
  • Increased rates of revascularization, especially distal angioplasty (OR: 2.7), and statin use (OR: 1.6) were associated with improved outcomes.

Conclusions:

  • Limb prognosis for critical limb ischemia patients has improved over the past decade.
  • Increased utilization of revascularization procedures, particularly distal angioplasty, and higher statin adherence may be key drivers.
  • These findings highlight the effectiveness of contemporary treatment strategies in reducing major amputations for CLI.

Keywords:
Cohorte des Patients ARTeriopathescritical limb ischemiamajor amputationperipheral artery diseaseprognosis

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